♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists on the internet ♪
- Welcome my friends
to the Bob and Brad podcast.
Produced by Bob and Brad,
the two most famous physical therapists on the internet.
- In your opinion, of course.
- In our opinion. Exactly right, Chris.
I'm Brad and I'm one half,
exactly, one half of the Bob and Brad team,
and we are fortunate enough
to have Chris the pharmacist- - [Chris] Hey guys.
joining us today and we're gonna talk about,
do muscle relaxers stop pain,
and how do they work,
and answers to common questions and concerns.
And Chris does a excellent job of talking,
and giving you good layman's explanations.
These are questions that,
when you leave the doctor
or the pharmacist, you'd say,
"Jeez, I wish I would of asked this question
or that question about the medication."
So, Chris gets 30 seconds per customer, right?
Or roughly, 'cause there's a big line?
- Oh, yeah there seems like it.
- Yeah, and we're gonna take much longer than that,
so this is a really good culmination of information for you.
So, are we ready, Chris?
- I think we're ready to rock n' roll.
- Tanner are we ready?
Okay. - All right.
- So, the a
the medication is muscle relaxers.
Now that covers a whole-
- Yeah, there's a whole bridge of,
I mean, there's several of them that we use, so I mean-
- Is there any one that's most common, or-
- Yeah, I'd say probably Cyclobenzaprine
is probably the most common-
- Wait, say that again so everybody-
- Cyc-lo-ben-zaprine.
- Cyclobenzaprine, yeah.
They always have these - I know.
- big words on there.
- We don't get out of school
'till we say each name five times fast.
- I mean, it's just, you gotta rattle it off
otherwise, they don't give you your degree.
- [Brad] Yep, I understand.
I just wanna make sure that the listeners, you know,
get a hold of it. - Yep.
- So, that's one of the
more popular- - That's, yeah.
- and more common ones? - I would say it's, yeah.
It's of the more common ones that I see.
You know, I mean, you're gonna see Methocarbamol
Metaxalone, you know, you'll see,
Tizanidine, you'll see Baclofen.
Some cases you'll see a Diazepam, actually.
So, there's a lot of different reasons why
they'll prescribe different ones.
The one that we, you know, Carisoprodol,
we can talk about that.
'Cause that's addictive, so.
- Ooh, okay. - Yeah.
So, we'll make a side note on that one.
- Yeah 'cause we wanna cover this.
So, let's go back to muscle relaxers,
and it's like the title says, do they stop pain?
So, what's the most commonly prescribed reason
for a muscle relaxer?
- Yeah well, I mean the,
the general term is going to be a muscle spasm.
And so this, you know,
we're walking right into the hallmark
of your arena, I think.
And so, when people come in
it can be for a variety of different reasons.
So, let's say you have a patient that's suffering
from fibromyalgia and they have real tight, painful muscles.
It could be just a back strain, a neck strain.
Maybe they were in a car accident.
A weekend warrior project, you know?
I mean, so there's a lot
of reasons why our muscles go into a spasm or very tight.
- And then when they go on that tight spasm,
pain is - - It hurts.
- totally associated with it.
- It's a bad day.
I mean, it can screw up your posture.
I mean, you can't stand up straight maybe
if you have something like.
I mean personally, I've had, you know,
problems with L4 and L5 in my spine,
and I've had points where I, you know,
C for Chris,
and I also look like the letter C
'cause it was hunched over like a
- (laughs) - you know, a little -
- It's not funny,
but- - No.
- you did a good job.
- But I mean it can hurt quite a bit.
And so, you know, it's always,
it's gonna be ER, urgent care visit in a lot of cases.
Usually aren't going to have time to
"I'd like to schedule an appointment with
Dr. Smith today. I'm really in a lot of pain."
- Right? They'll call you.
- You're gonna go in, and it's gonna be an urgent situation.
And you know, interestingly, the mainstays and a lot
of people will try Tylenol or Ibuprofen or Aleve.
'Cause those are kind of the mainstays
of therapy at first. - Over the counter.
- 'Cause they're, they help with the pain,
and the first thing that people,
"Gosh, I am in just.."
They're uncomfortable,
and you can, when they come in to see me,
they're having trouble walking back to the pharmacy,
they're, you know, maybe not
real comfortable with counter. - Yeah, life is not good.
So, you can see that it's definitely affecting them.
And so what-
- Well, I just want to back,
don't skip the point of
why do these muscles, we have a injury,
why do they contract and spasm and cause more pain?
It doesn't make sense.
- Yeah. I mean, it's, you know,
it's a whole complex cavalcade
of events that go on to lead to that point.
I mean, really in a lot of cases, spasming really
is kind of trying to act as a protective mechanism.
Your body recognized something wasn't right,
so they're trying to correct it.
- So, it's actually, and I knew this
but I still want to make sure that the viewers,
the viewers understand
that when muscles are contracting
around the injury to splint it,
- Yup.
- to keep it from moving and protect it.
But the over spasm,
and once a muscle contracts that tight
for so long, it becomes very painful
because we get the lactic acid build up.
We don't have circulation and it's a compounding thing.
- Yeah. And it, and it is.
And like you say, it's kind of like
that proverbial snowball rolling downhill.
The problem, it might be say,
you know, it's kind of funny.
Sometimes these injuries, you know,
get it's kind of mild,
and all of a sudden it's like, "Ooh."
And then later also and you kind of cool off,
and you're like, "Oh, this is not good."
- Sure. Yep.
- And so, they go in and they see the doctor,
and interesting.
So, they come in and we'll just pick
on Cyclobenzaprine for starters.
- Sure. - We'll just take that one.
And so they'll come and see me.
And you know, usually it's dose is a five
or a 10 milligram tablet.
- Sure.
And usually anywhere from,
it can be dosed up to three times a day,
most commonly because the biggest side effect
of these things is sedation.
And that's probably why it works.
I mean, when these muscles are really tight,
and hammered on like that, where they just don't
want to relax, basically it's not fully understood
by any one of the muscle relaxers that we prescribe,
but we just know that it works in a central.
So it works on the spinal system.
It works centrally except for the one
that's called Dantrolene, which is the only peripheral one
other than like Botox, but we aren't gonna
talk about those. - Yeah.
But they kind of help to just relax that,
the whole central nervous system.
It kind of calms down all that conduction velocity
with the nerve.
All the fancy stuff that kind of goes on, and it just-
- So in other words, it's telling the muscle to relax.
But it doesn't, it doesn't just tell
the tight muscles to relax-
- It relaxes all skeletal muscles.
So, I mean, so let's say you got a back problem.
I mean, you could, and that's one of the problems,
especially as we age too, - Sure.
- that these effects
can be much compounded,
and there's this fancy drug list called the beers list.
Which are drugs that we would call inappropriate
for people over the age of 65.
- Beers? B E E R-
- Beers, just like we're drinking beers.
- Okay. - But, the beers list.
It's named after a physician.
- So, you can go online and find this?
- Yeah, you really can,
and actually it's a very important topic for pharmacists
because we deal with this quite a bit.
- Sure.
Because we, you know,
we know the age of everybody that's coming in.
So, we're going to say,
"Oh, you got Cyclobenzaprine, Mrs. Smith,
and I see you're 68 years old.
You need to be very cautious with this
because it's going to make you very tired."
Now, a lot of times doctors recognize fully
that these drugs are on the beers list,
but there really aren't a lot of other choices.
I mean, so they kind of,
so they'll go with a lower dose,
and then what we do as pharmacist,
"Hey, you need to be careful with driving.
You should not be driving.
You should not be drinking alcohol with these products."
You know, you need to know exactly how you're gonna respond.
I wouldn't be planning on doing, you know,
extra heavy yard work because you may not have total control
of your muscles because they're more relaxed.
So, you might perceive some weakness.
So, these are things that can all occur
across the board and at any one
of these muscle relaxants will cause all of those signs.
So, let's say I talk about Metaxalone.
I talk about Methocarbamol.
I talk about Diazepam, Tizanidine, Baclofen,
they all have this side effect profile.
So, it's not just one. - Right.
- And so when I speak to them
it's gonna be a very generalized set of charts.
"Be careful because this is going to make you tired."
- And as a physical therapist,
I cannot tell you how many times I've had patients come in.
They've seen the doctor,
the doctor prescribes a muscle relaxants,
oftentimes for back spasms,
and that's the biggest complaint they,
"I'm getting so tired." - Yup.
"I just can't function."
And then as a therapist, I'm thinking, well
did you try a cold pack?
Did you try positioning?
And I don't ask them that, I'm thinking that.
- Yup.
So, it's possible.
And I think, I don't know if it's very possible,
but there's good odds that there are options
that a physical therapist could help you with.
For example, cold pack with proper positioning
of the body to reduce low back pain-
- Exactly. - and back spasms
can be very effective.
And then you may not need the muscle relaxer.
- And that's, you know and fully,
I think that's the point that we need to touch on
that's really important for everybody out there
that uses these things is,
you know, a lot of times I see people
'cause they come in an acute situation.
You know, I think doctors are just trying to treat the pain,
and move them on because they're in such a busy situation.
- Sure.
- I think, you know, and I oftentimes
at the consult and say,
"Hey, if this doesn't seem to solve your problem
in a couple of days, I would really ask your doctor
about getting set up with physical therapy
'cause they can recondition those muscles.
They can get you back on your feet much faster
than just relying on the drug alone."
I mean, the studies do suggest
that with or without treatment,
the muscle will go back on its own.
But the reality of it is, is you've got pain.
You've got discomfort.
People have busy lives.
They don't have time- - Sure.
- to be down. - Right.
- So, we give them these products
to help them to get on their feet
more quickly. - Right.
- But at the same time, it's probably the fastest mechanism
to getting back to better,
is seeing you,
seeing a physical therapist- - Sure.
- to actually help to recondition that muscle,
and get it back to its natural state.
- That's in our real house, we all the modalities
are options the way to treat it without medications.
That's what we do.
- And that's what's best, frankly.
- The doctors really don't always have the time
to, like you said, they may have 15 minutes,
and they may have, you know- - Or less.
- 10 more patients waiting for them.
And the people want relief now-
- Yup. and so.
- And they do.
And they're very good at judging what they need.
And it's, again, it's a triaged position.
They come from a point of,
"Well I've got this bad person
this bad back,
or bad neck, or they were in a car,"
you know, whatever.
But they're going to do something that they can
to help them to be more comfortable.
- Right.
- And then let everything else settle out.
- Sure.
- And it's not because they don't want
to take the time to,
"Yeah we can get you set up with Bob and Brad,"
or if you're a physical therapist of choice.
- Sure.
- And you know, it's something
that a lot of times in passing they'll tell you,
but sometimes they don't.
And so I always mention it.
I also have mentioned your, actually your website too
because you guys have such excellent do-it-yourself versions
that certainly can give people some acute,
- Our program series that-
- Yeah. - goes directly into-
- I mean I use it- - different aspects.
- as part of my consult with all my patients-
- Sure. - because I think
for the reality of it is is that
I think physical therapy is gonna do more
than a drug ever will.
A drug is a bandaid, and, you know
it's the one thing that we see,
and what I find very interesting and somewhat alarming,
is that muscle relaxants by their virtue should only be used
for up to two to three weeks at a time.
- Okay.
- 44% of people that get prescribed a muscle relaxant
are using it over a year.
- You mean as a result of an acute injury,
a back strain- - Yeah.
- an injury from a accident. - Exactly.
- And so their use, so they,
do they adapt to it, or do they just become-
- You do adapt to it. I mean, it's just,
it's a tolerance develops to the side effects.
And so, I mean, our bodies are freakishly adaptable
to just about any kind of substance really
which is bizarre, but it's just something we do.
We just kind of keep moving on.
- Yeah, the human body is amazing.
- It is.
And, but the thing is, is that, you know,
why would we put ourselves at adverse risk
for side effects long-term?
I mean, I think that,
I think the real message here is,
that if you're not better,
and I always tell people 5-7 days.
- Sure.
- But I, you know, realistically
by medical guides, it's 2-3 weeks.
If they're not better, they really should be
consulting physical therapy sources,
because really, we need to get those muscles healed.
So, I mean, we want you all back in the game.
We don't want, or if you're not in the game, I mean
if you just want you feeling better.
- Right. - So you can go take a walk.
Walk the dog.
Play with your grandkids. - Sure.
- What have you, your children.
I mean, anybody can get hurt at any age.
- Right. So, you know, I really think,
and for people out there,
if you are gonna see your doctor again,
and maybe you are taking muscle relaxants right now,
you're having the side effects
that we've mentioned,
and you want to get therapy.
Well, don't be shy to either call your doctor.
A lot of times you can just call the doctor,
talk to the doctor's nurse,
and say, "I'm interested in physical therapy.
Can I get a script for it?"
And they're happy to do so. - Yup.
- They'll do the consult.
- Sometimes they're not, but it never hurts to ask.
A lot of doctors will say, "Well, I'll do it," you know.
- Yeah.
- And therapists are happy to work with you.
And then you can get off of those.
And then you learn how to manage it
with therapy means. - Exactly.
- Which you can do independently at home.
- Yeah, you can correct the problem
so that it doesn't happen again.
- Right.
- And a lot of it's just simple, you know, imbalances.
I mean, it just, you guys do so much.
You know, there's always that balance
there's the antithesis, you know, the pull and the push.
(laughs) - Yeah. Right. Yep.
And, you know, postural problems back, low back pain
oftentimes, I find people are sitting with poor posture,
and they're causing it, and it can be a simple fix.
Not always. - No, no.
- Back pain, a tough one, but still, you know
we want to get the, you know,
get things going in the right direction.
- Yeah, 'cause there's a lot of things too, that,
you know, like things like fibromyalgia.
That's chronic- - Right.
- that's forever.
We don't have a cure for that.
And so these people will need
to use muscle relaxants long-term.
So, I want to be very clear
on that subject- - Sure.
- at least, because there are certain reasons.
I mean you have maybe a brain injury,
you maybe have, you know,
something like cerebral palsy where we need
to take these long-term, you know,
and there may be some different muscle relaxants
and things that they do.
But they are coupled with therapy
in a lot of cases all the time to,
to try and help to give them the relief that they need, so.
- And those people typically are working
with a doctor- - Oh yes.
- long-term as well. - Yeah, no,
they are long-term.
They are lifers really from that standpoint, so.
- Right. Unfortunately, they haven't got
that figured out yet.
- Yup. I wish we did.
- Baclofen and Baclofen pumps,
and that's actually enough information for, for that.
We can save that for another time.
- Oh yeah we could.
We could actually do the Baclofen one standalone.
'Cause that's an actually a pretty fascinating drug.
- So, I don't know, is there anything else
that you want to cover over?
I think we've covered the-
- I think the big thing is drowsiness.
I mean, the principle behind these drugs
is it makes you tired, and helps to relax the muscle,
and that's what's going to hopefully help it to relax,
so that you can begin the healing process.
But again, I think the takeaway is, is that, you know,
don't suffer, don't wait too long to get care.
I mean, if you've got the opportunity
to see a physical therapist, I encourage that
very highly from, from the get, just simply
because I think that's going to be the fastest
way to actively recover, actively heal,
and get you back in the game.
- Right. All right.
Thank you very much, Chris.
- You're welcome.
- Good job back there at Tanner,
and you know I'm very happy to,
I'm happy to be alive.
- There you go. It's a good time to be alive.
(laughing)
(keyboard playing)