♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(upbeat notes)
- 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.
- Today we're gonna talk about a piriformis test
and simple treatment that works.
Everything you need to know basically.
- Right, we're gonna put it into a nutshell.
We're gonna wrap this video up quick today Bob.
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- No. (laughs)
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- [Brad] Well, yeah.
- [Bob] Or you go to Facebook, it's always pinned
at the top of the page, Bob and Brad.
- Cause there's one day a week there's a lull, right?
- Yeah, there's a...
- Six days a week, it's a promotion
- [Brad] That's not my job so I don't keep track of it.
- Are you coming back, by the way, Brad?
- [Brad] I hope so.
- Alright, let's go.
- So piriformis test.
First of all we're gonna spend a brief time
showing where the location, anatomy, very important.
We're gonna have Sam, our roll-around skeleton
be our assistant today.
We'll let Liz give her time to adjust.
And if you look at the backside of a person
at your buttocks areas right about in here
that piriformis goes from greater trochanter
and by the sacrum.
- [Bob] What are the symptoms, Brad, of piriformis syndrome?
Should probably go over that first.
- Sciatica, it can be confused often times
with a herniated disk or bulging disk
with that pain that runs down the leg,
numbness, tingling, all the way down into the foot.
And it's because it can be up here from the back
like I mentioned, or if the piriformis muscle,
which is represented
- [Bob] The pink muscle right here.
- The pink muscle is connected to the sacrum
on the anterior aspect of the sacrum,
goes over and to the greater trochanter,
and when it contracts it externally rotates the femur.
We don't wanna get into that,
but you can see the yellow band here
represents your sciatic nerve, and if this muscle is tight
it can compress the nerve, cause problems,
and there you go you have your sciatic pain down the leg.
- [Bob] And it actually can go through the muscle too.
- Oh, right.
- It can contract on it,
but people who sit a lot can get tightened up
and they'll spasm the muscle.
Generally with sciatica, I mean if it's from
a disc in the back quite often
you're gonna feel back pain along with it too.
- Sure.
- The ones I've seen generally is that you feel the leg pain
but you're really not feeling the back pain.
- Right, it's pretty isolated.
It's there, only there.
- Right.
- But we're gonna show a test too.
- Right.
So here we go, you can see that when the leg moves
how the muscle moves and can get stretched
and we'll talk about that when we show you the test.
- [Bob] Sure.
- [Brad] Alright, so I think Sam did a good job,
A plus today.
- So to summarize basically you're getting
sciatica-type pain, you're wondering is it from your back
or is it from a piriformis.
You're gonna show a test on how to do it.
- There you go.
So Bob if you go to a doctor, and maybe a doctor's
jumping right into conclusions, so you got a piriformis
we can give you a botox injection,
they even do surgery on this.
Obviously these things that we're gonna show
easy to do and do them first
because we've had a lot of success.
- With piriformis, absolutely.
- Okay, so that piriformis muscle again,
here's my sacrum right there, that bony part right there,
so it's right in between here.
Now if you push it's normally I find a hot spot
or the tender spot closer to the sacrum
and it's in the meaty muscle, you're not gonna find it
over the bony part of the sacrum
or over the bony part of the
- [Bob] Hip.
- Trochanter.
- [Bob] Trochanter.
- It's gonna be there.
If it happens to be over the bony part
you probably have bursitis, but anyways
you could have both possibly.
So if you palpate in there you feel a real tender spot,
and then you go to the other side and you don't feel it
that's a good way to test, that's one of the tests.
The other one is the FAIR test.
Capitals F A I R, okay.
So that means you flex the hip, adduct it,
go across your body, and then internally rotate
which I take my foot and go out this way.
So I'm gonna go like this.
And if I pull that that stretches that muscle
and if it reproduces or increases the symptoms down your leg
that's positive, or if you feel a real tight here
and it's a little painful.
And on this one too, compare it to the other side
and do the other leg.
And typically with patients, this is oh it's tight here,
they may reproduce the symptoms
and this side they go oh nothing.
- Yeah, and more often then not Brad,
my experience is it reproduces the pain
or tenderness but I really haven't seen
the symptoms go down the leg so much.
I don't know maybe you have.
- Well I haven't either, but if it did
it would be a positive is all.
- Right, absolutely, that would be a real positive sign
that that's possibly piriformis syndrome.
- Exactly, so if you do the test and it's positive
you can do the stretches.
If you do the test but you're not sure
you can still do the stretches
no harm done. - Yeah it's not gonna
hurt anything, right.
- Yup that's the beauty of this.
Let me show the stretch first.
Well I was just stretching my back.
Yeah, we're gonna get on with the stretches.
Okay, so the FAIR just like we talked about,
and this is a treatment, you just do the FAIR test.
Now what I tell patients is think about
bringing your right knee to your left shoulder
and over this way like that
and you'll feel that stretch, and again
you can go pressure on pressure off like that,
relax, breathe, let it stretch.
Do that ten times or you can sustain it and hold it
15 to 30 seconds, and again really think about relaxing
and let that muscle stretch out.
Usually these will clear up pretty quick.
It's usually not like it's gonna
take two weeks of stretching.
Would you have that same experience?
- Well I generally, to get the response I normally want
I have to add the massage in too.
- Okay, yup.
- I mean the stretches generally don't do it.
By the time they come to see me
it's pretty bad usually and its been
going on for a while. - It's pretty tight.
- And usually the massage is required
and it usually takes a couple weeks of massage quite often.
- Sure, you know that sounds like a good deal.
- Yeah, right.
- But you also can do the figure four test like this.
Or not the test, the stretch.
Go like this and you grab the other knee
and you can pull up like this
and that'll get after that muscle too.
- Another way of stretching it.
- Right, exactly.
So you've got those two option that are both done
in supine on your back.
- Now if you're gonna use a foam roller Brad,
you probably won't even maybe necessarily
go right over the muscle to start off with.
- Yeah you're gonna have to take your time with it.
- Yeah 'cause you're maybe gonna work around it first.
- Right.
Can you get me on the floor with that Liz?
Because if you foam roll you're not gonna do it on your bed.
- That's right.
- You need to do it on a floor
and a carpeted floor works the best.
If you do it on a slippery floor the rollers
have a tendency to slip around
and it's kinda awkward, irritating.
- [Bob] I mean the nerve is already irritated
so you wanna be careful with this.
- Right.
I'm gonna support here with arms and here with my heels.
I'm gonna bridge up, I'm gonna work on that muscle
and kinda picture where that muscle is on Sam again
and if you get on this really tender spot,
you're gonna work not right over it, but around it,
and kinda work your way until you get some kind of
rocking back and forth on one side of it
and then maybe get to the other side of it.
- [Bob] Yeah, you can work your way in.
You can use a tennis ball too,
I'll throw one down Brad. - Probably a tennis ball
is even more aggressive than this
so that may be when it's getting better.
- [Bob] Right.
And again, the only thing I like about the tennis ball,
Brad, is you can stay off the muscle pretty easily
and work around it.
- Yup.
- [Bob] And you can get into areas.
- And you really need to control your weight.
You need to have good arm strength
and leg strength just so you can control it there.
- Well I've had a couple family members
that have had this and I'm not living right by them
so I just sent them a massager.
- Sure.
- We've been liking this massger, the Remfom massager
self massager because it cordless massages
is what I was trying to say.
I like it because it's less expensive.
- [Brad] What was it, like $40?
- Yeah it was somewhere in that range.
It was about half as much as the other one we like.
- [Brad] It doesn't have quite as much power.
- It doesn't have as much power,
it doesn't have as much percussion,
but for this it's definitely enough to do the job.
- [Brad] Sure.
- But I mean you can go ahead and get down
and it's easy to work yourself and massage yourself,
whereas normally it'd be very difficult
if you were using your hands.
- Right. Yeah a little massage on your piriformis.
You get tired, it's a little awkward on your shoulder.
- So you can work around it real easy and
- I don't think they can see that Bob.
- I know, I didn't think they wanted to see it.
(laughter)
- You're right, nobody wants to see that.
But you know,
- But to be honest this alone took it away
from actually one of my sisters who had it.
- And if you flex the hip you might
get in there a little bit better, depends on.
Black on black.
- Black on black, that works.
- You're not gonna see anything there.
And I'm not gonna take anything off, it's a family show.
- [Bob] Thank God for that anyway.
- But yeah you really need a massager that percusses,
that goes in and out versus just vibrating back and forth,
that's just superficial, this is gonna get into the muscle.
- And it comes with different attachments,
it's got different modes.
- Right.
- All right, Brad and I can fix just about anything
- Except for
- A broken heart.
- There you go.
- But,
- This has got nothing to do with a broken heart.
We're not gonna be able to relate this stretch
or this treatment - I guess not.
I guess you're right. - So anyways.
- We've given up.
- Carry on.
- Thanks.
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