♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Well hi there, folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- Today we're talking about the one simple change
to greatly help your spinal stenosis or spondylosis.
Spondeol, how do you say it, Brad?
- Spondylolisthesis?
- Yeah, spondylolithesis.
I don't think I spelled it right on there, Brad.
- No, you didn't. (laughs)
It's a tough one to spell, too.
- If you have either one of these, they're different,
but you're actually gonna use the same treatment,
because they respond-- - They have similar symptoms.
- Yeah, they have similar symptoms.
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- I like that name.
- All right.
Anybody who has spinal stenosis, spondylolisthesis
knows that one of the things that bothers them
is when you extend your back.
- Yes. - And why extending your back
would mean going back like this
or if you're lying on your stomach and you,
let me show 'em. - Yeah.
- We demonstrate everything here.
So this, too.
Very bothersome.
And it gets to the point where it can progress over time
where you actually feel so much better.
It's called shopping cart syndrome,
'cause you lean on the shopping cart,
it feels so much better.
And I've had many patients that after awhile
started walking like this. - Oh, yeah.
You'll see that people walk,
usually they're older people typically.
- Right, right.
So we're trying to prevent that.
So one thing that we wanna stop
is we wanna make sure your pelvis is correct.
- Right.
- Let me just show real quick.
So here's your pelvis and--
- Here, I'll do the tilt, Bob.
- Yep.
This is normal, if it's level.
But if it's tilted forward,
now the back is actually already extended.
So you're already at a, you're having to lean forward
just to stop extending your back.
- Right.
- [Bob] If it's tilted back, now you can easily
straighten up further than you could before
because you actually even flexed a little bit.
- Right.
So the idea is we need to figure out how can you change
the position of your pelvis, and the way
you're gonna do that, we'll show you an exercise,
strengthen the abdominal muscles
and stretch the muscles in the back.
- While stretching the muscles,
the hip flexors.
- The hip flexors as well in the front, yeah.
- The hip flexors will pull you down like this.
I'm gonna show you an anterior pelvic tilt.
I'm tilting down, I shoulda had tape on here, Brad.
- Yeah, we shoulda did that.
Just take your pants off.
- [Bob] (laughs) No, you see my pants a little bit here.
See how it's tilted forward?
Now I'm gon tilt it back.
- [Brad] There you go, yup.
- So if my hip flexors are tight,
can you see how they'll pull me down?
And if my abdominal muscles aren't very strong,
my core is not very strong,
it's not gonna help,
it's not gonna be able to pull them back up.
So we're gonna show you four exercises
that will help you do all of those.
The first one, we gotta stretch those hip flexors out.
Brad's gonna show it supine.
- Yup.
- Lying down on the bed,
and I'll show it kneeling with a pillow.
- Okay.
So if you're gonna do it lying on your back,
you need to do it on a bed.
A firmer bed works a little better.
You slide your body off to the edge,
your shoulders need to be on so you don't fall off the bed.
Take one knee up that's closest on the bed,
the other one's gonna go off,
and I can feel my hip flexor stretch right now.
If I do this,
- [Bob] It makes it even, it increases it.
- Yep, and we're just gonna hang out,
let gravity pull this leg down and let the stretch go
for 15 to 30 seconds.
- Very common to have tight hip flexors
because we are a sitting society.
And when you sit, those muscles shorten up.
And to be honest with you, your abdominal muscles
probably get weak too when sitting.
- Sure. - I mean, you're not
doing any strengthening when you're sitting.
All right, let's see.
The other version is actually going down on your knee.
I'm always trying to remember which one.
It's better for me to use this knee, right?
They can see better. - That works better, yeah.
- So you can see the stripes in my pants here.
I'm standing up nice and tall and I'm bending forward.
I'm really stretching that hip flexor.
- Right.
- Again, I don't wanna go down like this.
I wanna stay straight.
- Right.
Yep, and you know, if you're doing this,
if you feel some pain in your back, you may be extending
a little bit, - You have to lean forward
a little bit. - Yep.
And it all depends on how severe your stenosis is
or your spondylolithesis.
- I've had some people start this, Brad,
on the staircase.
So they'll hang onto both sides and put the one foot up
and they'll just lean forward into it, so.
- Yeah.
Too bad we don't have a staircase,
but that would be a step and you'd hold on to the rails.
- Yep, and that works really well.
I've had, you know, elderly people able to do that one.
- Safely.
- And surprising how much they go "Oh my god."
I mean, they don't have to push very far
and it starts hurting.
- Yeah, yeah.
- 'Cause they're very tight in that area.
All right, Brad's gonna, we're gonna demonstrate now,
oh, forgot your pillow.
You're gonna lie flat on your back
- Okay. - And we're gonna show
the progression here.
Now this is really for beginners.
This is for, this is, you know, if you have a pretty good
core already, you probably don't have problems,
but this, for someone who's never did
any abdominal strengthening.
The first thing you wanna think about is doing
the posterior pelvic tilt.
And this is very hard for a lot of people to do.
We give people cues like one,
pull your belly button down to the bed,
like you're trying to push it down into the bed.
And two, what really seems to help,
if you have something here that you're trying to squish.
So if somebody's hand is here or if you put
like a rolled towel there or something,
you know that you're trying to squish down.
- Yep.
And that's what I tell my patients.
I'll put my hand under there and I'll say
"squish my hand into the bed"
and then they tighten their stomach muscles
and things go the way they're supposed to.
- [Bob] So once you got that,
now you can start the exercise.
So Brad, you were gonna do it with this one, right?
- Yep. - Okay.
So he's bringing this one up.
That's all he's doing on the first one.
- But while I'm doing that, - He's tightening.
- I'm tightening and maintaining the tightness here
so that my back is pushing into the bed while I do this.
- [Bob] And if you're not able to keep that tight
and it just gives way, that shows you that you need
these exercises because you're very, very weak.
- Some people, this is all we have 'em start out with.
- [Bob] Yeah, you might start with that for a while.
All right, Brad.
Do it with the other leg, too.
- Okay so I'm pushed down here and then I'm gonna lift--
- [Bob] No, no, no.
This is the first one yet.
Then you do it with this leg.
- Oh, I see what you're saying.
Do right, left, yeah.
- [Bob] So you're doing both sides.
Hold for like five seconds.
You don't need to hold much more than that.
Three, four, five, yup.
- I'm gonna go a little quicker for the video.
- [Bob] Perfect, all right, next one.
Lift this up.
And now you're gonna just lift this foot off the bed.
- That's a big difference.
- [Bob] Yeah.
And then down.
- Stomach muscles are working.
- [Bob] Yeah.
Now that one's a little harder, right?
- Oh, yeah.
- So now do it with this one.
Lift and then lift this one off,
just lift it off the bed.
- Yep. (exhales)
- [Bob] Okay?
All right, the third one.
Now this one is a little bit of a challenge.
You can lift this one,
and now you're gonna straighten this knee.
- All the while my back is being pushed into the bed.
And so my stomach muscles are really
going to town now. - If you're able to this one,
you're able to maintain this during the day.
So five seconds again, so switch to other side, Brad.
Lift this one and then straighten that one.
Yep, you even have to hold on there.
- Yeah, it's definitely,
if you're able to do this, you're fairly good shape.
- [Bob] Yeah, you're doing pretty well.
But if you get stuck and you have to,
you can only do the first one, that's fine.
Do it for weeks if you need to.
- Right.
- But I'd like to see these done once a day at least
and do it over time and you're gonna find out
you're gonna have less pain and be able
to straighten up more with either condition.
- You'll probably find when you do that it just feels good
on your back while you do it,
while you push down and open that up.
- Now Brad has spondy, and he's gonna show you
what he does for his. - Right.
- Now you do a lot of core exercises.
- Right, right.
- But we're not gonna show that,
but you're gonna show what he does
with the hanging handles.
- Well, you know, this adds a little decompression to the--
- Yeah, it spreads things apart.
- Yeah.
Which typically feels good.
So I'm doing this.
I'm gonna slowly come down and you can see
I'm walking out with my feet to get some pressure,
or to take the weight off.
And then I'm going to, can you point out
right where it is? - Yep, I'm gonna show.
I'm putting my hand like this.
- So what I do then is I push my back up against the wall
at the belt line right there,
and I can just feel that open up in the back.
It just feels so good.
- So he's doing a pelvic tilt.
- So I'm pushing in and I'll hold it like that for,
you know, five or 10 seconds and then I'll come back.
So I'm getting some core strength.
- [Bob] Compression, good core strengthening,
and you're working on a proper pelvic tilt there.
- Plus I got the benefits, you know,
with this up against the wall, I'm working
my posture upstairs and I'm working on
good shoulder mechanics.
It's really a good, I do it in the morning just to wake up.
I'll hang, and boy, you get that sluggish,
so it's just, I can't say enough about that exercise.
Simple, too.
- All right, remember Brad and I can fix
just about anything - except for
- a broken heart, but we're working on it.
- That's right, Bob. - Diligently.
- Yeah, I took last night off.