♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet. ♪
- Check, check, check check. - We're gonna go big time.
Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we're the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- The title of today's program is, "Do you have fake
Sciatica, Herniated disc versus Piriformis syndrome
or Stenosis?"
This is an update.
- Right.
- We did this video before. - Exactly.
And don't get it confused with fake news.
- Right.
(chuckling)
- Anyways, you could have, symptoms down the leg,
things like that.
We found out, as we know as therapists,
there's more than, just one thing that can cause that.
And you need to know the difference
depending how you're gonna treat it.
And we're gonna show you some tests you can do at home.
- Yeah, if you get the wrong diagnosis,
you're gonna go down the wrong path,
it's never gonna get any better.
- Right, could get worse and then you'll see
what's going on.
- Yeah, so by the way, if you're new to our channel,
please take a second to subscribe to us.
We provide videos on stay healthy,
fit, pain-free and we upload every day.
Also join us on our website, bobandbrad.com.
Go to the giveaway section.
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- That's right..
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of Bob and Brad a day.
This week we're giving away the Romfour massage gun.
This one's a little different than their other massage guns
because it's actually adjustable.
So you can actually adjust the head.
So for different angles you can get
it under your arms if you want.
- Well yeah- - But I guess you
won't want to do that. - It is nice.
It's actually, it's a very heavy duty ones,
really good at getting deep, for those large muscle groups.
- Really nice.
Good for what ails you.
Actually, this is gonna work well for piriformis.
- Oh, yeah, that's right.
It can be used for that. - So we might bring
that up later, I'll leave that near by.
- Alright so, now that you bring up piriformis,
and it is in the title, the leg symptoms
is as a result of a pinched nerve.
Okay, and it can be pinched from a disc,
from the piriformis muscle, or it could be from stenosis,
where you have two bones that are coming close together
or some other tissues. - The hole that bones form
is shrinking sometimes too.
- Right, and we're gonna show that.
But first, so we all have a good visual of what's going on?
If we look at Sam, Sam is gonna show us his backside.
And we're gonna look at where the vertebra
and the most common area that you get sciatic
from the disc is in the low back between L4 and L5.
So here we're gonna look at...
This is a model, L5, then the bottom,
the disk and then L4.
Now what happens is, the disk can bulge right like that.
And the problem with that bulge is, most of the time
it bulges right into the nerve,
that feeds the sciatic nerve.
- Right, so that's one place where the nerve
can get pinched.
- Right, right. - First place.
- So the second place is if we look at Sam,
Sam I am, is the piriformis muscle.
- Oh well, second place, probably the hole.
You wanna show that?
- I wanna do the piriformis.
- Oh okay. - Cause that's what's first.
But you're right.
Yeah, that's a good, it would be a good segue
but I already had it in my mind.
- Alright, here we go. - You know how I go.
(chuckling)
- Don't mess Brad up.
- Don't change my sequence up here.
So the piriformis muscle connects from the sacral here.
It's actually on the backside,
but for this it doesn't matter.
And it goes across to your hip bone that greater trochanter.
So here we've got the (mumbling)
- Does he actually have the name on the muscle?
- Yeah, after when they do surgery, they look for the name.
- Yeah! (chuckling)
- But the yellow, represents the sciatic nerve
and you can see the sciatic nerves goes underneath
the piriformis muscle and if this muscle tightens up,
it actually puts pressure on the nerve,
therefore creating the leg pain
as a symptom. - Could be scarring too.
- I once cased where I think
the person's tore the muscle then it healed up
and it scarred, - Sure.
- down over the nerve.
- One way or another that needs to get loosened
up to take the pressure off.
And then stenosis, like Bob was saying,
we're go look up here so you can see it...
The pelvis gets in the way.
Where the nerve comes out of the hole,
it's called the Foramen.
But this hole can get bone spurs on it,
the disc may be shrinking, there's a number of reasons
why the nerve can get pinched, from stenosis.
And there's distinct symptoms that we can find
for all three of these so you could tell which you have.
- In essence the fake sciatica is generally the piriformis,
right? - Yeah.
Piriformis, I would say stenosis may have a issue
with that too. - A little fake too, right.
Because generally when you think of sciatica,
you think of the nerve.
- Yeah. - I mean, the bulging disc.
- Right.
- And so if it's not the bulging disc,
then it might be fake sciatica,
and that often is the piriformis,
or it could be even a little bit the stenosis.
- And the symptoms are the same though.
- Right. - Down the leg.
- Right, that's why I get so- - Numbness, tingling,
all those types of things.
Bob we're gonna have to move the Romfour
massage gun. - Okay, I'll move it.
- So we're gonna go through the test for a disc problem.
- Okay, first the disc.
So these are, our positive as they say,
is leaning towards the fact that you have real sciatica
or a disc bulging disc. - A disc.
- Or a herniated yes. - You wanna lay down?
- I can sure.
- On your back please, but don't fall asleep.
- Alright.
- So this is, the straight leg tests.
This you cannot do by yourself.
Well, maybe you could, but it's best to be done
with another person.
So we're gonna check Bob's right leg.
Completely relax the leg, the knee will be straight.
And I'm gonna lift it up like this.
And I'm gonna listen to Bob's when he has complaints
or some pain.
- Oh!
- And if he, once you get up to a certain point,
if he complains of pain, and the pain is in the buttocks
or in the low back, that's a pretty positive sign
that you've got a nerve being pinched in the disc, area.
And then once you get up to that point,
to further test it, if you take the foot
and dorsiflex it or pull it that way.
And if that makes it worse and usually dramatically worse,
that's a good sign, you've got a disc problem.
- And the pain, you're gonna feel stretching in here.
That's normal, but when you push the foot down,
if it increases, like pain again in the buttock or the back,
that's the sign it maybe a disc problem.
- Right, exactly.
The other thing you have to be careful for,
is with the knees straight and we're coming up.
There's a natural stretch
in the hamstring as well. - Right.
- So you can't get that confused.
And that's one of those things that, sometimes
you need a little practice so, a therapist is good
at that, at home that might be a little challenging.
Let's go to the second test, the slump test.
- Okay.
- Should I do it facing this way
so you could see it? - Sure.
I think that would
work out (mumbling). - So Bob do you wanna,
go through the mechanics of it.
- So you're gonna start off with the back completely,
with a bit of an arch in your back even,
a little back so that you have really good posture here.
And then what you're gonna go ahead is slump,
so you round out. - Yeah.
- And if this brings on symptoms,
when you're in this position,
but when you're in this position, it takes it away,
that's a sign again, that it might be a herniated disc.
- Right.
- So, you actually can do that with overpressure too Brad,
I don't know if you wanna show that or-
- Well, I was gonna show the complete slump tests
but we're already here and if it doesn't change
and then you - Oh, to bring the leg up.
- To bring the leg up. - Very good, yeah.
- And pull the toes forward, and then even worse,
bring the head down. - Right.
- If all those things continue to make it worse and worse,
and the back or the buttock area or down the leg.
Those are all positive signs
that you have a disc problem. - Very good, very good Brad.
- And then, the next test is a real simple one.
And this is what is done oftentimes with the doctor.
They say, "Can you walk on your heels?
"Or can you walk on your toes?"
Now this is pretty significant, if you're unable to walk
on your heel on one side, it keeps flopping down,
you better go to the doctor.
- Yeah. - That's-
- That means the sciatic has really progressed
to the point where it's starting to kill off the nerve.
- Right.
- That supplies the muscles, to your feet.
- Right.
- And your ankles and yeah, it's time to see a doctor.
- When the motor controls that far gone,
you don't wanna, you just wanna go to the doctor.
Get it straightened away.
And then the other one is you wanna do this one Bob?
- Sure.
- If you lay on your stomach.
Now these are again, all for indicating
the disc problem.
You're gonna do a press up.
So if you lay on you stomach, - (mumbling) Start off in this
position. - Sure.
- Or you can go then progress to a press up
where you put your hands on your shoulders.
And you ease you start having people
doing little baby press ups.
- Yeah.
- Just halfway up.
I'm keeping the pelvis on the mat.
I'm not lifting up like this.
- Right?
- And if this starts to give you
maybe a little relief down the leg.
- Yeah.
- Especially down, in the furthest part of the leg.
let's say the calf or the knee.
- Down here.
- That's a good sign that it might be a disc problem.
- Almost, cause when you do that, the piriformis-
- Yeah, it's not gonna help
to piriformis. - Is not moving that.
If you got stenosis, that's gonna be-
- It's gonna make it worse. - Make it worse.
- Yeah. - So, if it does make it
better, good chances of disc problem.
And that's gonna to be the treatment actually too.
So those are four tests.
Now, if all of them are positive,
that's a pretty good sign,
you've got a disc problem. - A disc problem, right.
- And it could be two or three.
If all in one of them is positive,
probably not. - Sure.
- Let's go to the piriformis tests.
- Okay. - Okay.
- I'll show this one Bob. - Sure, sounds good.
- This is the one I use a lot.
I don't know what you use Bob, but it's not the only one.
I'll have someone lay down.
And I'll say, "Take the side where the sciatic is."
See this is the right leg,
the one that gives me the problems.
I'm gonna take the knee towards my chest
and to the opposite shoulder.
So it goes across like that.
And if the person, feels the pain right in here,
that's where the piriformis muscle is,
I'm thinking, boy, that's a pretty good sign.
It's that, but then I also do the other leg.
And I've never had anybody painful and tight
on this side, on both sides.
- [Bob] No, I haven't either.
- It's always like, "Oh, that one hurts.
"This one is no problem, a little stretch there, but it's"
(cross talk)
- [Bob] Piriformis issue.
- Right. - [Bob] Right.
- So I'm thinking, "It's probably a piriformis problem
"here where it makes sense because that's where
"the pain symptoms are."
Then the next one, I'll do it.
You lay on your stomach, Bob you'll have to talk
through this, right?
I go like this and we do internal rotation.
- Okay?
- Do you know that one?
- What are you doing?
(chuckling)
- You do it.
- Okay.
- You know this one, but you probably don't do
it as much as me.
(grunting)
But if you go up like this,
the piriformis muscles here to here.
And if I bring the foot out like this
and it goes this far on this leg.
And then on the other leg, it's hard to see,
it doesn't go near as far, that's the indication
that the piriformis muscle is tight,
on the foot that doesn't go as far out.
Because a piriformis muscle is that internal,
external rotator and we're internally rotating.
Do you ever use that one Bob?
- No, I haven't used that one.
- Okay.
- I've used this one where you kinda
lift up sometimes- - Oh, that's a nice one too.
That was probably easier to show
for the lay person too. - So you cross over
and lift you up like this and that puts a lot of stress
on the, piriformis.
- Right. So that's gonna irritate it.
- So you do it, you cross over to the other side
and do it also, you lift the knee up,
and if that hurts, that would indicate on that side,
there might be a little piriformis issue.
- Okay.
Now, I would say this stenosis is probably the easiest one.
- Yes, it is.
- To, determine if that's what you have.
The key thing here I think is consistently,
if walking and standing consistently make it worse
and about the same distance.
You can stand for three or four minutes,
pain down the leg, back pain.
And then if you sit down-
- It relieves.
- Relieves it very quickly.
- Yeah.
- And you can stay seated for long periods of time
and it's still relieved.
On the other hand, if you sit down and feels better,
but then the leg starts getting more painful after time,
then we're thinking, (mumbling)
it's a disc problem, yeah. - Disc problem, right.
- So stenosis doesn't do that.
- Stenosis generally Brad as a rule of thumb,
55 and older.
- Right. - I mean, it's more
of an arthritis thing.
And you're also gonna talk about shopping cart syndrome.
- Right, yeah.
The only time I think stenosis isn't for older people
is if there was trauma or-
- Sure. - Or like spondylolisthesis.
- Right. - Like in my case.
The shopping cart syndrome, how many times have you
had someone- - Always almost.
- They say, "Enough I can walk, two or three minutes
"and it starts to hurt, pain down my leg.
"But when I go shopping and I can lean forward,
"I can walk so much longer- - Yeah.
- "So much easier."
- Very- - Classic sign of stenosis.
- Right.
- The final one if I wanna add one more Brad.
- Sure. - Is you just have to stand,
and lift their arms above the head,
and that often will bring on the symptoms too.
- Right.
- Where it may or may not was a disc problem.
I mean, disc problems. - Right, yeah that's...
So Bob-
- Alright we got windy today Brad.
- Yeah, we covered a lot of territory there
and it took almost 14 minutes.
Sorry for the lengthy.
But it's just not that easy.
- It is all critical - That's-
- information that you need in your life.
- Absolutely study it again.
- Thanks for watching.
(soft melody)