♪ 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.
- Well, in our opinion, of course.
- You happy about that Brad?
- Mmmmm, strong like bull today.
- Okay, today, we're gonna talk about,
you haven't said that in a while.
- I know, I felt like it though.
- Today, we're gonna talk about absolute best self-treatment
for SI, sacroiliac joint pain, and
- That's a mouthful.
- I think we need to talk about a little bit of what it is.
- Exactly because it's a little scary otherwise.
- Right.
Let's come on up here, Brad.
Lonnie, are we okay?
- Well, we're okay.
Are you okay?
Am I okay?
Okay.
Right here.
- [Bob] All right, so we have here,
Brad, if you wanna put yourself in the position
that this is right now.
- Okay. So we're looking at the back side.
- [Bob] Just like this.
- [Brad] Yep.
- So if you go down here,
you know where your pelvis is,
you have the two bones on each side,
which are called the innominate bones or ilium.
And in the middle here,
is a triangle shaped bone, is the sacrum.
- [Brad] All right.
These are actually the nerves.
Let's get those outta the way
cuss I think that's a little misleading.
- [Bob] Yeah.
So, now you can see the triangle shaped bone.
And in between the ilium and the sacrum
is this SI joint, this sacroiliac joint.
- [Brad] Right. And it's, it's a rough joint.
It's not smooth like a knee or like a shoulder.
- [Bob] No.
- [Brad] It's rough, there's, you know, cartilage in there,
but there's a lot of connective tissue ligaments.
- [Bob] Yeah. A lot of ligaments holding it together.
- [Brad] Right.
And it's supposed to be a stable joint.
- [Bob] And one of the things, it's a weight bearing joint.
You know, a lot, all the weight to the spine
is going through those joints.
- [Brad] Right.
- [Bob] So it, it takes a lot of weight.
- [Brad] Right.
And when you're walking or running,
each side, it's, you know, it takes a lot of forces.
And we need to keep that stable
and there can be one source of pain
when you have some irritation there.
- Right.
And I think that's quite often what you'll see
is when you're increased pain with like, going upstairs,
or uneven surfaces, and such like that.
- Right.
And sometimes just with walking can get it,
get you flared up if it is.
- Right.
- Irritated.
- So one of the problems,
oh, also Brad,
I should have showed when I was up there.
Is that, a lot of times,
one of these bones,
these iliums gets rotated.
- [Brad] Oh yeah.
- [Bob] And most often it gets rotated back this way.
- Yeah. We'll, we'll exaggerate that a little bit, Bob.
If we just loosen that up a little bit
and you can
- [Bob] There you go, yep.
- see some movement there.
- [Bob] And that's not good.
- No.
- [Bob] Because, if it gets rotated and stuck back there.
- [Brad] Yeah.
- [Bob] It's gonna give you pain.
And so, as a manual therapist,
a lot of times we're rotating it back
and that's beyond what you can do.
I mean, you can't do that yourself,
but we'll show you some things to try to help coax it back.
- Right, yep.
There's some nice little stretches and some exercises that,
you know, we teach patients easily to go home and do.
- [Bob] The other thing is, as we get further along
if this is a little unstable here,
and it's not holding it like it should, the ligaments.
We might have you use a belt
to help hold it together better.
- Would we call them SI belts?
- [Bob] SI belts.
- SI belts.
- All right.
And, and that's what the muscle strengthening
we're gonna show too, Brad.
- Right.
- Is to help strengthen the muscles around the pelvis
to help hold that SI in place.
So it all kind of comes together here, Brad.
- And that's why I'm carrying this green ball around.
If you wanted to know.
- Ha, I'm sure people did.
- Now, Bob, another thing of importance
is there's a lot of people out there,
thousands, that have not seen us before.
- Please come to us and subscribe.
We have a subscribe button over here, on the left.
Or, if you're on your phone,
it might be down here somewhere.
Take a look, you'll find it.
We provide videos on stay healthy, fit, pain free,
And we upload every day.
- SI round, SI joint.
- SI why?
(quiet laughing)
He totally lost me there.
I don't know what he's trying to say.
- We're going onto the SI now.
- All right.
One of the things is,
when you have SI problems,
quite often, you're gonna have a leg length discrepancy.
Which means is one of your legs is longer than the other,
which throws your pelvis off.
- And it may not be longer
but because the SI has shifted,
it may appear longer.
Or,
- Or, sometimes you're right.
If, if the pelv, if the ilium is rotated,
it makes it look higher on one side.
- Right, sure.
- But either way,
one thing you might try.
So, if I take Napoleon bone apart here.
- Ahhh
- If you guys haven't heard the joke
and if I'm, if I just put my hands here on,
and stick my fingers in the pelvis right here, on myself,
and I see one that is higher.
So I'm standing here and I go like this,
and it's hard to see on me
but you'd have to have someone look at it.
And if one is higher, that leg might be higher.
And therefore, you may want to try correcting
and see.
- Why don't you turn around, Bob.
Cause I think the best way to do this
and you probably do it,
is from behind the person.
I'm gonna get down out of the way.
And right there, I can clearly feel his bones
and right there.
Now actually, the viewers are in a good angle to see.
And I want you to shift a little bit, Bob,
there, on purpose.
(indistinct)
There you go.
So, you can see there now.
Correct it.
Go down.
There you go.
So that was exaggerated, but you know,
it's possible you could have that much.
That's kinda like dancing, Bob.
- Or, let's say it's been determined
by someone that, you know, a professional
that you do have a leg length discrepancy.
- Sure.
- Then, you know, based upon asking that professional,
you might want to correct it.
And all you you wanna do is, you know,
you can slide a heel wedge in your shoe.
- Mmhmm.
- I've had people just take a piece of carpet
and cut it out in the shape of a heel, Brad.
- Yep.
- And put it in there, and try it.
- Right.
It's just a temporary thing.
If it makes it feel better, it's like,
"oh yeah that does feel better".
Then you can go to the store and buy an actual heel lift.
- Right.
And usually what we do is,
we'll first, I'll put something down
and then correct it,
and then see if it does level it out.
And you can even see how it feels when they,
when they put it down on the floor.
- [Brad] Right, sure.
- Now they generally,
do not correct the entire discrepancy, Brad.
- Right.
- Generally, it's half.
- Sure.
- So like, if it's a quarter inch,
the heel should only be, you know,
the heel wedge should only be a eighth inch.
- Right.
And this is one of those things that,
you know, people at home never done it before.
It's, this is hard to do,
- Right.
- when you're experienced professionals.
So, we're telling you what you do.
You can play with it a little bit
but it takes some practice, usually.
- Okay, again.
This is gonna be based upon averages and the average person
you know, quite often, if they're having SI pain
it means that, generally on that side,
the ilium is rotated back.
- Okay.
- More often than not.
- Right.
- So this is the first thing I want you to try.
Let's say the pain is on this side.
I'm gonna have you lay down
and we're gonna try to rotate it back forward again.
So what you're gonna do is,
you're gonna put this leg off the edge of the bed.
Don't fall off.
I don't want anybody letting us know that they fell off.
And you're gonna let it hang like here,
and you're gonna bring this one up.
And, if you even didn't have anybody with you, Brad,
you could just do a little bit of this, rocking here.
- Yeah.
- And see if it'll, you know,
kind of again, rotate that ilium back in place.
- [Brad] And you're gonna know
if it's the right thing to do.
Cuz when you do this,
it's clearly gonna feel better.
- Right.
- [Brad] It's like, "oh wow, that does feel",
make the pain go from a six down to a three.
- If it's worse,
then you might wanna do it on the other side,
and see what happens.
- Right, switch it around.
Yeah, if it makes it worse, you stop.
- Yeah.
- If it clearly makes it better,
you know you're on the right track.
- Good point, Brad.
This is, we're always looking for things to get better.
We're not no pain, no gain.
This should not hurt.
- Right.
I suppose you could have someone give a little resistance.
Right.
If I'm working a patient and they do this and say,
"boy, that feels better".
I may do this and add slight pressure.
- And then they can even push up,
- little muscle energy.
- Yeah, they're pushing up with this one,
pushing down with that one at the same time.
- Yeah, exactly.
- So, and if it didn't work,
maybe try the other way.
- Right.
- You know, try going this way
and doing the same type of thing.
- But again, you know, you get some people,
they think that it has to hurt to get better.
But in this case it is no,
it's further from the truth, has to go the other way.
When it feels better, you know you're on the right track.
- Now one of the patients I just had,
we did a bracing on her.
So again, what I did as a test on her first is,
I actually just pushed her pelvis together, like this.
And I had her walk,
cuss she normally had pain with walking.
And I know this looks stupid but actually,
this is the way to do it.
(Brad laughing)
And, and it actually felt better right away on her.
She just said, "oh, that feels better".
So we got her a belt, and
- What kind of belt, Bob?
- An SI belt.
What did, what would you think would be called?
So, you know it's just belt,
a very thin belt that straps around you.
- Here let's show 'em where it goes anatomically.
- Yeah, that's a good idea.
So, it's going right around like that.
So you can see how
it's just gonna squeeze these bones together.
- Right.
- And, and keep 'em in place.
- One thing, if it's up here, above the ilium
or the pelvis, it's gonna go into the stomach area.
And that's not gonna do any good but,
you know, make you feel uncomfortable.
- Right.
- It's gotta go down below that.
- And you gotta be able to cinch it up.
- Right.
- I mean, that's, that's key.
Otherwise it's not gonna help you out.
- You know, an elastic belt is probably not gonna be enough.
- Right.
All right, let's go into a couple exercises, Brad,
that you can do to try to help stabilize.
So we're trying to strengthen the muscle.
- Should we show how that belt goes on?
- Well, if you want, sure.
- You go talk Bob,
and I'll put it on while you're talking.
- So one of the ones, one of the exercises you're gonna do,
you're just gonna lay flat on your back.
You're gonna go ahead and arch your back a little bit,
tighten up your stomach, and then you're gonna,
well, can you throw me the ball Brad?
- Oh, you bet, Bob.
There'd be nothing more I'd wanna do
than throw you the ball.
(Bob laughing)
- [Brad] Catch.
- So you put the ball between your legs,
and you're gonna feel this.
This goes down, you know, the muscles that attach
all the way into the pelvis.
So again, I've arched my back.
I've tightened my stomach.
And, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
And you can do a good set of 20 of these, Brad.
- [Brad] Sure.
- You can really work these.
- Right.
So you working the adductor muscles?
- Right.
And adductor muscles attach all the way into the pelvis.
- Right.
- Trying to help stabilize a little bit.
And then you're gonna go in the other direction too, Brad.
You can actually take a belt.
Here, I'll help you Bob.
I'm clear now.
- And you're gonna tie it around your leg.
You could use a sheet too, I guess.
But anything,
- Could you use TheraBand like this?
- You could use TheraBand, you could use,
- You have something stretchy.
- Sure.
This is more,
- This would be like an isometric.
- More isometric, so,
same thing, I'm gonna arch my back a little bit,
tighten up my stomach.
Make sure you're breathing during these.
- Sure.
(Bob blowing out air)
- Yeah, you hold your breath,
your face turns red.
- Same thing, count to 10.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
- Arch right here, huh, Bob?
- Yeah, little bit of arch.
And again, you can repeat.
You can do 10, 20 of these too.
- Right.
So the idea is, we're strengthening all these muscles.
- Those external rotators that are gonna,
they go all the way into the buttock, you know?
And they help.
- They're gonna help
- [Both] stabilize
- the pelvis.
- Yeah, right.
- Yep.
- Um, you know, as another one you could do,
you could do clamshells too.
Which is, I worry about my mic here a little bit,
but you lay on your side like this,
and you're just gonna work on doing clamshells.
- Right.
(indistinct)
And this is one if you had the TheraBand in there,
- Yep.
- You could leave it on and use it for more resistance.
- So you're showing the belt, Brad?
- Yeah.
So, we talked about the belt.
Get it low enough below the pelvis.
And, this one is designed like this.
You just pull and I'm gonna cinch it up like this
and I'm gonna get tight, tight, tight,
and there we go.
And now when I walk,
- It should feel better.
- it should feel better.
That would be the indication
you're gonna wear it.
- All right.
The other thing is to change some of your habits.
Make sure you're not standing on one leg like this.
- Yeah.
- You know, that's throwing off those ligaments,
stretching them out.
Don't sit on uneven surfaces,
like one, one, you know,
on the butt on one side, or a couch.
Do not sit on your leg, like this.
- Some people can sit like this a long time.
- Yeah, and that's with men,
don't sit on your wallet for, you know,
especially you have a big thick one, for a long time.
- Bob's got a really big, thick wallet.
- That's cuss I never take anything out of it.
(laughing)
The dust comes out when I open it.
And the last one is, you know,
like, I imagine mostly it's women shaving their legs.
They cross their legs and they lean way down,
or they're like this.
That could throw the pelvis off.
- Sure, sure.
- So, you gotta hire someone to shave your legs, I guess.
- Oh, exactly.
And you put your shoes on.
- Right.
- That's a shorter one though.
- Again, the whole thing is,
don't do these in a prolonged period of time.
- Exactly, go on and on in repetitive motion.
- Remember folks, we can fix just about anything.
- Except for that broken heart.
- Well, we're working on it.
Thanks for watching.
- Say no more, Bob.