(upbeat music) ♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(clapping)
- Hi folks I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- I'm sure you agree.
Today we're gonna talk about is leg pain
sciatica or femoral nerve pinch?
You must see to assess and stop the pain.
You must see this video, right?
- Exactly, Bob.
Right, these actually can have similar symptoms
and different treatment
but they kind of criss-cross,
and if you find out some simple things right off the bat
you can get to the problem.
- Just the very location of it can be a pretty good clue.
- Right, we're gonna cover all this
over the next ten minutes.
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- There you go, Bob.
All right.
- Let's talk about the femoral nerve, huh, Brad?
- So once again, the femoral nerve,
you could think of it as the opposite of the sciatic nerve.
- Right.
- They both come from the low back, the lumbar spine.
The difference is the femoral nerve
comes from higher levels.
- Sure.
- From L-
- To L1?
- No, L2 to L4.
- L2 to L4.
- So we're talking in this level where the sciatic nerve
comes from L4 to S3,
so way down into the sacrum. And that-
- So it's higher up.
It's higher up on the low back.
- Right.
Now, here we have, this represents the femoral nerve.
So I've got it coming from a higher level.
And it goes in front of the pelvis into the hip flexors.
In other words, the muscles that make your hip
or your knee go up like this.
Now, if that muscle group gets tight,
it can actually pinch that nerve
and give you symptoms in the leg.
Also, you could have a disc up in that level
causing the pain.
- A disc bulge or a disc herniation.
- Right, right.
So you have to kind of determine which is which,
which we're gonna help you with.
Now, if you go into the sciatic nerve,
I'll pop it off of there,
it comes off the lower level.
It goes to the backside and then you have
the piriformis muscle being an issue.
- Yeah, so, in both cases,
you could have a pinched nerve.
- Yep.
- From the herniated disc or bulging disc,
or a muscle pinching on it. - Right.
- Somewhere along the line,
something's pinching on that nerve.
- Exactly.
So let's do the big picture thing first.
- Sure.
- Sam, you're gonna have to leave.
Sorry, you did a nice job, but we don't want you anymore.
And we don't want you to feel displaced or unwanted.
- Unwanted. - Right.
So the big picture is if symptoms.
Sciatica, typically numbness, tingling, burning, pain
down the back and maybe the right,
or the lateral, the outside of the leg,
and going down into the calf and into the foot.
It may wrap around to the front, depending on what level.
And this is where it's not always clear cut.
- Right.
- But the femoral nerve will typically be
in the front and to the thigh and into the shin.
Front and higher level
because it's higher on the lumbar spine.
So if the pain and the numbness and tingling is here,
much better chance it's a femoral nerve versus back here.
- Less frequent, too.
- Right.
- I honestly could count on my one hand
the number of patients I've had with a femoral nerve.
- Right, right.
- But it was very clear that they had
a femoral nerve problem when we saw 'em.
- There you go.
So, one of the ways you can actually,
you know, if you feel the symptoms in your thigh,
you will want to find out the severity of it.
And one simple way you can do it is
just with a chair, this is a little too high for me.
Let's say this is the side you're wondering about.
And your quads are tingling, numbness there.
Go out like this with your good leg, okay?
And see how easy that is to bring up versus the other leg.
If this leg feels weaker, then if it clearly is weaker,
it's hard to get it up, and that muscle's weak,
and it's numbness and tingling, it's that level,
it's a femoral nerve.
But if it's that weak or, let's say,
I'm gonna stand up.
Oh, we were gonna use that chair.
- Yeah.
- It's best to use chair with armrests,
which now we have in our new facility here.
(Bob laughs)
It's a beautiful chair, too, nice.
- All set?
- Yep, so, I'm gonna get up with my good leg.
If I can stand up like this and it's not too bad,
then I take the leg that you're concerned about
and it's like much more difficult.
Again, that side is weak, the quads are weak.
I would recommend- - Numbness and tingling.
- Right, yep.
- And you don't think you have a quad tear.
- Exactly.
- Then you're starting to think yeah,
the nerve is so involved,
that it's no longer able to enervate
and provide strength to the muscle.
- It's weak, numbness, tingling.
You know, you may want to consider seeing
a therapist or a doctor at that point.
Or you can continue to watch the video
and see what other options you could try.
- We never wanna discourage you from seeing a doctor.
- No.
- I mean, by all means. - Right, right.
- If you're at that point, it probably is good to do.
But we'll show you, after you've seen the doctor,
what to try then.
- Exactly.
So at this point, what we wanna do is determine
if we can, is it the hip flexor,
the femoral nerve from the hip flexor
or from the disc?
- The back itself. - Right.
So, what I'm going to do is, let me get-
- You know, one thing, Brad,
I wonder if you don't try some extensions first,
just see if it gets better.
- Some prone?
- Yeah.
- And isolate.
- Right.
- There you go, that's a good point.
This is one of those things
that we wanna make it as easy as possible.
- Yeah, we're trying to work through this
even as we're two discussing this,
but do you think that maybe?
If they try that and it gets better,
then why do they even need to do the rest of this stuff?
- That's a good point, Bob.
Let's keep it easy.
- So, some prone extensions?
- Right, go ahead.
- Okay.
So what we're gonna do is
we're actually gonna lay like this first.
And you can even lay on your elbows a little bit.
- Sure.
- And you wanna see is your symptom
down the front of the thigh feeling better?
Or is this making it worse?
And you can even try some micro press-ups like this.
- Yep, mini presses.
He's keeping his pelvis down tight.
- Right, I'm not lifting up like this.
- So, if this is making an improvement,
it's a good chance it's in the disc, not in the hip flexor.
- Right.
- Although you are stretching the hip flexor
a little bit with this.
- I'm stretching the hip flexor which makes,
you think it might make it a little bit worse,
you know, if the hip flexor's tight.
- Or it might loosen it when you come down.
- Right, right.
- So this is a good, I think you're right, Bob.
This is a good way to start.
Do some press-ups and see how it responds.
- Right.
- And if it starts to feel better, stick with that.
- Right.
- I mean, we're gonna go purely by symptoms.
What makes it better?
- Exactly, 'cause that-
- So.
- And that's all it should be.
- That's always safe.
- Now, the other thing you can do,
let's say that does not offer any relief.
- Right.
- Then we're gonna do a little nerve flossing.
- Sure.
- And go to that.
And what we're gonna do there
is lay prone, again, like Bob already was.
- Do you want the strap, Brad?
- Yes, I do.
Bob's gonna give me a strap.
You don't need to have a strap for this.
- Can I put it around your foot?
- You can use a belt or anything.
All right.
This is a little awkward until you get set up.
So I'm gonna be on my forearms here.
Let me get that.
And with flossing the nerve,
what we wanna do is bring the knee,
or bend the knee, bringing the foot up like this,
and at the same time, watch my head.
It goes down.
- Yeah, it's important that you do both at the same time.
- And up.
So, I'm visually thinking that my head,
the top of my head, like this is connected to my foot.
So as I go down like that,
it doesn't work out if I actually physically touch it,
but how I coordinate the two.
So when I flex my knee, it stretches that nerve.
And that nerve is connected to my spine
which goes up into my head, of course.
- So he's actually stretching here,
but he's relaxing it up here.
- Right.
- So at the same time, it's like you're flossing
on the two ends of the nerve.
And you wanna be very careful with this,
because flossing can make things worse.
If this starts making it worse,
I want you to stop.
- Right.
- But if you can do it like ten times the one day,
and afterwards, it still feels fine,
then you can continue this ten times a day.
But if it makes it worse, stop, try some of the other stuff.
And then maybe try it the next day again.
If it makes it worse again, you forget it.
It's just one of those things that can really help,
but it can really hurt, too,
if it's not appropriate or if you're not doing it right.
- Right.
And then we're gonna go into one more option, Bob.
- Sure.
- Let's say you did the press-ups,
you weren't sure if you were having any progress,
or you weren't.
And then you did the flossing and the next day,
you know, it seems like nothing's happening.
Well, you're doing it, or the next day, it's not improving.
You can do a nice stretch on that hip flexor muscle
to loosen it up.
And, actually-
- Got a little bonus here.
- A little bonus.
They're saying you can actually,
this also incorporates a little flossing,
so it's two at once.
Put your knee on a pillow.
I'm gonna go here, I'm gonna keep straight,
and I'm gonna stretch that hip muscle.
- Look how he's not bending forward,
he's keeping really good posture here.
He's standing up nice and straight.
- I'm not doing this.
Keeping up and flexing or extending the hip.
Then, you need to take the hand on the side of the hip
that you're stretching,
go up over your head like this,
and go behind your head.
And then you can put pressure on, pressure off.
- He's stretching like this,
I don't know if you can see that.
- I'm gonna go like this.
- There you go.
- So I'm here, and I'm going here.
- And again, it should not make your symptoms worse.
- Right. - Right, Brad?
- We're just looking for a stretch sensation here.
And, you know, from what I've read,
this, now I can't say this 100%,
but they're saying you get a little floss benefit
from this as well, which I can understand.
The big thing is does it make it feel better?
Does it feel good while you're doing it and afterwards?
If it does, you're gonna continue to do this stretch
on a regular basis, three to five times per day.
- Now, you could do it to the other side
just as a comparison, too, to feel it.
Get a sense of what it feels like.
- Yep.
- So if Brad does it to the non-involved side,
and that one feels really loose, no pain, no problems.
And he does it to the involved side,
and yeah, it feels really tight, really different.
Then, yeah, you might have a little bit of hip flexor issue.
- So you're gonna stretch the tight side.
- Yeah.
Either way, you know, we don't want to do anything
that makes your symptoms worse.
- Right.
- This is not a no pain, no gain,
this is no pain, get rid of the pain.
- Exactly, and have it improve.
So, very good, this is a rather.
- A difficult topic.
- It is.
- It's a difficult one to,
but you have it, it's definitely treatable.
You just gotta do the right things.
- Exactly.
And the other good news is
femoral nerve pain is not near as common as lower,
which we have a whole, the sciatica.
- Sciatica, yeah.
- Which we have a lot more videos on.
- Check those out.
- For your help.
All right, Bob.
- Brad and I can fix just about anything
- except for
- broken heart.
But we're back, and we're working on it,
we're working on that femoral nerve pain
and we're working on our broken heart at the same time.
We work on a lot of things.
- Yeah, but the distance, Bob, is a big difference.
And I'm not going there.
It's not gonna work.
- It's all the distance between the ears, too.
(Brad laughs)
So, thanks for watching.