♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob
- What they don't tell you about herniated discs.
- Bob, this is a subject
that I am just passionate about
because I...
And I'm sure you do too, and most therapists,
they get people coming in
and they say they had a MRI and they have
they got a herniated disc
- Or just a disc buldge
- Yep. And they're just absolutely.
They're, they're just freaking out
because they've got this problem.
They've just been diagnosed and we gotta calm 'em down.
- Yeah. Do you know Brad?
I've got a herniated disc!
- Right? My MRI says this and then I gotta,
- And then we find out sometimes
that that's not even causing their pain.
- Exactly. Exactly.
So why don't we back up a little bit
- Right
- Let's talk about the disc where it is and the breakdown.
- Sure.
- Let's bring
- Bring in Napoleon Bone Apart.
Get it.
- I get it Bob.
- We're funny guys.
- Okay. Here we're looking at the back side of,
of Bone Apart.
- Yep.
- And most herniated disc
either occur in the back occur right down here.
L four L five.
That's the majority.
- That's where most of the stress is Brad.
When you, if I bend forward, like now
if you just think of it as a lever arm.
- Yep.
- All the stress is gonna be right there.
- Exactly. So it all makes sense.
- Yeah.
- And if you wanna look where a model
of a herniated disc, if I don't, maybe I'll bring this
up closer, but there's a red spot right here
- Right there.
- And you got it.
Good. Thanks Lonnie.
That is a real typical place for a herniated disc
between L four and L five.
And it's bulging out typically in the back
and the corner and that's where it can pinch
- Back and side a little bit.
- Yep.
And it can pinch that nerve.
Then you got the problems down the legs,
sciatica, and all those types of things.
- And that's what sciatica is,
it's a pinch nerve
- Right
- quite often and it's there's pressure
on the nerve and, and it sends pain down the leg.
- Exactly. So let's take a look at this herniation
because that's the leg pain we're talking about.
If we took L four and F five out of there
and had him in my hand, and then we had a model right here
here they are L four L five in the disc again.
And if we look at that disc, you know, I always
thought a disc when you slipped the disc that you actually
the disc shifted.
- Yeah. It fell all over.
- Yeah. It was like, it was
like a hockey puck and, and here it is, you know
it just would kind of side and shift over and then you'd go
to the chiropractor and they'd
- Push it back in again
- Magically crack you and push it back in.
And life is good again.
Could be the farthest thing from the truth.
- Right?
- Exactly.
So we have to put this model away and go to the
- Big model.
- Yep. The real model that really does a nice job,
I think
- Just real quickly, Brad, as an aside here
by the way, if you have, I know a lot
of you haven't ever watched us before on YouTube.
- Right.
- And if you haven't make sure you subscribe to us
we got a little button right down there below.
We upload a video every day
- Mm hm
- and uh, it's gonna
they're all gonna help you stay fit, healthy pain free
and maybe avoid going to the doctor sometimes.
- And more attractive.
So, back to the disc.
Okay. All here we go.
This is our model.
This is actually a coffee cup.
That looks like a,
- [Both] A vertebrae.
- Yep.
For therapists and doctors who, you know
want a Christmas gift.
Here's L five and here's L four
this green ball represents a disc
because a disc is not like a hockey puck.
It's actually has a
a tough outside that
- Outside
- that's elastic.
- Yep. And the inside is kind of like a gel fluid.
- Right.
- Okay.
- Almost like a toothpaste, I think.
- Yep. Yep.
And they say, as you get older
it gets a little more like
- Dried out and yeah.
- Crab meat.
But we're gonna get back to younger person.
We'll get into that more.
- So here's L four here's L five.
- Yep. Now the, the disc
it works like a little shock absorber.
When you've bend forward,
you bend forward like this
it allows your spine to be flexible.
- Right
- If you didn't have discs, you could not be flexible.
You wouldn't bend twist or, or extend.
So what...
- They also give you some height by the way, Brad.
- Oh, yeah.
- As you get older, that's one
of the reasons you get shorter is
because some of the fluid is coming out of the disc.
- Exactly.
- So
- Degenerative disc disease.
- Right.
- You know, it's like getting gray hair.
You'll hear that when you go to the doctor too sometimes.
Okay. Now let's look at a model of a bulging disc.
This is, does a really nice job.
There we go.
You got a closeup of that Lonnie.
- Yep. Right here.
- Now where does the nerve come through Bob?
- Right through there.
- Right.
- Especially right off to the side here.
- Right. Actually, if it was bulging in this place
it'd be going right
- Right into right to the spinal cord itself.
- Right, and so it more often is off to the side here.
- Right.
- And that's where it hits the
some of the more spinal nerves,
- [Brad] The peripheral nerve there.
- Yeah.
- [Brad] Yep. Okay. So what is going on?
We have that bulge.
How do we know we have a bulge Bob?
Well, people say let's get an x-ray.
You are not gonna see a bulging
or herniated disc on an x-ray.
They, that only shows bone.
So you need to get an MRI
- Sometimes what does show though, Brad,
is that there's not as much space between the bones
and then they suspect...
- Sure, yep
- that there may be degenerative disc
or that it may be bulging.
- Sure. That's a good point.
Um, other than that, if we have the, the, the space in there
and then with the MRI
you see a herniated or a bulging disc, it's all of a sudden
everyone gets lit up and patients really get concerned
but let's go to the facts.
They've done studies on people that have zero symptoms
no back pain, they MRI 'em and then here's the statistics.
And they did those larger groups of people.
So they know these are good numbers.
Out of these people
out of the, the, these MRIs that they had taken
38% of 'em showed they had a disc bulge.
So it wasn't a full blown herniated disc.
- Again, Brad, did you say
that these are people that have no symptoms?
- No symptoms.
- Yeah. These, these aren't people that went
in because of back pain, they have nothing wrong with them.
And they just did a and, and 38% of them had a disc buldge
- Right.
37%, another 37% had a disc protrusion
which is a little bit bigger
of a buldge getting into that herniation.
11% had a disc excrusion excursion, I'm sorry.
Excursion where actually some
of the fluid actually is outside
of the right of the disc itself.
It actually leaked out.
- Right. And they call it sequestered disc.
- Right? Yeah. There's different ways.
They have a lot of different terms for very similar things.
- Right, right, right.
And then 4% actually showed a nerve entrapment.
And again, all these numbers and people have zero pain.
- Right.
- So because of that
they're not gonna go in and have surgery just because they
the MRI showed 'em to have, you know, they got
they got a herniated disc.
There's no symptoms, a body has already adapted to it.
And it's not a problem.
- The point we're trying to make with this is
that as you get older, this is gonna happen to you.
It's like aging.
It's like arthritis.
It's like gray hair.
- Right.
- All, it's just all part of the aging process.
So don't panic.
When, when it's, you know, shows an MRI, that's that
you know, even if you're having pain along with it
that does not mean necessarily
that what's causing your pain.
And, but it is, it doesn't mean
that it can't be treated.
- Right
- Without surgery.
- Exactly. So overall, 60%
of these people had some kind of...
- 60% people with no pain
had some type of...
- Herniated disc. Yep
- And believe me, it gets worse as you get older.
I mean, I've seen stats where it's like
if you get up to the age 70
it's like 70% are, have, have some type of deterioration.
- Right. And that's just part of the aging process.
So, you know, one thing I would like to, to show Bob
Okay what I wanna do is talk about the
the disc itself and have an explanation of back pain
how it starts and can pro eventually
- Progress
- Progress into that herniated disc.
So if we look at the disc, a nice healthy disc here
and if we were to take a slice, a cross section slice
of the disc here and then opened it up
to see what it looks like inside.
- So in other words
it's like this picture would be like this.
- Yeah. The, the disc would be here like that pancake.
We cut it.
- I'm flipping it over.
So you can see that you're looking at it from the top view.
- Exactly.
- Right.
- Now, the outside of the disc is that annulus.
It's a tough, flexible
- Fibrous material
- fibrous material and it allows that flexibility.
So you can move and whatnot.
Inside there's a gel or liquid type substance.
And that is just like that.
It's like a jelly filled donut.
- Yeah.
- Okay. So this red represents that jelly.
The blue represents the annulus and the annulus
isn't just like a balloon.
It's just not like a one wall.
There's actually layers upon layers, kinda like lamination.
- Is that what these are, layers Brad?.
- Right. Okay.
And when you're bending forward
or sitting on the poor posture
the force may want to have this fluid go this way
all the time, so more gets here, less gets here.
- So this would be the front of the body
- Right
- [Both] This would be the back of the body.
- So when you bend forward, the fluid actually
starts migrating
- Exactly
- Towards the back.
- And it doesn't just go and make a big buldge right away.
It'll start migrating through the layers.
Here you can see us getting there
and it's gonna work through here and get halfway through.
And as it's happening
this is creating pain and it might create pain here.
Sometimes it may be radiating
over here or down into the buttocks.
And it's the early phase of a herniated disc,
as it works its way through.
And this is where when you do the proper exercises,
you can reverse it the easiest.
Once this travels through these layers
and these laminations, it starts to get to the outside layer
and you start to get that bulge and a true herniation.
That is where you got the problem.
And that's where that nerve comes through and it hurts.
And it goes down the leg
and then you got true sciatica and all those other...
- So as we were saying, Brad
sometimes this cannot will not cause pain
but sometimes it will.
- Right. Right, right.
- So, but it, we can't always blame it for our pain.
- Exactly.
- But when you're showing the incidence
and where it does cause the pain and why don't
we show, Brad, on a person
what, what, you know, what involves
- Okay
- You know
- Let's do that.
- You know, let's take whenever you're putting
your body in this position on a regular basis
basically this slump forward position
now that what that's doing exactly what he showed
on that disc it's pushing the annulus or the, the
- Nucleus
- [Both] Pulposus
- That's a big one, nucleus pulposus
- The center of the disc towards the back.
And it's working and making it worse and worse.
And that's why sitting is often more
of a problem than lifting.
- Yeah.
- Cause you're sitting all day long
and you're making that, especially
if you're sitting in that slump position
Brad was sure all day long, you you're working it
making that disc protrude to the back.
- Right. It takes time over years actually.
Sometimes.
- Yeah. So if you, if you sit this way in your car
you sit this way at work, you lift this way.
Eventually it's gonna end up that way.
And all of a sudden you do something
like lift and then that's when the back actually gets hurt.
- Right.
- But you've been doing it over years.
- Right? Exactly.
- Kind of a hidden culprit.
So I hope that answers the questions
about things you didn't know about a herniated disc.
They won't tell you at the doctor's office.
They don't have enough time in 10 minutes.
We went through it real quick.
- Right.
- So it's good information.
Keep it in mind.
It's gonna help you save some gray hair.
- Yeah. Thanks.