♪ Bod and Brad♪
♪ The two most famous♪
♪ Physical Therapists♪
♪ On the internet♪
- Hi folks I'm Bob Schrupp physical therapist.
- Brad Heineck physical therapist.
- And we are the most famous
physical therapists on the internet.
- Oh in our onion of course Bob.
- Most stretched out ones too.
Today we're going to talk about
stop back pain and hunchback from stenosis.
These are at home exercises.
- Great.
- And we have been using these on real patients.
(laughing)
and they have been working!
- Right, absolutely!
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- Ah yes!
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All right.
- All right, so Bob, stenosis.
First of all
we better clarify,
it's one of those words,
that I think scares people more than it really needs to.
Uh, so uh actually,
and I did a little research,
300 and, approximately 350,000
US citizens are diagnosed with this.
- That's a lot.
- Over 50 years old. Which is pretty typical.
- Yeah.
- Stenosis usually happens to the older crowd.
Um but there are people that have a minor degree of stenosis
and no symptoms, and don't even, they're unaware of it.
- I think you can think of it almost like,
it's like arthritis.
You know I mean its a deterioration and it creates uh.
- Yeah, the aging process.
- It's yeah, part of the aging process.
- Exactly
- A quick way of saying it.
- So if we grab a spine,
lets just take a look, what, what it is.
Stenosis as a term
actually refers to the narrowing of a whole
or a, or a
- Foramen
- Foramen, which is where.
Oh where's my pen, my pointer.
So on your back the narrowing
foramen
or the whole,
cause you can have stenosis of your arteries,
which means your arteries are getting plugged up.
They're getting smaller.
- [Bob] And you can have stenosis of the main canal,
that the spinal cord go down to.
- [Brad] Right, right in here.
So it can refer to anything
that there's a narrowing of, and right here,
each level you can have a spinal nerve come out.
The whole right there is called foramen
that becomes narrower sometimes it's
because the discs are shrinking,
or getting smaller.
Sometimes it could be from, uh,
osteophytes.
- [Bob] Yeah, a build up of calcium, yup.
- [Brad] On there, and you know there's a number of reasons,
but the, what we need to do is,
if they're causing pain, which
that's why you'd be watching this video.
How to rectify that.
The other thing about stenosis is,
a few common symptoms, Bob,
are if you lean forward it feels a little bit better,
if you're up tall
or extend backwards with repetition
or like with walking,
it can make things worse consistently,
and then if you flex,
oh, it feels better.
- Often called Shopping Cart Syndrom,
because a lot of people feel better
when they lean on the sharping cart, shopping cart.
- Right.
- So, not the sharping cart.
- Assuming you're in the grocery store.
- That's if you're in the grocery store, right.
(laughing)
- Um, so there you go,
so actually I just had a patient.
I'm still working with him right now,
he had the exact same symptoms.
69 years old, gray hair, very active person,
but he says when I walk,
you know I have to walk flexed forward,
it feels better.
When I sit down he slouches forward,
so he says, I know
but as I get older
I'm gonna end up like a hunchback.
- Right.
- Because I'm, I'm always doing this.
And I said you're exactly right.
- And I've got a patient exactly like that too,
but she's female.
- Okay, so eh, both genders.
- Both genders, yeah.
- It's not, uh, it doesn't matter.
So what we need to do is first of all,
if you're getting pinching of those nerves
we need to open up the foramen.
And now Bob and I were talking about this,
we're gonna show you six different exercises
and maybe a couple extra bonuses.
You may not be doing all six of them.
- No, you gotta pick the ones that you're able to do
pain free.
- Right the ones you respond to positively.
Feels better, and your, feels better when you're done.
So watch the whole video,
and then go through them one at a time,
and pick the ones that work for you, so.
- Yeah so don't make us angry.
If its hurting stop.
- Right, right, it should feel good.
- So.
- Should I do hook line?
- Yeah, do the hook line Bob.
This one is a real general exercise,
very simple.
And most people will probably tolerate this,
but you may not.
- So I'm putting my feet together,
my knees together,
and I'm going back and forth,
Brad likes to call it windshield wipers.
- [Brad] Yeah.
- And uh,
what's nice about this is if one directions hurts,
lets say going to the left hurts,
- [Brad] Yup.
I could just work going to the right then.
Start with that.
And thank you Brad.
- [Brad] Oh you're welcome.
- And then eventually you'll check that left side out again,
because eventfully you, you may be able to go to the left.
- So what we're doing here,
this is for the lower back,
and some of the middle back,
if you have stenosis, or so up there,
it's just starting to loosen those areas up.
- Yeah the body has a great capacity to heal.
- Right.
- And they're not even sure why sometimes,
uh why it gets better, you know?
- The stenosis, right.
- Yeah why the stenosis gets better,
but they actually talk about chemicals
that maybe, you know eat away at some of the bone
and such.
- Right,
I feel strongly that's what happened with my stenosis.
Cause I had pretty bad case of it a few years ago.
- Sure.
- Then also we're gonna go into the knee to chest.
- Sure.
Then we can go to single knee to chest.
So we're gonna start off with, uh,
you know if you can't reach around your knee,
you can grab beneath the thigh here
and pull forward like this.
- Sure, yeah.
- Or, and then eventually grab there.
If you need a towel,
Brad is gonna give me a towel,
you know if you, if you can't pull the leg at all,
just ut the towel around there,
or belt,
and pull it up like that to get it started
with a single knee to chest.
And then eventually what you'd like to do is
go to a double knee to chest,
and usually what I have people do with that
is I, have bring one up,
and then bring the other one up.
- [Brad] Right.
- And then give a little bit of,
you know a little bit of pressure on,
pressure off.
Pressure on, pressure off.
- It's usually repetitions of ten.
- Right.
- Right, um, and uh, the reason,
you know some people, it's amazing,
if you're pretty able bodied, you would say
well just bring your knees up.
But there's a lot of people
that may not be able to do that.
So you need the towel roll.
- And the thing is,
I don't want you to have pain when you're bringing it up.
- [Brad] Yup.
- Um, you really don't want to have any,
you know things that
uh, trigger the pain.
- Right.
Now I would say typically,
in most stenosis people I work with,
these two exercises are tolerated well,
but the person I have right now,
these aren't tolerated,
so we had to skip these two.
- Right, interesting.
Even the?
- [Brad] The windshield wipers were okay.
- Okay.
Oh the knee to chest, oh single and double leg.
Okay.
- All right.
Now this.
- Now next one,
this is gonna be yours to do Brad cause.
- This one works really well for me,
I used to have stenosis in my low back
to the point where it pinched a nerve,
and I'd get numbness down my leg.
Um, and this is one of the exercises
that helped me get through it.
You could either, if you have a six in roll,
use that, if you don't,
you don't have to buy one,
you can roll up a towel,
pretty thick though,
and you gotta roll it up pretty firm.
- [Bob] That'd be a couple towels actually.
- Yeah, yeah, yeah exactly.
So it's gotta be about,
five or six inches.
Nice and firm.
We have duct tape,
red duct tape, to hold it together.
Um, I'll show you on that first.
The roll does work better,
but not needed.
And you're gonna put it below your belt line,
about three or four inches so it's still on the sacrum,
and you may not be aware of the anatomy that way,
but you're gonna do this,
and you can actually so double knees to chest,
and this actually opens that gap up,
and for me this immediately,
I'm pretyy happy right now, this just feels good.
As a matter of fact I'm gonna go to this,
cause this even works better.
- And aagin if it doesn't,
if it hurts.
- Yup.
- Stop immediately.
- Cause this one is a little more aggressive.
So some people it would be too much for,
or it's hard to get it organized so it helps,
and if, if it does work, use it,
if not, just go to the next one.
Boy it just feels good Bob.
I could just sit here for the rest of the video,
but we got work to do.
- All right.
- You could probably just stay right there Brad,
cause you're gonna show the next one, right?
- Yes.
Now those exercises,
are not gonna help your upright posture.
They're gonna open up facets,
get the stenosis better,
but you have to address these exercises.
The next three are for posture.
And the first one, eh, this is,
you use this on your patient too?
Laying supine?
- She, eh, she wasn't able to do it.
- Right.
And actually the gentlemen that I have,
he could tolerate this
a little bit.
Um, but we, we went to another one,
but this may work for some people.
If your head doesn't go down flat comfortably,
make sure you get a pillow.
Because if you have stenosis up in the neck,
or the upper back,
that may prevent you from doing this comfortably.
- Even if it's, lets say it's
even in the central spinal cord,
it might feel better to have the, the neck forward.
- Sure, yeah.
This is a real individual thing,
and depending on the degree of your stenosis.
- Right,
- Um, so the idea is,
you might have a pillow here
and start out with your knees up,
and that might be better,
but eventually you wanna start trying to get flatter,
and maybe a thinner pillow,
and possibly get down to the point where you're like this.
And now your posture it good,
expect for you're laying down.
This is the way you want to be standing,
as opposed to hump.
- Right
- Flexed over.
- And again she had, yeah,
she couldn't get close to that even.
- So.
- She had to do this next one.
- Okay.
Prone?
- Yeah prone, and she,
we actually had to have two pillows, but so.
- Well we got two.
- I mean you could start off,
and see,
I mean you, you first can try without a pillow.
- Sure.
- And if you can tolerate that, great,
but you probably won't be able to.
You, you may need one or two pillows to start.
- So what we're doing here,
if you have, if you're flexed over from your stenosis,
and you want to start to get straight again,
if you lay flat on the floor,
a bed would work okay if it's a firmer bed.
Um, like Bob said if you can get like this,
it's gonna stretch you out to get you more straight,
but chances are that's gonna be too aggressive.
Put two pillows underneath,
and you can lay like this.
And the idea is,
if that's tolerated well,
you're gonna lay there for a few minutes,
just for a stretch and then you're done.
If it's.
- You're gonna try to work your way,
away from the pillows.
- Right if it feels pretty good after two or three minutes,
take one pillow out
and then that's gonna get you a little straighter,
and you should feel a stretch,
not a sharp painful stretch,
but a mild stretch,
and just lay there.
It's kind of a nice easy exercise.
Um, and eventually get to
no pillows.
And possibly, you know,
you, you might even just start to do this.
- [Bob] Right.
- The patient I had one pillow was all he tolerated.
- [Bob] Sure.
- And we couldn't go down flat.
- But you said he got 50 percent better.
- Right, which was amazing to me
because that brings us to our next exercise,
is he's got this, and he wants to get up.
So he didn't tolerate this really well,
but he did tolerate this,
which really surprised me.
I had him put his forearms on the wall,
and his feet about two feet from the wall.
And then I had him to this.
And it tolerated it fairly well.
- [Bob] Yeah that's very interesting isn't it?
- Yeah, it was.
I did not expect this,
but I had him do that,
he does it two to three times per day,
and his back was tender.
I'd touch it, and it was tender,
and I says, he's been using a hot pad,
and I said well, but he wasn't getting really good response,
So he started using the cold pad,
and he sat against the cold pack,
and he said oh that feels good.
So now he uses a cold pack everyday.
- Yeah, and that's why we try different exercises
and different modalities
because you never know what's gonna work.
- Cause a lot of times with stenosis,
and you got tight muscles,
you're thinking hot pad.
- Right.
- But in his case he was so tender,
I just touched and it was painful.
Then we try cold and it changes, you know.
- Very interesting.
- Yeah, Yeah.
We're all different individuals
but there you go.
I'm sure you'll find some things here
that are gonna make your stenosis
and your posture better.
- Yeah and remember Brad and I are not just pretty.
- We're pretty ugly Bob.
- No no we're pretty helpful and handy.
- Yeah pretty handy!
- What the show.
Thanks for watching.