♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- All right.
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.
- You try saying that fast, Brad.
Today we're gonna talk about
how do you determined directional, specific exercises
to stop sciatica and low back pain.
- Right. And that's not a question.
We're actually gonna
show you how to determine it. - Show you, right.
We're gonna provide the answers
- Right. Directional exercises are not new by any means.
Mackenzie Stuart Miguel,
there's a number of great therapists,
including Bob and Brad, who always use this,
not always, we usually use this
for exercise for back problems.
- Yeah we're really humble too.
So by the way, if you're new to our channel,
please take a second to subscribe to us.
We provide videos, how to stay healthy, fit, pain-free,
and we upload every day.
Also go to bobandbrad.com.
Go to the giveaway section
because we're always giving something away.
- That's right.
- This week, we're giving away actually the FitGLIDE.
I'll show it to you in just a minute here.
You can also go to Facebook,
it'll be pinned to the top of page.
Twitter. Instagram.
TikTok, if you want a 60 second version of our program.
I guess, yeah, Instagram.
Also we have what?
- Great clips,
or short clips on YouTube. - Short clips.
- And a podcast-- - Yeah we're everywhere.
- wonderful interviews. - So here is the FitGLIDE.
What's nice about this,
you can actually use it as a bed too,
if you have to. - Oh, yeah.
- All right, here we are with the FitGLIDE
on the floor in the seated position.
And we got the little stilt up there, the little stand,
- Elevates it. - Yep.
And you can work it that way.
You can work it flat.
And, of course, you can spin it around
and actually work it with the other direction.
So it works more hamstring.
- Incline, decline, or the flat.
- I tell you it's great for underneath a desk.
- It is.
- Yeah, 'cause you don't bump your knees
up against the desk like you would with a bike.
- Yeah.
So, otherwise going (imitates bouncing desk).
- Yeah. - The desk keeps bouncing away
- You get knee pain that way. - and the computer, and,
yeah that's no good.
- All right Brad, let's get talkin' here.
- [Brad] Okay.
Directional specific exercises,
as I mentioned before, they're not uncommon.
As a matter of fact, in 2012,
there was a study by a Manual Therapy Journal.
They did a systematic review,
so they took 62 studies and looked them all over,
and they came out with very positive reports
using directional exercises, - For directional exercises.
- especially associated with centralization of symptoms.
In other words, with sciatica,
where you have numbness, tingling, pain,
in the back, running down the leg.
When it centralizes
we're looking for the symptoms to go up towards the back.
So, the-- - So it's going on in the leg,
but it's coming up.
You feel maybe even a little more tense
up in the back, - Right.
- but it's getting better then.
- Exactly.
And the directional specific exercises
are key point of getting centralization.
So, how can you do it at home?
And we're gonna show you some of the tricks
that we use from our, going to our experts,
and from our experience
- Yeah. We're not going to do too much detail here, Brad.
We're just kind of giving it a broad brush overview of it.
- Right. - So you can
look into it more, we'll talk about that later on.
How to look into it more.
- Exactly.
We're gonna give a good kind of a case history,
your typical case history that'll, may work for you,
but we're going to give you some options for the,
you know, for the details of your situation.
And so you can also get this down pat.
- So you first need to really determine, Brad,
whether or not you are having more pain
with flexion, or extension.
Correct? - Right.
Those are the two directions
that oftentimes are the problem.
- Sure.
- And so as therapists, what we do is,
I'll ask my patients, and I'll write it down,
- Right. - or I'll have them
write it down.
I need a list of activities or postures
that make the pain worse.
- Right.
- And then that make it better.
- Right.
- And sometimes they'll say, well,
everything makes it worse. - Makes it worse.
- Which I understand.
I've had severe back pain myself.
But we need to step back.
And there are some that irritate it more,
- Right.
- and some not so much.
- Right.
- So I've got a list here.
This is kind of a, a typical list
that someone may come up with. - Sure.
So we got, you know, posture or movements,
things that make this back pain or the sciatica worse.
Sitting, but not so much right away,
but greater than 10 minutes.
- Sure. - Okay. That's not unusual.
Brushing teeth.
And you might wonder what does brushing teeth
have to do with it?
Most people, when they brush their teeth
they're leaning forward,
and that little bit - Right.
- of back flexion we have to be aware of.
- Yeah.
If you're brushing your teeth with your back straight
it probably is not gonna affect your back.
- Right. - But...
- So then we look at that.
So, typically, - Yeah.
people are leaning forward without even being aware of it.
And then any bending to lift anything up,
even if it's a pencil,
that seems to make it worse for this person.
What kind of things make it better?
Well, walking seems to not bother it.
Even if it doesn't make it better,
but it doesn't irritate it,
that's gonna go in the better section.
- Sure.
- And also sitting in a firm, upright chair
seems to be better - Right.
Instead of slouching, - Yeah.
into like a soft chair
or recliner. - Or your car seat.
You know, - Right. Yeah.
- sometimes those are not very good, as far as that.
Standing tall, eh, it seems to be better
than if I'm going forward. - Right.
Kind of like brushing the teeth.
- Yeah. - So we're coming up
for some pretty good information just from here.
And you may not be aware of this,
but as therapists we realize that while sitting
your back is flex forward like bending,
brushing your teeth is the same.
And of course bending is out.
Now walking, you're more upright.
- Right.
Puts the back more into extension.
Sitting in a firm chair usually helps get you more upright.
- Right.
And of course, standing tall.
- Right.
So this is all good information,
but we're gonna go one more step to specify.
- So this is all indicative
of someone who's having trouble, flexion intolerant.
- Right. - They will,
- In other words-- - they're not good on flexion.
- Yep. In other words
bending forward. - Bending forward.
Yep. - And sitting is something
that a lot of people don't realize--
- Right, it's a real killer.
- It's the same as bending forward.
- The problem with it is you're bending forward
for a long time.
- Yes.
- And those forces can be much worse than the quick lift.
- Right. Oh, absolutely.
And that's a big key.
Now, what we can do next, Bob do you want to lie down?
- Oh sure. Wow.
- I, yeah, see I've been working on my grammar,
- Good yeah. - my English.
Karen, or, is that her name,
that is very, - Yeah. Karen.
- she would be very proud of me.
All right, so, what we can do
to kind of confirm what we're already thinking about,
which direction the stretch, forward or backwards,
is, we're gonna do a flexion activity
which may not seem like a flexion,
if you're not aware of it, but,
bringing both knees to your back
actually flexes your low back.
- You can do like repeated ones in a row,
like 10 in a row, - Yep. Yep.
- to see if that stuff's making your back pain worse,
or your leg pain worse.
- Right.
- Now if it does, stop.
- Yes.
If you go, I've had people go one or two times
and it's not comfortable.
- Right.
- And I just say, okay, that's enough.
- Just getting up from this position they don't like it.
- Right.
Sometimes they might do it,
it's not till like six or seven
and it just starts to irritate the back or the leg.
Then we put a hold on that,
and then we have the person lie on their stomach.
- (grunting)
- Oh, Bob, tough weekend huh? - Grunting, yep.
- Now sometimes if the back's pretty sore, or the leg,
we start with a pillow underneath
- Right. here.
It might be too much for the back to tolerate,
- Yeah. - going into even neutral
or extension right away.
- And a key point is, I'm sorry Bob,
whether you, sometimes you don't need the pillow,
but at first it's uncomfortable,
but it's important that you just relax for,
- Yeah. - you know, 20, 30 seconds
because with some time things can mellow out.
And it's like, a little uncomfortable at first,
but after a little bit, oh, it feels okay.
- You might even need two pillows.
- [Brad] Yep.
- I started my nephew and he had, it took two pillows
for it, and, - Right.
- but it calmed down then.
And then eventually you can work the pillows away.
- Right.
- And just try lying flat
like this. - Yep.
And you know, we had mentioned we want to work the back
into extension, is what we're thinking,
- Which is this way.
- And we're gonna confirm that now.
So Bob, can you go up on your elbows a little bit?
- That would be the next thing - Yep.
- is just try elbows.
Even, you can bring your chin
up like this too. - Sure.
All that helps extend the back.
Now if your back pain or sciatica is not too bad
you might be able to go into the press-ups right away.
Or you might have to take your time and just see if--
- Hands beneath the shoulders.
- Yep.
- And I'm just doing micro press-ups here.
- Baby ones.
- Baby ones. Yep.
- The first one, if it hurts a little bit,
just go back down and try two or three.
- Yep.
- If it improves with numbers, keep going with it.
If it makes the leg pain worse, now then maybe not.
- Yeah.
Now the key is don't lift up the pelvis like this.
- [Brad] Right.
- All the movements should be coming from the back.
You want to have the back nice and relaxed
- Mm-hmm.
- in order to get movement there.
Because if you go like this
you're not getting any back movement.
- Right. - Whatsoever.
- We're not getting that.
So let's say lying on your back,
pulling your knees to your chest irritates it.
Prone, after you lay there for a little bit
you can start to do some press-ups.
Ah, it's feeling better and I've had patients get up
and they, boy they feel good after that.
You know, I'm smiling
'cause I know they're gonna get better with their exercises.
So then what they're gonna do for the home exercise program,
the directional specific is important,
which is the prone press-ups.
Were you looking for something Bob?
- Well I was looking for the pillow for support.
I was gonna--
- Oh! Yeah, yeah.
Well we got it right here.
But you need to avoid the sitting,
because that irritates it.
Remember the list. - Yes.
- So we're gonna avoid these things that make it worse.
We're gonna avoid the long-term sitting,
particularly in a slouchy,
uncomfortable chair. - Now again,
in this video we're specifically only talking about people
who are having trouble with flexion.
- Right. - Because some people
have trouble with the other direction,
extension. - Right.
- That's a whole different video.
- Right. And we've got options.
We've got some videos
we're gonna direct you to - Right.
- so you don't have to search the whole world over
on the internet, - Yeah.
- in just a second.
But we're gonna also avoid brushing your teeth.
Actually brush them nice and tall.
- Yep.
- And-- - And get the toothpaste
all over your body.
- (laughing) Exactly.
And then bending.
We're not gonna bend like this anymore.
Everything is going to be like this.
- All the hips are taking the movement.
- Yep. Right there.
Perfect posture--
- And sitting, you want to sit,
you want to avoid sitting, really, if you can.
- Mm-hmm.
- But there's sometimes it's unavoidable,
like driving a car.
Even though you want to limit how much you drive a car,
- Yep. - if you can,
but when you do
you definitely want to have some support there.
- Right.
- In the low back to keep a little bit of an arch there.
- Mm-hmm.
- So you're not router, out flexed the whole time.
- Right, right.
And then we're gonna go back to the exercises
probably every couple hours,
where Bob demonstrated laying and doing the press ups.
Going up as high as you can. Ten repetitions.
And then take a break
and come back in a couple hours and do it.
Now you're gonna, some people are gonna find,
were you going to say something, Bob?
- No. I was just going to say, you're looking for more help.
I mean, if we're, if you're looking for more help,
- Oh! - I was gonna give them--
- I was like, I need a lot of help.
- Yeah you need help.
- Right.
If you need more help,
this information it doesn't seem to make sense,
which is not too unusual.
Go to bobandbrad.com.
We have a sciatica program.
- Go find the program section.
- Yes, go ahead.
You do this much better. - And under the programs
you will find a number of program titles.
One is sciatica and back pain. - Mm-hmm.
- Check that one out.
We probably, what,
forty, fifty-- - Forty.
There's 40 I counted. - Forty videos?
Forty videos on back pain and sciatica alone.
- Right.
- Check it out.
You can get answers.
Watch the ones that only pertain to you.
- Yeah. You just look at the titles.
You'll know if it pertains to you.
You're probably only gonna need to watch a few of them.
And then look at them.
There's a PDF printout, which is a big bonus.
So you have a review of the whole video
with the exercises on it.
- You can take it with you
and you can do the exercises - Yep.
Without having your computer
or phone with. - Right.
And they're asking, well how much is this gonna cost?
- Yeah.
- Absolutely nothing. We don't even ask for an email.
It's very convenient. And it's all for you.
It's a gift from us.
- That's right.
And you know, your birthday is probably coming up, right?
- (laughing) Somewhere in the next 365 days.
- Yeah, all right.
- Take care. - Yep.
- Good luck with that back.