♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, Mike Kenitz, Physical Therapist Assistant.
- Brad Heineck, Physical Therapist.
- And together, we're the most famous physical therapy team
on the internet.
- In our opinion of course Mike,
Mike is filling in for Bob today,
he's got the day off.
We're more than happy to have Mike here,
he's gonna do an outstanding job,
he's gonna show me up a little bit I'm sure.
So..
- Today's video, best exercises for sciatica
from bulging disc,
in addition to spinal stenosis or spondylolisthesis.
I can say that word Bob can't.
- Yeah that's a tough one,
but yeah this is a tough one
and we're gonna go into some detail
if you have the combination,
so you understand it and hopefully treat it
with great success.
But before we go any further...
- Make sure to check us out
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check us out on Facebook,
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- Outstanding job, Mike.
Plus, we got the TikTok version too, don't we?
- Oh TikTok as well,
dance a little.
- And also here we have...
- We have Jake here,
I injured his back playing pickle ball yesterday,
I broke him,
so, he's gonna be in the video a little later,
don't mind him.
- Okay, so yeah,
so he's gonna be part of it,
he's gonna be very helpful with this video.
So the problem is, a spine,
you got back pain
and we've had a number of viewers
comment on this over the years
and we never went through and did a video on it,
because it's not a real easy
diagnosis to approach.
So, here's a scenario,
here we got a model of a bulging disc at L3,
let's say you have a bulge,
just the location's not that critical.
But also at a different level,
you're diagnosed with stenosis.
- So this is the L4 right below it.
So you got the opposites.
- Yeah and that may be a little confusing,
but, we'll explain it just a little bit.
A bulging disc, let's just look at a bulging disc.
The disc here, the red,
represents the bulging disc
and what happens is that this bulges out
and pushes into that yellow-
- Nerve root. - Nerve root.
- So that causes pain.
- Exactly and the pain will go down the leg,
because that's where that nerve goes.
So let's show how this works a little bit.
This'll be L4,
this will be L3.
- And this'll be your disk.
- Right.
Now the disc has fluid in the middle
and the outside has,
the annulus it's called,
is the wall that holds in the fluid
and it allows your disc to have some fluidity,
or it actually can be a shock absorber
and allows you to bend, flex and rotate.
Now, if you have a bulging disc,
right through here,
is the spinal and your nerves come out,
which you can't see,
but we can see the disc bulge.
Now, we can show you some exercises,
which includes, extension of the back,
why don't you show extension right?
- So just straightening going backwards,
is extending of the back this way.
- Now you can do that laying down
or lying down on the floor,
which we'll show you in just a second
and that can help get that bulge to come in sometimes.
Now, typically that's the motion that happens,
it's an extension,
whether it's lying or standing,
but let's look at stenosis.
So here, stenosis,
can you point that?
- Right in here.
- Right where that nerve exits
through this called the foramen.
Now, let's go up here,
it's the same, just a different level.
- You can see it here easily-
- Right, now, right where Mike is pointing,
stenosis means at that foramen is getting smaller
and there could be a number of reasons,
it could be scar tissue,
there could be some bone spurs.
- So the area that opens up here is getting smaller
and compressing on the nerve roots.
- Exactly, if you're a spondylolisthesis,
like I do, the reason that hole gets smaller
is because your disc is disintegrating or gone.
- And your vertebrae is typically slid
in a different position
so it's actually grinding and uncomfortable.
- Now here's the thing with stenosis or spondyl,
if you bend backwards or extend,
that is painful.
- So, helps bulging disc,
makes spondylolisthesis typically worse.
- Right, it's a double-edged sword,
if you have a bulging disc,
extending, whether you're lying or standing,
typically that can help it, depending on where you're at,
but stenosis or spondyl,
that makes it worse,
so, what do you do?
Do you extend or do you flex?
- You kinda try which feels best for you
and we'll show you some exercises
and if that doesn't work,
then we'll get into some other options.
- Yep, Okay.
You wanna...
Let's demonstrate. - Sure.
What are we doing first, flexing?
- Yep.
- Alright, so, the first one would be to flex it,
so this would be for stenosis, spondylolisthesis,
something like that.
So all you're gonna do
is bring both knees towards your chest,
you can grab with your hands
and just go what's comfortable,
if you can only do this much, stop here,
if you can handle more,
you can press a little towards your chest,
if this feels good,
meaning your pain is getting better,
if your pain's referring down your legs,
that's getting worse,
if it's coming back up and more towards your back,
getting better.
So typically try and do which feels best,
so if this feels good for your diagnosis,
then try this one.
- Now, if you do that
and the first time you're not sure if it's getting better,
do it up to 10 repetitions and monitor it.
If it's feeling better in your leg,
if you have leg pain associated with it
and clearly the leg pain is better,
everything is feeling better,
that may be an exercise you're gonna do,
if you can't tell that it's feeling better or worse
or it's clearly getting worse,
then you're gonna stop
and roll over on your stomach.
- Yeah and you don't have to have your legs crossed,
I just kinda do.
- Yup that's- - Its comfortable.
- The opposite version,
if this feels better...
So this would help a bulging disc,
going into some form of extension.
If it's really painful,
you can just go on your elbows like this to start,
I'm laying funny, 'cause I'm on my pack right now,
my mic pack.
But, you can use your arms to push up
and feel whats comfortable,
if this doesn't hurt, feels better,
you can go full range,
feels good, stay there.
If it doesn't feel good, you can only do partial range,
just stop there.
You can just do little mini press-ups to start,
or you can even just sit prone on your elbows.
- Well we're not really sad.
But, I wanna mention,
the waistline or the belt line
stays glued to the floor,
if you roll, that's important
Show the wrong way to do that Mike,
where you actually...
- So now my...
The front of my pelvis is off-
- Yep, go on your knees instead of your toes,
yeah that's probably more common.
- So people try to do this like a push-up almost.
Keep it all flat, keep it all down there
and just push up what's comfortable.
- Now, what probably or may be a strong possibility
as you lie on your back,
pull your knees to your chest,
aah, it doesn't feel much better,
maybe the leg pain's worse,
whatever it's not doing well,
you roll over to your stomach and you do press ups
and it still doesn't feel good,
that is not an unusual scenario,
So what do you do?
Both of these things aren't working,
then we're gonna go to traction or decompression.
- Yep.
- So, here's how it's gonna work,
if we look at a bulging disc,
and you put some traction,
in other words, you pull the disk apart from the weight,
we're gonna use the weight from two different forms,
pulls apart, it allows the ball to go back in.
That's a good thing.
If you have stenosis,
remember in stenosis,
the foramen is too small, pinching the nerve
and if we pull the spine apart, we're gonna exaggerate,
see how it opens the spine.
So you can achieve both things-
- At the same time.
- With traction.
So there's two ways to do it,
- We have three ways, - Three ways
actually three ways,
one way, that's what Jake is doing here,
we can use a Teeter inversion table.
However, you don't have to use this,
and obviously you have to have one they're little expensive.
So you can do two other things that you can simply do.
This one you can do at home, you just need two chairs,
- Two chairs, equal height
as long as you can get in this position comfortably,
all you do is get them even, make sure they're sturdy,
and you want to put pressure through your arms
and try to get your knees off the ground.
If you need to keep your feet,
your toes on the ground the balance, go ahead.
But this is kinda decompresses the spine a bit,
it's easy way,
you can also do if you have a countertop that's cornered,
you can kinda do it there as well,
if you don't have the shoulder range.
- One thing that's really critical on this is you'll learn
is the mistake that my patients to do
is they'll tighten up their stomach muscles
and that will not allow the decompression in the spine.
- Yeah, it'll actually make you flex your abs
and in my spine is actually rounded right now
so you gotta relax and keep it straight.
- So this one does take some strength
in your arms and shoulders.
- Yap
- If you can get the right height of the chairs
and depending on how tall you are,
if you can do this,
great learn to relax your stomach muscles.
The other way is if you have a pull up bar,
or we're gonna use the hanging handles
to use your body weight overhead.
So I'll pull up bar will work just fine.
Mike is on hanging handles this works really well.
- This is an easy to reach height as well,
I'm not jumping up high,
so you could start and just slowly bring down
if your pain starts to get more centralized,
mean the pain is going from down your leg
up your back more.
That's good, so you can keep sinking,
eventually you can walk your feet out,
you can just hang like this, this is decompressing my spine.
You can lift your feet up,
don't wanna go two hikes
and you're actually gonna round your spine,
but this is just another option for traction.
If you have trouble hanging the swang,
just keep your feet down,
it's fine, I'm still getting some decompression
in my spine doing-
- You will know this is the right thing or this
is when you do it the pain drops immediately.
When you start that decompression, that traction,
the pain should clearly go down
and then as you hang there, you leave it and it feels good.
And then when you let go like Mike did
continue to monitor it and walk around,
as long as the pain drops,
doing the exercise or the decompression
and it stays gone for the next half hour or whatever,
then you're gonna do this on a regular basis.
If you do it feels good while you're hanging
but five minutes later it made it worse,
I would not anticipate that,
but it could then you would not want to continue it.
- Yeah, this is just got it.
You have to pick which exercise of all these
seems to benefit you
'cause there's not a right and wrong answer for everyone,
everyone's gonna be different,
depending on how bad their back is.
- Again, this is a challenging one,
this is one that you probably may need to see a therapist,
but you can try these if you're cautious.
- This would be probably more for the younger person
that injured their back versus the 80, 90 year old person.
- Right, now, if both of these seem to help.
the inversion table may be a good option
because they work quite well.
Jake's not miked up, so you can't hear him talk,
though you might be able to,
but actually Jake has back pain, he just hurt himself,
was it yesterday?
- Yesterday?
- Yap, so we wanted to try him on the inversion table
to see if it helped
and we've already worked with the monitor
the first day on it
and had relief, how you doing okay yet.
15 minutes ago we were going through
and instructed him how to use this
'cause it takes a little bit of practice.
You wanna show him how we got them all set up on this
Teeter inversion table.
If you want an inversion table,
we do recommend Teeter because they're built well,
we like 'em, I'm sure you'll be happy with them.
- We even have a discount code farm to you.
So If you want one look down below in the description.
- Go ahead, let's...
He's gonna get it so that...
Now we went through,
we're not gonna talk about how to use this specifically,
we have six other videos on inversion tables,
Bob and Brad inversion table
and they'll go through how to use those specifically,
and go ahead and tilt backwards.
Once you get adjusted rate, you're very good control.
And now instead of the body hanging on the wall,
the weight or the chest and the arms and the head
are gonna use for the traction
or the decompression of the spine,
how are you doing Jake?
It feels good, thumbs up.
Now I have it limited, so it's not a full inversion,
which I recommend.
I don't like full inversion,
I think there are some problems with that.
If you do have glaucoma, heart problems,
if you had a stroke, things like that,
you should talk to your doctor before you use one of these
to make sure you're safe with that.
There's any outlying conditions
or what we call that comorbidity.
How are you doing?
and you may hang there, now we've done this before
he responded very well to it before.
So we're gonna leave him hang there for a little bit
and we could adjust this a little steeper.
I would never go longer than five minutes the first time,
as a matter of fact, one or two minutes is good enough.
- Yeah
- I did this for five or 10 minutes 'cause I used to use one
and I had a headache for the rest of the day,
too much, too soon you feel you're okay,
your head, nothing, no dizziness
and that's what you wanna monitor,
everything feels comfortable,
your back pain should drop down as you're on it,
just like on the hanging handles.
And then make sure after you're there for a couple minutes,
can you get back up Jake?
- Slowly come up and you typically wanna get kinda level
for a while before you go all the way up.
- Right
- Cause your blood pressure kind of equalize all the blood
was going in your head so now you have to get it
more centralized and then go up you'll feel better.
- And can you go to the rest of the way,
ah, that's a perfect demonstration,
and you said no, why don't you hop out of there?
(Mike laughing)
- He can't bend over to get-
- Yeah, his back It's still bothering him fairly well,
but normally you can do that very easily.
How are you doing Jake when you walk?
- [Jake] Better
- Is it same better or worse than what it was?
- [ Jake ] Said it little better
- It's a little better.
So was same, better, worse while you're hanging.
- [ Jake ] It was same or better.
- Okay same and better, and it's still better worse or same.
- [ Jake ] I'll say its better
- Better, okay. I'm not trying to lead him on as a thing.
(laughing)
As a therapist, you wanna say it's better, isn't it?
But anyways so that's how you work the inversion table,
they work great again,
do the other decompression methods first, if they work,
then this might be worth getting.
- Those chairs are free and the handles are pretty cheap,
if you want the handles compared to this,
is little pricey,
but it's definitely worth it if you need it.
- As well as with the Teeter, you can return it
with a full refund within 60 days of purchase.
- Yes.
- You have to pay for the shipping of a delivery
it's my understanding.
So there's a cost there,
but it's not like you're stuck with it.
So they're a good company, good table.
So a complicated diagnosis,
this is the options that we're giving you today.
Again, Mike, what talk how are we gonna finish this out?
- We can fix just about anything-
- Except for-
- A broken heart,
you think if we Teeter it.
- No, no this is no, not there,
we're not going there.
- I'm trying
- Take care.
(upbeat music)