Hi folks, I'm Bob Schrupp physical therapist, Bob Heineck physical therapist,
together we are the most famous physical therapists on the internet, in our opinion of course Bob, and today Brad we're gonna talk about how to
stop low back pain at home using a shotgun approach. So we're gonna take an actual shotgun and shoot your back and it's going to feel a lot better?
I'm afraid not Bob, but when I first started in therapy 20 years ago
I had a therapist who was my mentor
And this is what he termed, he said sometimes you just gotta throw everything at it and get to the point
right away even if you're not sure
which exercise is gonna do it or which treatment, but you know it's not gonna hurt
So just get after it. I do this a lot Brad,
I have a patient we try some things and we see what works
The ones generally do work
But they don't always and sometimes you have to throw some different
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Yeah, I don't know
Brad let's start off with number one
Let's say this is back pain
It's come on and it's severe and you got to continue on with your life obviously and you really want to get things
going as soon as possible so
there's two scenarios that we're gonna touch on, if you've got central back pain or back pain here
Or if you have back pain where it's localized
Or if you have back pain, with the pain going down the leg, the sciatica symptoms
And we're gonna address both of those
So two different scenarios, just back pain here or back pain, but the treatments are pretty similar
They're going to cross over quite a bit. The first thing you need to do is if it's severe and you got one of those
situations where you're walking like this, and it just hurts to sit hurts to move, you think everything hurts
you need to find a comfortable position and then use a cold pack on it and
So that's what we're gonna go over first, and actually at the same time you're gonna
do that, as long as you tolerate ibuprofen or some kind of anti-inflammatory
Across the counter medication you want to start that as well
And the ibuprofen they recommend, we talked to a pharmacist about this
He said do a three-day blast, yeah and I talked to my regular doctor
Yeah, and his
prescription, which I talked to pharmacist and they both agree, so we got a lot of feedback on this
They're saying three times a day,
Times three days right and it's like 600 milligrams, depends on your body weight
If you're not sure, look it up
But typically like I'm 180 pounds, I can take three up to four
200 milligram Ibuprofen
That's the max, but if you're a lighter person you're gonna take less, if you're a 100 pounds it's two possibly three
you may need to check on that, so I can maybe take five, Oh Bob yes
Take the prescribed three times per day, you're gonna get on that right away
You're gonna find a comfortable position which oftentimes we find
laying down, the leg wedge works with a lot of people, but you could just use pillows as well
I'd put pillows under your back. I've had people lay on a carpeted floor and put their feet up on soft furniture.
90 90 position
Lay and put their foot up on the couch. You could lay on the floor and put your foot up on the couch
right yep perfect
Cold pack is one of your best friends when you're really inflamed
You don't want to put a hot pack on it, to start right, initially. So if you're just starting up, it's just acute
What we call acute meaning it just happened, you want to start with a cold pack
But eventually you definitely could try the heating pad. Typically after two or three days
depending on how it's feeling
if it's still really tender and sore to the touch you may want to stay with the cold pack
I just got one of these for my wife, but not for her back
I got it for her knee
because it was a good position for her knee to be in, and she thinks I'm a genius
I said it wasn't me, but her knee pain has gone away. Now she did some other things which
we're gonna go over in another video today. Okay, so we're talking about backs.
Let's get "back" on track. Okay, so you're gonna lay down with a cold pack 20 minutes. You can go longer
I actually use this when I have a flare up and I'll fall asleep with it in bed, and then as
I wake up, I'll just put it on the floor
Because it's settled down by then, so those are two things to start out right away with:the ibuprofen
comfortable position, cold pack you can use a cold pack in this position three four times a day
Now the idea with the ibuprofen is to do it three days and then stop
I mean, not keep going with the ibuprofen. It's done what it's gonna do. Plus you're gonna save your stomach and your liver
It's being safe with it. Okay next thing once you can start to walk without
irritating it or walk as far as comfortabl I want you to start walking
Walking is a big part of trying to get your back to recover
and I just read a book on it and they said exactly the same thing and i'm gonna say walk on the flat if
you're gonna walk outside. Don't walk up hills or on uneven ground, on a nice flat surface
If you live in town you can walk around the block so when you've had
enough you can easily get to your place. If you're on a treadmill by the way a lot have a natural incline
Sometimes you want to go to the back of the treadmill and put the screws up so that you raise it up a little
I just had a
neighbor that was having trouble with sciatica and
she was having trouble on the treadmill. We just raised up the back and it felt better then. Perfect so good input
Okay, so again
Cold pack, position, ibuprofen, start walking. If you find yourself having one of these shifts
We call it a lateral shift where you're crooked and you can feel it or someone else
you can see it when someone walks in the clinic. As a therapist
you know one of the first things you're gonna work on
You've got to correct that shift. If you don't correct that shift your back pain's not gonna get better
So you've got to get back to normal again, and Brad's going to show an exercise to do that. So if you shift
like you can see I'm shifted to my left, I'm gonna take my left shoulder.
My feet are gonna be about a foot from the wall right here and
close together
I'm going to take this elbow and bring it up here and elevate the shoulder slightly. I always put a towel here too.
That's a good idea. Yeah, like that. There you go
And then this gap right here
He's got a gap right here, and he's gonna be pushing his hips this way
And this is gonna straighten them out. Now you're gonna
do this gently, you're not gonna force it in right away
you're gonna kind of bump into it and it might take ten or fifteen times,
Particularly if you're having the leg pain with this, if you do this and the leg pain starts getting better
That's golden. If you do this and it starts getting worse
It might be too early for it, but you got to give it a few repetitions and give it a chance
It's one you're gonna do throughout the day, Brad, and you can do this every hour
Yeah
but you got to get it straight or your back won't get better, it can go on and on
Typically about ten repetitions is all you need to do at once, you don't want it to keep doing it 30 40 times
That's too much, and then the next one's laying down Brad
And this one can kind of cross over, sure this one almost everybody can do. Right away
depending on how you're feeling when you can start laying in bed with your knees up
We call this hook line position knees together feet together
And we just start going gently back and forth, I call these windshield wipers to my patients
yeah, cuz the knees are going back and forth and
Sometimes it'll happen and Bob and I talk about this a lot is maybe to the right
It feels pretty good, but to the left you bump into it
and it hurts. Don't push into that pain, you're just going to go up to it
And then you're gonna go to the right you might go to the right five or ten times in a row and then go back
To the painful way and oftentimes you'll feel you can go a little bit farther, it's subsided. So all these things we're working
pain free range of motion or close to it
You can start with really small arcs if you want to. Exactly so again we're trying to get motion back into the back without
irritating the back. I'll do the next one Brad?
So now if you're starting to get pain all the way down the leg, then you're gonna want to make sure you
try the McKenzie Method basically and you're gonna wanna try some extensions, now we're just going to show the basic pattern today
Let's see them back up because if we are in that initial flare-up we may need pillows
You may not be able to tolerate laying flat, you're gonna do this not on a table
but on a carpeted floor is the best, and you might need more than one pillow even
But we'll start off with just one
You're just gonna start by laying down and see how your back feels with that, if it feels fine
Or if it doesn't feel fine
maybe try a couple more pillows. The idea is it builds up the waistline, and then the back is more comfortable there
It's like this and any gradually you're gonna
take the pillows away and get into this position and then gradually you're gonna get into this position, prone prop here
The final move then is to try to go ahead and do some press ups, so you put your hands underneath your shoulders
And you can just start pressing up like this. Now I'm not lifting up my pelvis
I'm keeping that down on the bed
And I'm trying to put an arch in the back
right
So right here stays glued down, right at the belt line
Now it may take a few days before you can start to do press ups
But we're still working towards that direction, with the pillows, and then without the pillow, on elbows.
We should say too Brad, you can do these with regular back pain too, just pain in the back
By all means try these. These are good for most back situations except for what Grad has
spondylolisthesis
Spinal stenosis would not be good for those so
Eventually you want to get way up into here, and we've got other variations on that too
We don't want to go into that now. We don't have time. That's more once it starts to feel better typically
but
Okay
And then go ahead number seven right I would say Bob
Would you probably agree this, anytime someone comes in with back pain, we're addressing posture? Yeah immediately. Particularly seated posture,
often times if sitting is
uncomfortable, you want to minimize your sit time as much as possible. We understand if you got to drive to work
you got to sit in your car. So at that point
we look at lumbar support actually the support where the pain is, you know starts here
and if it's going down the leg we want some lumbar support, and we actually have a
sample of lumbar supports if you look here, we got one two three four
Those two are the same five six
Six different lumbar supports and there are many more
And you can see the differences, the size of them and that depends on the person's body shape
The type of chair you're sitting in, whether it's soft firm, car seat, or if it's in a office chair, recliner,
So what we do want. Let's just grab one of those out Bob that you like like
I like this one
and we've got some of them down in our Amazon link down below, but
we should get more because these are good quality yeah, they're very good quality
And this has a strap on so it can go around the chair
office chair or in the car
Yep in the car as well is pretty stretchy, you put it down right in the low back
I like it a little bit lower on that sacrum there
And it keeps you in that arch while you're working or while you're driving
And you know you've got the right size because it's gonna feel good right away. It's gonna fit. That is very
comfortable. Right it
shouldn't feel awkward or bad and what we always suggest is how do you know which size you should order?
Take a towel
Take a towel and just roll it up
You can put some rubber bands around it, now this would be a pretty thin one
And if I use this one and I put it here in a car seat like Bob has, or a chair
And I find out that this particular size works
Well, you can see that's gonna be about where you want to be and
It's got a size on there, and I believe this is
medium or small without my glasses, I can't read it
They have different densities too, is what you're saying right? Right
Yup some say they're firm, some say they're soft, and you'll get a feel for that
They have an inflatable one that we haven't tried yet
I'm kind of curious to try this one. You could put a little bit of different amounts of air in there and
depending on the day
vary the amount of arch you have in your back
Yeah
Now, we're spending some time on this part because this is important, particularly if you have back pain when you're driving, you need to adjust
your back so that you don't irritate your back and leg pain as a result of driving to work. Sounds good, Brad
I think we're running a little bit long
Time just flies when you're having fun. Alright, thanks for watching