♪ Bob and Brad, ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi folks. I'm Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course Bob.
- We're getting in the weeds,
getting into the weeds a little bit with this one, Brad.
So we're going to talk about the examination
of the S1 nerve root,
everything you need to know, Bob and Brad.
- That's right.
Bob and Brad, we're going to show you this.
And this is rather interesting, you know, I think,
'cause you may find out if you go to the doctor
and that you have some pain going down your leg,
they may mention which level it comes from.
- Right.
- They'll say which level in there,
L4, L5, S1, S2, et cetera.
And this is going to explain to you the pattern
of where the nerve physically goes and how the symptoms,
if that nerve gets pinched, how you can test it at home.
- So you may find if you have some of these symptoms,
you may have an S1 nerve root problem.
- Right, exactly.
- And that may be a pinched nerve or a sciatic nerve
or from sciatica.
- Right, yep.
It all, we'll get into it as we go through it.
- Right.
- But do we have to mention our giveaway?
- Oh yeah, that's right.
We're doing a massive giveaway. We're doing 10 products.
One person wins it.
- Yep.
- One couple.
If you want to submit it as a couple,
- Right, it doesn't matter, but yeah,
10 of our favorite products that we use
on a regular basis at home for exercising-
- Just go to the giveaway section of Bob and Brad
and sign up, you can also go to Facebook,
It'll be pinned to the top of the page.
- Exactly.
- And what else do we have Brad?
- Oh, that's right, the podcasts are out there-
- Podcasts, don't forget the podcasts.
- And they are rolling strong.
Let's start with the anatomy.
- All right
- So S1, what does the S stand for, Bob?
- Sacrum!
So here we got Sam and this is kind of nice,
it is, Halloween just got done.
So Sam was busy at work, he's resting,
(chuckles)
but the sacrum I usually think of it
as on the backside, it's that solid bone.
- [Bob] It's kind of a triangle shape.
- [Brad] Yep. And they're, you know,
they were evidently vertebra at one time,
all fused together.
- [Bob] Right.
- [Brad] The nerve S1 is the next one down from L5,
but it does not come out the backside.
It actually comes out the front side here.
Can you zoom in on that Tanner?
And this is just, it continues from here, goes down,
and goes into the nerve,
sciatic nerve.
- Right, yes.
And then it goes all the way down into the leg
and we'll show you where this goes and what it-
- So again, if your pain pattern follows that,
you may want to pay attention to this,
- Yeah, and we're going to show you
exactly where you may feel at the sensation of that.
So Sam, we're done with you, Bob is up next.
- All right.
Do you want me just to stand?
- Yep, stand up Bob.
'Cause Bob volunteered to show,
we've got a pink piece of tape here,
Kinesio tape actually,
this is where if you feel numbness, tingling,
any unusual sensations that have this pattern
going down the back of the leg.
- Obviously not over the pants.
- Yeah.
- But I didn't want to stand here naked
with my butt hanging out.
- Exactly, You can stand up tall, Bob,
You don't have to be all bent-
- No I just wanna-
- All right, whatever turns you on.
Goes down here around the heel,
and then when the nerve comes down,
it's only on the side of the foot
to the pinky toe, the smallest toe.
- Outside of the foot.
- Yep, now there's a little variation
from this for person to person,
but this is S1 generally.
If you feel it on this side of the foot,
it's almost certainly not S1.
- Or top of the foot.
- Yep, so that's, we call that the dermatome
in the medical field.
So if you feel that area
possibly in this one problem,
now you can do the test strength test.
- Sure.
- Because this nerve is responsible
for certain muscle groups in the leg
and all the way down to the foot.
- Right.
- But what, and there's a number of the glute max.
There's a hamstring in there,
but we're going to focus on one of them
that, not one muscle, but one group
that is responsible from S1 innervating it.
And that is simply going up on your toes like this.
Now, if you have a serious S1 compression problem,
you may not even be able to do this.
- Right.
You may be able to do on the other side.
- Yep.
- That's a good test.
- Yeah, test the good leg
you should be able to do, a healthy person, you know,
average age up to in the 50's or 60's possibly
if they're active, should be able to do 10 of these with-
- Right.
- I've got one finger here for balance.
- Right.
- And I'm feeling fatigued.
- It should be difficult.
- Then test the other one, maybe you can do it,
but by the time you get to five or six,
it's getting difficult.
- Right, you can tell the difference.
- Your balance is off a little bit. That's another sign.
So you're going to do each one of those tests.
- Right.
- The next one.
- Straight leg raise.
And this is one that you have to have another person.
I'm glad you picked that side Bob, because-
- That's what I thought, I was thinking.
- Yeah, exactly, you can't get anything past Bob.
He is right on the ball. He's Johnny on the spot.
Bobby on the spot.
So knee must stay straight, the person relaxes,
the other person comes up like this
and that person, Bob, will respond
- Ah! It's starting to get tight, starting to hurt.
- And you may feel pain anywhere along the leg,
all the way up into the back.
And if I go like this,
- Ah!
- Makes it clearly worse.
- And if I bring my head up like this-
- Yep.
- That make it worse too.
- Exactly.
- Like this, I go like that.
- Right.
- We're stretching the nerve along the entire,
through the canal and everything.
- Right, so if this nerve is irritated or pinched,
this, it may hurt at this level.
- Right.
- Then we go to the uninvolved leg,
and it's like, oh, it goes way up to here and I do this.
And he feels a normal muscle stretch.
- Exactly, right.
- So you always compare one leg to the other.
So that's, typically that one is pretty clear.
I think even the lay person will be able to do that
if they follow our instructions.
- Very common test,
a straight leg raise test that they do on a herniated disc.
- Yes, exactly.
Now this last one you could try,
but it takes a little practice.
- Yeah.
- Sometimes it's from the professional,
but it's a reflex test and that's,
you know, where's my hammer. Oh, here it is.
You know, you go into the doctor's room
or the therapist or whoever,
and they'll pull out a little hammer like this
and you don't have to worry,
They're not going to bunk in your head with it,
hopefully, it's just a reflex test.
The typical one was where you hit on the knee
and your knee jerks a little bit.
- Right.
- And how your muscle responds can give
good information on the nerve,
if the nerve is intact or if the muscles
are working the way they should.
And a grade, there's four grades, 1, 2, 3, 4,
we're looking at a grade 2.
And you'll see on this quadricep,
if I do that and I get a little response right there,
that would be normal.
If you do this and there's no response,
it means there may be a problem.
- Right.
- But not necessarily.
- And unfortunately, as you get older, they tend to.
(chuckles)
Mine are not real active.
So we're actually going to bring Tanner in.
- Yeah, he's our camera man.
- Camera person, Bob.
- And it gives you a chance to see Tanner.
- And really, Tanner. Don't be shy, come on out.
There's different ways to do this.
It can be done in the seated position,
but your doctor or therapist may have you do it this way.
And can you move this foot forward just so they can-
there you go.
And just relax.
There we go. I'm going to go like this.
They'll take that reflex hammer,
put a little tension on the Achilles tendon
and simply go like that.
And if you watch his foot,
relax again Tanner,
I'm not going to tell you what I'm going to do it
'cause I could do it in a minute from now or now.
Did you see that foot? There's a jerk right there.
And that would be a normal reflex.
You do it on the other one. And we did this before.
And he has the same on both sides.
- Sure.
- If you do this and it goes more than once
and it starts doing this, that's called clonus.
- Right.
- That's abnormal.
If you do it and there's nothing going,
he's got a pretty good one there.
It's kinda fun.
(laughter)
That doesn't hurt, does it, Tanner?
No, it's a fun thing to do.
And you can do it just with your hand.
I've done this before.
- Right, I've done that before too.
- So you can try that.
You're not smacking the person.
It's just a gentle, it's a reflex that the muscle does.
It's kind of fun to do. That's kind of having fun there.
Okay.
Again, this is something that probably you won't do at home,
but you can just like that and see how it goes.
Again, compare right to left.
So that pretty much takes all of the tests
that can be done pretty efficiently.
- Yeah, if you find all of them are there,
all of them were present.
Like, you know, you find a dermatome, like we said
and your strength is decreased and reflexes decreased.
You know, you have a S1 problem.
- Yeah. And a straight leg raise.
If all those clearly positive, S1 is a problem-
- You can impress your doctor by saying,
I think I have a S1 nerve root problem.
- Right, you can say all my tests were positive.
The straight leg raise, reflex test, the dermatome.
And they'll say, oh my goodness, why'd you even come in?
So that's a good point.
(chuckles)
- That's right.
- All right. Good luck with it.
Now you understand it.
- Thanks for watching.
(synth chords)