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
best exercises for sciatica pain relief
herniated disk and or spinal stenosis
Right you can get the same symptoms pain down the leg with all of these diagnoses. That's the common denominator
The big thing is how do you cure it?
Yeah, because the thing is with each one of these quite often you may do something quite different,
Yeah, we didn't mention piriformis, Bob
How could we forget the piriformis? Piriformis is another thing that can send pain down your legs so it's a little small muscle in your butt
That can cross over the sciatic nerve and put some pressure on it, and that's not good. I like to say buttocks
Okay, good for you Brad. There are some people out there. We forgot it. Oh
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Yeah, well Bob you know
Once in a while we get lucky and that happens alright
Let's start to talk about the first one Brad what we're gonna talk about a bulging herniated disc right so you've got that pain going
down the leg as a matter of fact just yesterday treated a woman with this all the way down to her heel and
You know you need to figure out what's it from and as a therapist we're thinking right away
There's a number of options
We just mentioned but in her situation sitting
Was very much irritating, going from sit to stand she could hardly bend forward in her case bending backwards was very uncomfortable
and the symptoms were classic so I
Went through the evaluation and the first thing actually the second thing that I tried that she can do at home
To help alleviate the pain was traction, in other words pull on the spine
Lonnie can you catch this bulging disc right here? This is just a model of our spine with the the red bulging disc now
Bob can you pull on those two femurs down there so if we pull, put a little pressure
it's gonna pull the bones apart and take a little bit of stress off the disc and
Hopefully sometimes what they used to say is it provides a centrifugal force
Oh really, yeah
I know you don't believe that
One way or another if we can get the pain out of the way we're doing good
And this is exactly what happened to this woman
And this is something you can do throughout the day, you don't need to do it like once a day you can do it
every hour if you like
So what you do is if you got two good sturdy chairs
Just like this
You said she did it with a walker? Right
Yeah, she didn't have a good setup, and I had a walker that wasn't, it worked out well
And I just let her use a walker
She's gonna take it home and use it for a while and when she gets better you know hopefully she'll bring it back
And this is all she's doing she's holding
Locking her elbows out and kind of relaxed in the stomach muscles and right now I've got very little toes
You can see the weight through my toes and feet are very minimal
Yeah, you don't have to lift the legs all the way up
You don't have to do that, right and she was an older lady or not, 60 years old so and she was able to do this
yeah, and she was doing this and immediately
The pain in her leg went from a 4 pain level down to about a 1 and it's just you know the look
On her face like oh that feels good
And so with her when she put weight back on it would come back but with her
She's gonna do this throughout the day every hour
And she's gonna hold it for about 30 seconds until her arms get tired and do that a few times
And then she's gonna start doing the next exercise. Should I show that Brad?
Along with this and again throughout the day you can do this
But a lot of times people have trouble getting down and doing this during the day
That's why that's a nice option
but if you can if you're able to
You're gonna want to be able to do these every hour too, and this is the McKenzie technique. We're only going to
Briefly touch on it today
You start off just laying prone like this laying on your stomach
And then eventually you might just get up on the elbows again
You're looking for the symptoms to, you want to point this out Brad? Yes
Symptom to stop going down the leg and actually start coming on up. We call it centralizing.
Yeah so like in this case pain all the way down to the heel if we can get it up and in her case we
Could get it up above the knee that day, so it goes out of the foot out of the calf
Yep
And you just feel it from the knee and up or you might get it to the point where you
Feel it in the buttock only. But then eventually you're gonna put your hands below
Underneath the shoulders then you can start working this way and this helps try to push that bulge back in basically
Precisely Bob, so eventually you could try to get all the way up
But you want to make sure you're not doing this you're not lifting your pelvis up
Now in her case Bob I just wanted to carry through she's right now using the pillow. Oh, she is
There's some people can't lay prone
It just doesn't feel comfortable yet
So they start off with a pillow or two
so her goal is to get
Rid of it do some mini press ups, can even work some press ups like this
and then eventually get the pillow out of it and
then start press ups that way so if you know it is a
Herniated disc you probably want to look at some of our other videos. Just type in Bob and Brad herniated disc or sciatica
Quite a playlist on there and you
Got a very good chance of figuring out a way to be successful to get rid of it
so the next one if the sitting doesn't change things and these symptoms aren't consistent with the herniated disc we
just talked about
This one you can try very easily just lay on your back and start stretching that piriformis
And what I do is I just test one side to the other. I do the same thing
So what he's saying is
It's a little muscle in the buttock like we talked about and
What happens is if you have one side that's involved it tends to be tighter on that side so
Very easy the way to test it is just to go ahead and bring the knee up and to the opposite shoulder
So that piriformis muscle is right in here so this particular stretch stretches it so yeah
I do it with this side
And then I try it the other side and this one, oh this one feels much tighter and maybe even recreates the pain
Then yeah that stretch would be good for you to be doing right and you're gonna hold it you know
10 to 20 seconds it depends on how it responds, and how tight it is and you'll do repeated stretch
You know you could do the pressure on pressure on
pressure on
pressure off typically up to 10 repetitions is the most you'll need at one stretch, but that's a nice way to
Do that, the other one why don't you stay laying down Bob you can do the figure with the knee up?
So I'm putting my ankle across the opposite knee and I'm actually pulling this leg up like this
So this is he's doing the right leg right now. Yeah
It really does do it and here I'm going on the other side and pulling that one up. This is one more
You know if you're tight in the hips or you're a little older
Sometimes this figure four is a little more difficult to get the flexibility
But you can do the knee to the opposite chest for sure, the thing that I found that worked the best Brad with this is
Actually my sister who was just suffering from this since she had emailed me, and I said we had given my mom one of these
This is the Pure Wave massager
It actually does percussion so it works out really good people really like this thing anyway I said go over mom's and
Borrow it and so she did and she was just gonna go ahead and she's gonna work that muscle and massage that muscle
You can even do it in this position here right and it's because
The best success I've had with my patients is when we've done massage Brad
And the thing is it's very difficult to massage that area yourself especially for any length of time because your hands just get too tired
So that's why it's great to have an external device
That's gonna do the work for you right, so we got this listed down in our Amazon products. I mean again
We all love it. We all use it. We endorse it. We give them to our family members for presents
Yeah, that's right. We know they're gonna like it so
That's how that works and the next thing Bob is stenosis
Typically stenosis is with people who are older, but certainly not always I've got stenosis if you got spondylolisthesis
There's a good chance that stenosis is gonna get involved with that a really common symptom
Is if you're just standing like grocery shop not grocery shopping, but shopping in the store
I'm watching my wife try
You know go through things getting bored and all of a sudden that down my leg, and I'm getting or walking longer distances
Oftentimes will cause that leg pain with stenosis, but if you bend forward like this, feels better
Or you sit down pain goes away very relieved
That's a very strong symptom of stenosis and the nice thing about stenosis is it's a little easier to treat
Simply lay down on your back, go ahead Bob
You want to? Yeah absolutely. He just got back from vacation
He's kind of catching up on the world so you start off usually single knee to chest Brad
Yep, single knee to chest and see how it responds to that and you can bring this knee down, but a lot of times
I'll have my knees up like that to get a little more flexion in that lumbar spine
But you do what feels best and the same with this you can do pressure on
Pressure off pressure on pressure off and then we're gonna go ahead
And you know maybe do the other side single leg, but eventually you want to try to do
Both legs and when you do this it should feel good if it's the right exercise
It's gonna feel relieving right away. It's gonna eliminate that leg pain and stretch it out, stay down there one more time Bob
I want to show this next thing
That we did you could take a towel roll, or if you happen to have
One of the six inch foam rollers this works the best, you can roll up a towel nice and tight
To about six inches we got this little model we made here with some red duct tape
We put sheets and towels together, and it's a nice firm roll, it's solid
But we're gonna show with this because it does work a little better with
The six inch roll. This is from OPTP. We really like this particular roller because it's just it's built well, and it's comfortable now
You're gonna put it on the sacrum below the belt line so it's gonna be right about here
And when you put weight on it do you feel that?
Yep it's kind of pushing me into flexion a little bit
That posterior tilt which opens up the gaps and relieves the stenosis, and then when you do that it looks a little uncomfortable
So when you're doing this do you start just doing this Brad or
Do you go right to the knees too? No I'll just start like this
That's what I was thinking. Yep. Yeah, it looks uncomfortable. It's not at all it actually feels good
Yeah, and you need a roll that's a little softer not the real hard one
This one's more definitely the lower density lower density, yeah
Go ahead and start pulling one knee to the chest and you don't have to get aggressive because it's already
Putting that posterior tilt on the pelvis. I really enjoy this, I could go both knees to chest, if you've got stenosis
I've got a patient that I'm working with and she's doing this exact same stretch too, it's a different one I don't have stenosis but
It's still very comfortable to me. It's not an issue. I don't know how this might feel
Worse if you have a herniated disc
Yep, then if it hurts and it doesn't give you relief right away
Yeah, this is not something no pain don't gain, don't be doing it if it hurts
Precisely Bob. You're right on the money for just getting back from vacation
Got the fog out of my head hopefully so
Alright, thanks everybody for watching