♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet. ♪
- Hi folks.
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.
- Brad, you wanted to talk
about some advanced sciatic treatments
that someone could try.
I guess these are just basic exercises you could do to see
if you can decrease your sciatic pain.
- Right, right.
If you've got pain, let's talk about sciatic pain
to begin with.
What does sciatica mean?
I think some people kind of get that confused
about what it really is.
And it's pain that radiates into the buttock,
down the leg, all the way to the foot or even the toes.
And that by definition is sciatic pain.
- It could go a little bit less.
I mean, it could go like to the mid-calf.
- Sure.
- For the reason it doesn't go all the way to the foot,
doesn't mean it's not sciatica.
- Yeah. I may have misspoke there, but yeah.
It goes down one of the legs typically.
- Right.
And with this, it's really very important
that you know, what's causing it.
Right, Brad?
- Exactly.
And that's part of it, with sciatica,
from the definition that I found, it's from the lower back
although it could be from a structure lower,
like in the buttock, the piriformis.
- Piriformis, yeah. - Or something else
irritating that sciatic nerve.
- Right. - But we're gonna
just assume, 'cause I think a lot of times
probably I could be safe to say,
the majority of the time,
it's from the back.
I don't know if that's-
- So, generally from a herniated disc basically, that type.
So, that's how we're approaching it today
is that your sciatica is from a herniated disc.
- Exactly. - So, and by the way, Brad,
we have a lot of people
that are watching us for the first time.
Please take a second just to hit that subscribe button.
- Right there. - We provide a lot of videos
on how to stay healthy and fit, wide range.
- Right. - And we upload every day.
- You bet. - So.
- Okay.
So, we're looking at the lower back
'cause that's where a majority
of a low back herniated discs are,
vast majority in-
- L4, L5, L5, S1.
- Right.
So, here's the pelvis
and your beltline,
if you're not familiar with the anatomy of this model,
the beltline would go right across here.
So, this is here.
Here's the sacrum, L5, L4.
This red disc right here,
if you can see it this far away,
you don't have a red disc in your back,
but that's just there so it brings attention
to the involved disc for this model.
And if you look right here, I'll get up closer,
so you don't have to zoom in.
If you look right here,
this red bump, right here, is a representation or a model
of a herniated disc, which is pushing into this nerve.
As you can see, this is a nerve that actually runs
down into the sciatic nerve and down into your leg.
And that's why a herniated disc, the symptoms and pain,
numbness and tingling, are felt down in the leg.
But we're gonna talk
about some exercises that help reduce
or get that bulge smaller.
But not only that, we're gonna show the first exercise
that we have a number of videos on
that is kind of a go-to exercise to do this
but it doesn't always work and it gets more difficult.
And then we're gonna talk later in the video
on how to get those difficult bulges.
- You wanna show this now or later?
- Yeah, let's show it now
because we just showed the model here.
But now we're gonna show-
- It's really important to understand this.
So, this will take a second.
- This is a model of-
This is actually a coffee cup.
It's a vertebra coffee cup.
We should actually mark these L4 and L5
This is gonna be L5.
And then this is gonna represent the disc.
And a disc has fluid inside or a jelly substance.
And then it has an annulus
on the outside of it that holds everything in place.
It's real tough and it is flexible.
And so here we go, we got the disc on top.
So, when you walk or you jump,
there's a little shock-absorbing going on.
And it allows when you bend forward,
each vertebra has to flex a little bit,
the bone doesn't flex, so the disc has to flex.
- Right, that's where you get your motion
and a little bit of height.
And then, like you said, the shock absorption.
- Right. Allows a little bit of rotation, not much.
Okay.
Now, let's talk about a herniated disc from-
- And on a healthy disc, you can bend forward like this
and nothing happens. - Exactly.
- Right.
- If you've got a herniated disc-
- Or a disc that's weakened over time,
because you do a lot of bending forward or sitting,
this is what could happen.
- Right. - Right.
- Can you zoom in on that, Lonnie?
- [Lonnie] It shows.
- Okay. Okay, good.
So right there, that's a herniated disc.
Now, this model is hard
for me to position this where I want to.
- Yeah, 'cause generally it goes more off to the side.
- Right.
Just like on the model I showed you earlier.
- And that's where the nerves are coming out
and then it can actually hit the spinal nerves.
- Right.
Now, you could get the bulge,
see if I can get this to come out.
Not off to there, but even more laterally
or to the side like that.
Okay?
Or there's actually a possibility of an anterior
or the bulge comes out.
I don't know if I can make it.
There we go, to the front.
- Less likely though, 'cause there's a big,
wide ligament there that helps hold it in place, so.
- But there is, you know, a slight possibility.
- Yeah. - So, we wanna show
you some exercise.
If you do some exercises, should we go
right into that? - Yeah.
- The typical herniated disc-
- You wanna throw me a pillow, Brad?
- Sure.
- 'Cause sometimes people
can't even get into this position, Brad.
Sometimes they have to start with a pillow here.
- [Brad] Exactly.
- You know, they start like this
and then eventually they move to the point
where they can move the pillow out
and they can just even get into a static position like this
onto their elbows.
- Right.
Let's even back up
one step forward. - Sure.
- If you have a herniated disc,
there's a good possibility your posture
is gonna be flexed forward.
And it's very uncomfortable to go up
and very unlikely to go backwards in the standing position.
And it's because of the mechanics
of that disc is forcing you this way.
- At the very least, you're gonna have trouble bending back.
- Right. - You know what I mean?
I mean, you may not have trouble straightening up
but you're gonna have trouble bending back.
- Exactly. - So.
- The idea is that when you can allow the range
of motion of backward bending,
then the disc is back in place, when it's pain-free.
- So again- - Go ahead, Bob.
- We generally start, pillow, and you might even lay here
for five minutes or so.
And then if that feels fine and you're not getting pain
going down your leg, tell 'em what we're looking for, Brad.
We're always looking for the symptoms to do what?
- We want 'em to centralize.
So, if you've got the symptoms starting here
and they're going down the leg, they might go
to the knee, sometimes to the ankle or even into the foot,
and you lay like this.
And why don't you lay flat, Bob?
If you lay like this and after a couple of minutes,
let's say you got numbness into your foot.
The foot starts to feel normal again.
That's a real good sign you're on the right track
for exercises here or even just this position.
And as you lay there more, if it feels like
it's feeling more normal here
and more normal here
and it's working up this way, you're doing great.
Then as a therapist, I'm gonna say, Bob,
why don't you try a press-up?
- Or maybe even just get up on your elbows.
- There you go. - A little bit.
- Yeah. - And then a press-up
where I put my hands below my shoulders like this,
and I'm gonna press up to the point where, again,
I don't wanna increase the pain.
And if it starts going down my leg,
I don't wanna go all the way up then either,
I'll just maybe work in a small range right here.
- And the whole thing that's gonna guide
how far you go up or how far you work it,
is if the pain, the numbness,
all the symptoms that you may have in your leg,
they're disappearing down here
and they're going in more central,
central being this.
This would be the center.
So, if you do on your stomach, you take the pillow out
and you end up doing 5 or 10 press-ups
and all of a sudden the symptoms are gone in the leg,
boy, you've got a really good chance of-
- But let's talk about, Brad, what normally happens.
A lot of times, I'll get someone into this position,
and they start doing, it's like,
ah, it's really not helping or-
- Sure.
- So, then the first thing I try, Brad,
is if you wanna throw me that towel.
- Yep. - I dunno if you've done
this one lately but I'll just put a towel
right underneath here.
- Oh yeah, actually I don't use that one
but I probably should try that.
- You put a towel right under the pelvis here
and now I do it.
The same thing.
I put it on the side that the pain is at.
- Yep. - So, my pain
is at this side. - Okay.
- I put it on that side and then I have 'em try it.
- Okay. - And they go, "Oh yeah.
That feels a little bit better.
Now, I don't get as much pain going down the leg."
- Sure. - It's coming up a little bit.
So, that's one little variation you can do again,
kind of an advanced move.
- Well, I wanna show you another trick that I've learned.
If the press-ups aren't working very well.
- Do you wanna do overpressures at all?
- No. - Okay.
- I wanna show-
- Do you want me to do it?
- No, well, you can do it.
Yeah, let's do it.
This is a kind of a weird name (chuckles)
but we call it in the therapy world, roadkill.
But go ahead, get in the position with this, Bob.
If the pain and the numbness
are symptoms are in the right leg
you're gonna bring your right leg up in that position.
- Which one are you talking about?
- Roadkill.
- I'm not sure which one that is.
I always talk about the banana first.
- Oh, we have here...
(Bob laughing)
Therapists have their own tricks after a while.
You know this one.
- I know, but, oh, roadkill.
That?
That? Okay.
- So, I'll have someone go in this position
and if sometimes just doing this, they'll say,
"Oh, my leg's starting to feel better now."
Then I know we're on the right track.
- Sure. - And then I may add
the press-ups as long as the symptoms and the pain
are going out of the leg.
- I had forgotten that one, Brad, to be honest with you.
- And that, yeah, that's the one I use.
I don't use this towel one.
So, you're getting a lot of good information.
- So, a lot of times then often
we'll take a towel or a sheet.
Let's say you start getting some improvement now
with what that, and this would be an advanced one too
as you'd take
a belt or a sheet.
- Yep. - And you're gonna go ahead
and put it around you here.
And this is to try to advance it.
So again, you're gonna lay down
and now you're gonna put your hands on the sheet like this.
- This would be, if a regular press-up is doing well.
- Yeah, exactly.
- Then this would be the next step.
- Right, now you're gonna put some overpressure on the back
and you're gonna get a little more bend.
And this is to advance it along
and, yeah, to try to get that pain up even-
This is where you maybe got it up to the buttock
and now you want to get it up even further.
- Yeah.
This one is oftentimes you need help
because a sheet wants to slide too far up.
- Right. - You might need someone
to help pull it down by your beltline.
- We've had some people
even just do it this way, right, Brad?
- Yep. In the standing position.
- Yep.
- As long as the pain in the leg goes away
when you're doing it, you're on the right track.
- Right.
- So, what's the other one you wanna do, Brad?
- Well, this is the other one
I'll go to if I'm having problems.
I just call hook-line rotation
because it's easy for me to document
in the right down.
If it's on the left side, down the left leg
and I've tried my other techniques and they're not working,
I'll go to this one.
And this one I would have to say, needs to be done
by a therapist.
I can do it to my myself and I can teach my patients.
But over YouTube, it's gonna be hard for me
'cause you have to shift your hips like this.
You're gonna bring your knees up
and slowly go over this way.
And you're only gonna continue this
if it feels good and it will feel good right away.
If your leg starts feeling better right away
then you're gonna continue with it.
If it just hurts and the leg starts to hurt worse,
you stop immediately.
But again, that's a little bit more advanced.
- Mulligan actually does one like that too.
It's almost exactly what she said.
- Sure.
- Yeah. - Yep.
All these great therapists that we know,
we really like, they think alike.
- Right.
(Brad laughing)
Exactly.
- That's why they're successful.
- All right.
If you get stuck, you're gonna wanna try to find
a therapist trained in the McKenzie Method.
So, we'll go ahead and link that up to that video
that you can watch. - Right, right.
- And remember we can fix just about anything.
- Yeah, except for that broken heart, Bob.
- But we're trying.
- Yeah. When we get that baby figured out-
- We're gonna be in good shape.
(Brad laughing)