♪ Bob and Brad ♪
♪ the two most famous physical therapists on the internet. ♪
- Hi, 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, this is one we've gotten a few requests for.
- Right.
- And it's Ischial Bursitis.
They also sometimes talk about a, what do they call,
a high hamstring injury,
or high hamstring tendinopathy and we're gonna discuss this,
what these things are.
- Yeah we've got a lot of big words going around here.
We better clarify it for everyone.
- And basically what it is, when you're getting pain
on what they call the sitz bones.
Do you wanna show the sitz bones on this Brad?
- They call 'em the sitz bones because
you sit on them. - Right. Exactly.
- It's as simple as that.
When you sit down on a hard surface,
you can feel that bone.
- Yeah. Those bones underneath there.
- Yeah especially if it's a concrete surface.
- Right, or a bleachers.
- Sure. And if you look at the pelvis,
it's your ischial tuberosity as they call 'em right here.
- You wanna take it one up there Brad?
- Sure. Here. Oh, too close. How's that?
- Don't get too close, you'll break the camera.
- Now there's like protuberance as they call 'em
and actually there is, your hamstrings connect
up to the sitz bones.
- Yeah. We're gonna show that right on here.
- Yeah. And we'll see how this all connects together.
- So the reason why these are often mistaken
for each other, they both originate in the same spot,
on those sitz spots. - Sure.
- So the bursa is a fluid filled sac that actually is
underneath the hamstring tendon.
- Right, so it lubricates the tendon so it doesn't wear out.
- Exactly. So that is indicated by the blue here.
That's the fluid filled sac bursa.
Well, the hamstring, you know, the hamstrings
are also attached to this area
and some go to the one side and some go to the other side.
- Right. - But you can see they run right along in here
and they help bend the knee like this.
- Right. It's one of those muscles that's
kind of complicated because it crosses two joints,
it crosses the knee and the hip.
And so it's hard to say exactly what it does
because it's a complicated, uh.
- Right, it extends the leg too.
- The biomechanics of it is
something you can study for a long time.
- So, by the way Brad, before we go any further,
if you haven't already,
I know many of you are new to our channel.
Please take just a second to subscribe to us.
We got the little button down here on the screen.
We upload a video every day
and they are all on things like this.
How to help you stay healthy and fit and pain free.
- Exactly. Carry on.
- All right. The big thing,
first you're gonna wanna do Brad,
I think in my mind is determine
which one do you have. - Right.
- Is it a hamstring problem or is it a bursitis problem?
- Sure.
- So let's first go by your history.
If you're an athletic person and, you know,
you were doing some squats,
or you were doing some hill workout,
some speed workout,
- Right.
- I'm gonna bet my money more now
it's on a hamstring injury.
- Right.
- Because the guy that just contacted us,
he thought it was ischial bursitis
but he goes, I was squatting.
- Okay. - And I did this.
I think, I'ma right away say
I think it's a high hamstring tendinopathy,
if you sit a lot and you don't do anything athletic,
well then I'm gonna say it's more likely the bursitis.
- Right. Right.
- Especially, you know, you're an accountant
or something like that.
- And you still you're sitting on it.
You don't, you don't get up and move very much.
So the circulation is depleted, it's compromised.
It's more at risk for this kind of injury.
- Couple things you can do, Brad,
a couple tests you can do.
If it's a, if it's tends to be a hamstring,
if you do something like this, put your foot up on a chair
like this and lean forward, and that makes it worse.
I'm leaning more towards a hamstring tendinopathy then.
- Sure.
- You can also lay down like this Brad,
and you can even have somebody lift it up for you.
And if that makes it worse,
again, you're stretching the hamstring.
Now, while that person's in that position too
you can also push down.
- Resistance, yep.
- And if it hurts, when it,
when he's providing the resistance,
again, more likely to be hamstring. So.
- These can be tricky to rule out one way or another.
So that's why we're saying - It can be.
- More likely, we're not gonna say for sure.
- It is very difficult. It fools many people.
- Right.
- Many professionals, so,
Alright. Let's say we decided that it, you know,
we think it's the bursitis. - Sure.
- The first thing you're gonna try with that
is you're gonna want put some ice on it.
I mean, you're gonna want ice it down.
- You just, you can simply, you know, sit on a cold pack
that's a soft, pliable cold pack.
- Or you can lay down on your back
and put a cold pack on there too, that way.
- And it should feel good.
It should give you some relief.
- You're trying to get some of the stresses off that bursa.
So to let it calm down.
So the other thing you can do is you take,
when you're sitting,
and a lot of you are having pain with sitting,
is to take a pillow and fold it like this.
And you're gonna just put the pillow
under more, under the meaty part of your thighs like this.
- Right.
- So now the sitz bones are kind of hanging out there.
There's really not any stress on 'em.
And I can sit like this, you know,
a little bit of a balancing act. - Sure.
- But it's taken the stress off of it.
I've had one person that contacted me, Brad, that,
he was all worried about being on a plane.
And he goes, it worked beautifully.
He just took a couple pillows
from the plane and put 'em forward and he was able to sit.
- It's just a matter of where you change the pressure point.
- The other thing you may try,
I mean you may need to get an injection.
- Sure.
- That's just one of those things that,
- If you tried all these things and it's still bad,
you can hardly work.
I mean, you gotta get back to function.
You gotta get to work.
- One thing you wanna make sure you're not doing on this,
Brad, is I wouldn't do the foam roller.
I mean, if you take a foam roller and you roll
right over that bursa, you're just gonna irritate it.
- Yeah. So, and it's gonna hurt,
- Right.
- It's gonna give you some pretty nasty pain.
So listen to your body on that.
- That might be okay for, if it's a hamstring problem.
But it's not gonna help with a bursa.
- And that's where you have to be careful.
- So, all right. Let's say we believe now
that it's a hamstring injury, it's a high,
what they call tendinopathy.
Tendinopathy means it could be tendinitis or tendinosis.
I know those are big words.
Tendonitis means it's inflamed. - Right.
- It's fired up.
And in that case, you could also ice on that in that case.
- Yep.
- And it's certainly won't hurt to ice it, in most cases.
- Right, you're not gonna do any damage with a cold pack.
- Now if it's been there for a long time
and it's more chronic Brad, it's probably not a tendinitis.
It's not that anymore. Now it's a tendinosis,
which means it's a chronic thing that,
it's become deteriorated.
There's some tears in there, it's not,
it doesn't have the strength it had before,
so we're gonna want to do some strengthening and
and some cross fibre to it.
- Right. Cross fibre massage.
- Yeah. So with cross fibre massage, what we're doing is,
this is very difficult to do on this particular area
by the way, but you're gonna take your fingers
and you're gonna rub the bone,
right below the bone here,
and you're gonna go cross like this really deep.
And you're trying to break up the scar tissue.
And you're trying to get a little more blood flow
to the area.
- Right. Right. So again,
this is why it's so difficult to determine
whether it can be the bursitis or
the tendinitis or tendinopathy because, it's right next,
the tendon part is right connecting to the bone,
I mean, they're, you know, a millimeter apart,
- But that's a good point though, Brad,
is that if you do the cross fibre and starts getting worse,
it might be bursitis.
- Right. Yeah.
- I mean, cause cross fibre will feel good on a hamstring
after a few, maybe 30 to 40 seconds
it should start to calm down,
but on anything else, on a bursitis, it's gonna hurt.
The one way to do this cross fibre really, is really to use,
like we often recommend using the pure wave massager.
I'll put up a video on the link to this here.
The reason is, nobody can do this for any length of time.
It's just so fatiguing.
- On your fingers.
- If you're laying down, you're putting your foot up
like this, and you're going like this.
I mean, you can try it.
- For sure.
- But I mean, they're recommending like 15 minutes, Brad.
- Right. Siri X, you know, says that.
Usually two to three, four minutes
and your fingers are tired and it could benefit
from more of that cross fiction massage.
- Yeah. And if you don't wanna put
out money for a pure wave, you know, start this,
just do a couple minutes. - Yeah.
- And then do some of the strengthening and we'll,
but the pure wave, you know, you can just relax
and watch TV and you can get in there deep.
And it really works out well.
- It is a nice device that it reciprocates
versus vibrating, you know, horizontally.
- It has percussion, like this.
So it really, it's a well built machine
and we really are big fans of it, so.
All right. The thing that we have found, Brad,
the studies have shown that has really helped on this type
of condition though, is eccentric strengthening.
- Eccentric. So in other words, the muscle is getting longer
with resistance, which sounds kind of complicated.
- Well, let's do, I'll show one easy one to do, Brad,
is just to do bridging.
So when I bridge up like this,
now the hamstring is lengthening,
but it's also strengthening. - Sure.
- So you can just start off doing some sets like this.
I don't want you to increase the pain.
It's okay if you bump up against the pain,
you know, we just slightly feel it,
but I don't want you doing these and going ow ow ow.
It just, it flares it up.
And I know this again from treating it with my wife,
and she was able to do these. - Sure.
- And you can also make 'em harder
by putting the feet out further.
- Oh yeah.
- And you can also go one foot, you know, once you start,
- Yeah, that's quite a bit more aggressive.
- Yeah, that's a lot more aggressive,
but these are the things you can start,
without using what the next thing is.
We're gonna use the ball.
- Sure.
- Okay.
- Get the red ball, not the blue ball Bob.
- These are, you know, if you have this,
I would invest in a ball Brad. - Right.
- Cause these are what are helping my wife by far.
- Yeah. This is a superior way to work the hamstrings.
- So what she does, is she rolls it in like this
without putting any stress on the hamstring,
and then she lifts up and rolls it out.
- So as she's rolling out, that's the eccentric.
- That's the eccentric. So she goes up, rolls it out,
and she does a set of 10.
- Then she puts her butt down and rolls it back in easily.
- Yep. Exactly.
This is just a beautiful way to get eccentric strengthening.
And I become a big fan of that because,
Brad, I was having a tendinitis up in here,
and I did eccentric strengthening on there.
It takes a while. I mean, I told her,
it may take her a couple months.
If you have a chronic condition, if it's acute,
I don't think it take that long.
- But she's been dealing with this
hamstring issue for years.
- Years. Yeah. So then you can also do the one leg at once.
Brad, if that gets to be too easy.
- Yeah. So he's crossing his leg.
The foot on the bottom is the one
that's doing do all the work.
- And then you also go like this, don't you Brad.
- Yeah. If you're doing that,
you probably don't have a problem.
- Yeah. It's probably already starting to go away.
- You're feeling pretty good.
- So that is what I would recommend, Brad,
the eccentric strengthening over anything
if you have the hamstring problem,
and I hope that helps.
- Oh, it will help.
So continue to enjoy life and have fun.
And if you get that broken heart, continue to watch this,
cause sooner or later we are going to,
- Remember, we can fix just about anything,
- But that broken heart.
But not long. We'll get her figured out.
- All right. Thanks.