♪ 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.
- Brad, today, we're gonna talk about
the absolute best treatment, in our opinion,
that one could do for thoracic pain
or thoracic disc problem, thoracic herniated disc problem.
- Right, yeah.
We've been getting a number of comments,
people asking for-
- Which we like, by the way, we like requests.
- Which, yeah, so we're gonna satisfy our viewers
and show 'em this video.
- Now, I think we can safely say, Brad,
that thoracic pain is not that rare.
I mean, we see a lot of that.
- Sure.
- But a thoracic disc problem is fairly rare,
you don't see a lot of 'em.
- Yeah, the majority of herniated discs
are gonna happen at the lumbar spine
or up in the neck.
- So lumbar is the lower back.
Thoracic is pretty much every level
where there's a rib attached, right?
- Sure, right.
And so there's 12 and, of course, the neck.
And if you look at the mechanics of it the reason why
there are not so many disc problems from here to here
is kind of self-explanatory once you think about it.
You look at the vertebrae here or the back here,
it is supporting the whole trunk, the arms, and the head.
- Yeah. - So there's a lot of stress,
particularly with bending or with seated posture.
And it's all focusing right down in here,
usually at the lower lumbar.
- And that's about where your body hinges too.
- Exactly.
- So I hinge here and that's where
you're gonna feel the pain then, is in there
- Because that's where all the stress is.
It's a physics thing.
There's a mechanical pressure and leverage.
Here to here you have the support of the rib cage
and a lot of connective tissue, a lot of muscles,
that really take this section of the spine and support it.
It's like a major back belt, you know?
You put a back belt on your muscles here
and talk about core strength.
Well, you don't need it here
because you have the ribs doing all this for you.
So that's why there's not so many herniated discs
in the thoracic spine, but it does happen.
- And the ones where I've see it, Brad,
or the ones where I see with thoracic pain
are a lot of times when they have the habit of
like, when they're bending something
like, they bend more from the midback.
- Yeah.
- And you can see that's where it hinges
is right here in the midback instead of down here.
- Right.
- So they're like working,
they do a job where they're working at a table
and they're like this all day long
and it's right, you can see
where the stress point is gonna be.
- I think a good example if you're working
where you have a bend where you have to reach over
and down to get some product out of, on a repetitive basis.
- And that's funny, 'cause that's exactly
one of the people I treated.
They had to reach into a bin
and I could tell right away
that's why it ended up being thoracic.
- Exactly.
But we're so we're gonna talk about how to address pain-
Oh, bring him one more time, Bob.
- Sure, come on back.
- Come on back.
Now, one thing I did wanna mention
is something that therapists refer to
as radicular pain or where the pain can refer to.
- Sure. - Okay.
- Good point.
- In the back, the nerves in the back
actually the, you know, from the spinal cord,
the nerves come out and exit and they go around,
actually they pretty much follow the ribs
to the front of the body.
So if there's pain here,
it's not uncommon for someone to say,
boy, it's wrapping all the way around here.
And sometimes there might be numbness
or tingling up around the ribcage and up into the front.
And when we hear those symptoms-
- Yeah, then we're thinking thoracic.
- Yeah, we're thinking thoracic, we're thinking
a pinched nerve somewhere in this area.
- Not Jurassic
- Not Jurassic Park, no.
- Sometimes trouble breathing too.
When they breathe, they feel it
because you know the ribs are all attached to those nerves
And so on.
- Well, the other thing we did, should talk about is
what other things can cause pain in this area
that are not related to the disc, you know,
so you're not getting all concerned about it.
Number one, the muscles can be getting spasmed
and tightening from poor posture.
- Right. - Okay.
And once these muscles, won't you turn around Bob,
you know these muscles between here,
they got the rhomboids and when they can tighten up
and up in the upper traps, they can tighten up
and the pain can spread up and down.
And a lot of that I think is due to posture.
Wouldn't you say, Bob?
- Right.
And so these exercises will help that too.
- Exactly.
- These are good,
no matter which issue you're dealing with.
- Exactly.
The other thing is facet joints,
that could cause a problem.
- Oh, sure.
- And we're not gonna get into the detail of that
but there's two facet joints at each vertebra level.
So you got 12 vertebra, you got 24 facet joints.
- A lot of joints that can give you trouble.
- Exactly.
All right.
- Of all the gin joints in all the, okay.
All right, should we start with the first exercise, Brad?
- Yeah.
So oftentimes we're thinking, you know,
we have on the title, we have a McKenzie reference.
- Right.
- And so we're gonna go right to that.
Why don't you move Bob, please?
- You gonna start?
- Yeah, why not?
First thing I would try
if you're having pain in thoracic spine is just laying down.
And if this feels better than standing up,
that's a good sign.
You might lay there for a minute or two
and then you're just gonna do a simple press up like this.
And if the first time you press up,
whoa, it kind of hurts you-
- So he's keeping his pelvis down.
- Yep.
And if you do these,
the first time maybe it hurts a little bit more
and then you go down, it feels better.
Well, then test it again.
And if you find that with repetition
it starts to feel better,
then you're gonna keep working it.
You're gonna go a little higher if you can,
And just listen to your body.
And I wouldn't do more than 15 of 'em, for sure,
usually it's 10 and give it a rest.
- The other thing you're looking for,
like Brad said, is if it's spreading out more,
if it's spreading around that rib cage
when you're doing these, stop.
- Exactly.
- You're looking for it to narrow up
and even concentrate more.
- Exactly.
- So if it's starting to spread out,
that's not what you're looking for.
We're looking for the opposite,
we're looking for it to centralize.
- Right, and that again, relates to the
directly to the McKenzie system.
- Right. - Okay.
Now the other thing you can do,
let's get a chair out, Bob.
- Do you need the ball right away?
- Not right away, but we will. - Okay.
- Get a chair that does not go too high.
If it goes to your neck level
then you definitely need to use the ball.
But typically a chair that goes
right around the bottom of your shoulder blades, scapulas.
Okay, and you're just gonna arch and extend over that.
You can put your hands like this
and you're gonna work it,
or you can go up like this,
and the same thing you're gonna look for
if the pain comes to the center and decreases.
And all that happening you can maybe get
a little more range of motion with repetition.
So if I do it once like this
and it kind of hurts a little bit.
And I was like, well, it wasn't real bad,
but then you do it again and again
and it starts hurt more towards the center of the back
and feels a little bit better by the fourth and fifth one,
then go up to 10.
By the 10th one if it feels better,
pain is more towards the center of the back,
then you're gonna use that exercise every hour
as long as you get the same response.
- Most patients I see, Brad,
if it's working, you can tell
just by the look on their face,
like, oh, this is, it's a little better.
- Right. - You know what I mean?
They can sense that it's the right thing to do.
- Exactly.
- [Bob] It's not getting worse
or it's, ah, it doesn't feel right, you know?
- Right, yep, just listen to your body.
- Right. - Now.
- [Bob] This is a neat trick.
- Yeah, this is a nice little thing.
It's the same concept of what we did.
But you can kind of take the force
and go to a certain spot on your back a little easier,
and it's comfortable too.
Get a ball that's a little soft,
not one that's got a lot of air-
- [Bob] A couple bucks at Wally Mart
or something like that, right?
- Right, and sometimes you get those really cheap ones
and there're too hard,
so you gotta get 'em a little bit softer,
throw 'em in your freezer or something of that nature,
but these kick balls are really nice.
Can you help? I usually have to hold that there.
Gonna go right there.
And then you're gonna kind of experiment start out-
- [Bob] Yeah, you can move it up and down different spots.
- Exactly.
A lot of times you'll find one spot where it feels better,
you can get more stretch with less pain
and that's the spot where you're gonna go
and you're gonna hit and stretch back.
- [Bob] This is a great idea, by the way.
This is just really a nice little technique
to help get you that extension in a comfortable manner.
- I wish I could say I thought of it,
but I didn't, one of our PTAs, Mike, did.
We have to give him the credit.
And actually what he was doing with it
with one of his patients was,
Bob, can you grab my shoulders?
- [Bob] Sure.
- And just pull back, just gimme a stretch back.
And with this particular patient, she just felt much better.
It was a really comfortable stretch.
She was very happy to have someone do this
to help her back pain out.
- [Bob] Yeah, I gotta, this is a little bit of genius here.
I'm impressed.
- Yeah, well give Mike kudos when you see him next time.
All right, now we better go on to the next one, rotation.
Now this is a tricky one.
This is something that takes a little practice sometimes.
Or you may be liking to start right away.
Sit down, not in a bed, but a firm surface
so that you're scooted back a little bit
and your pelvis is down to the table.
- Brad, would you say you're doing this if this didn't work?
- Right, use those first.
- Yeah, if these take away your pain
you don't need to do this one, right.
- Right, exactly, good point.
- Okay. But if it, if you're still kind of stuck
or it's it is not going any further,
then let's go to this one.
- Good point, Bob.
This is why we gotta work together
because only one half of my brain is working,
he picks up the other half.
- I got the other half, yeah.
- Okay, so those don't work
you're gonna do this rotational technique.
And first you're gonna go rotate to the right.
You're gonna rotate to the left.
- Really important that you have
excellent posture with this.
You wanna sit up as straight as possible,
maybe even exaggerate a little bit.
- The pain might limit you, that you're working with,
but do what you can.
Now, if you go to the right it goes not too bad
and you go to the left and it locks up, wow.
Then what you're gonna do is work to the right.
Do 10 rotations to the right
as far as you can comfortably,
and then go back to the left.
Now, if after doing 10 to the right,
going to the left feels better
then you're gonna work more to the right.
- Yeah, you want move
in the direction that it allows you to,
you don't want pain.
Sometimes I put my hands here too, Brad, by way.
- Yep, that's a good way to do it too.
- Yeah, 'cause then you really know what you're doing here.
You're not just kind of
it just gives you a pure rotation.
- Yeah, that's a good point.
It locks up the upper, the upper trunk.
- So again, so I feel good this way,
I'm gonna work this way.
If it feels good this way, I'm gonna work this way.
I'm not gonna push into an area that hurts.
- You know, this is where it can get tricky, Bob.
I think sometimes if you go into the direction it hurts
and you go two or three times and it starts to feel better-
- Right.
- And the pain starts to go towards the center back, then-
- Then you can go in that direction.
- Then you can go that direction.
So this gets a little tricky-
- Little experiment.
- This is where a therapist that has some experience
really helps you out, but we're gonna, you know
show you how, the way we think.
- Okay, so you do the rotation
and hopefully that's gonna help solidify things
and get things feeling better
and you'll be in good shape.
- All right.
And this really works into
that problem that we've been working on again, Bob,
that broken heart.
- That's right.
- I'm thinking maybe this could kind of translate into that.
- Yeah, we fix this, we fix the heart.
- Right, it's all in the trunk, right in the core, almost.
- Genius.
All right, thanks for watching.