♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet. ♪
- Hi I'm Bob Schrupp, physical therapist
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad you wanna talk today about sciatica.
- Exactly.
- And also,
issues about is it gonna come back if it goes away?
- Right, I get a lot of questions
or we get a lot of questions like that from our viewers.
Will it return?
Is it a higher risk to return?
And it's like, well that's a pretty good question,
because I know, and you probably know from experience,
we think that people who have sciatica, it heals,
there's a better chance of it coming back again.
The recurrence rate is...
- You have a higher chance being the fact
that you had it before.
- Right, exactly.
But not to get too concerned about it
because there's things you can do about that.
- Right, you're gonna have to change some of your behaviors,
basically, because what led to the first time
can happen again if you just keep
living your life the same way.
- Exactly, so you need to learn from your mistakes,
and a lot of times mistakes you had you weren't aware of
and that's where the therapist comes involved.
Can we get our Napoleon over here?
- Sure.
I think that's the first time
you called him was by his right name.
- I was wondering if that was right.
- Napoleon bone-apart.
By the way,
since Brad's trying to go get something right now,
if you're new to our channel,
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We provide videos on how to stay, healthy, fit, pain-free.
And we upload every day.
- And we have fun doing it.
- Yeah, I would say that.
- So sciatica, we're talking about
pain that goes from the back and extends down,
I forgot we had the hamstring on here,
It goes down the leg,
and it can go all the way down into the foot.
And the reason, because is the nervous system,
the way it's,
put together,
now this is a pretty crude model,
- That would be the sciatic nerve.
- Right, that would be your sciatic nerve.
And it is one big bundle of nerves.
This tape off my finger.
Up here, in the area here where you got
your piriformis muscle and your buttock muscles,
which can be a source of sciatica
if these muscles are pinching it.
A lot of times, the problem comes from up here
where the disc interferes with one of the nerves
and it sends signals and pain down that nerve track,
it can go all the way up to your toes
which is not uncommon at all, right Bob?
- Right, it'd be down to the toes though.
- Yeah, down.
Man, I've gotta quit reading so many books, Bob.
- Okay. - Okay.
- Where are we at Brad now?
- All right, so now we know where the source is
and we're gonna actually look a little bit
at the low back because I would say,
probably 50% or more of sciatica comes from the low back.
And with sitting with poor posture,
just even things like bending over
while you're brushing your teeth
or bending over to pick up a pencil to picking up
that 40 pounds of salt that you're gonna
put in your water soften, even more stressful.
But we're gonna look at that disc, and see why,
what happens with that disc,
that disc with poor posture
and all those things we just talked about.
- Can bulge out or herniate out.
- Right, you got a good view of that herniation Lonnie?
- Now this isn't gonna happen on a healthy disc,
this is gonna happen on a disc that's worn out in the back,
over time, you've put the pressure on over and over again.
And it just gives out.
- You know, we've heard a lot of experts say
you don't injure your back from one event.
It's almost always accumulation of what you've done.
- Kind of a lifestyle issue.
And a lot of times it's from,
well we'll talk about some of the issues, Brad.
- And then you get that pain down the leg
and then you have sciatica.
- Right. - Okay.
So we talked about, is it gonna return?
I thought let's look up a study.
So I looked up a study
by the Journal of Clinical Epidemiology.
- Epidemiology.
- Yeah, we've gotta get that speech therapist
working on me today, Bob.
Okay, 622 subjects.
This is at a workplace, and all 622 of these had sciatica.
Okay, there's a certain number of 'em that did improve
and got rid of the sciatica, no leg pain.
However, of those resolved cases, 61% of 'em
continued to have back pain,
but it was intermittent come and go,
and it wouldn't interfere with their life.
- So sciatica was gone, but they still had back pain.
- They still had back pain coming and going,
still could work, but it just was an irritant, okay.
27% of the resolved cases of the sciatica
had chronic back pain.
That meant all the time they felt that nagging pain
still functional, but you know,
it made life a little unruly.
- Unbearable.
- So right there are some statistics,
it can continue to haunt you right afterwards.
But, the interesting part is
they looked at the factors that all of these people had
were the same.
They all drove more than two hours per day,
in other words, they're sitting,
I don't think it matters whether you're driving a car
or if you're in a sitting position.
- I think that's what we've discovered here Brad,
more than anything that I say to patients is that
back pain and sciatica has become not a lifting problem,
it's become a sitting problem.
And part of it is because your back's in that
somewhat rounded position all day long.
I think driving is a little worse than office Brad
because there's shock absorption too.
- Sure.
- So there's a little more,
little more stress of the spine,
plus there's no breaks,
well, there's brakes in the car,
but there are no breaks that you can take,
stand up while you're driving, you can't take pressure off.
- Exactly, if you're on a long road trip.
- Especially, if you have an hour commute one way,
an hour commute the other way,
that's a lot of stress on the back for driving.
- So, well actually let's go through the four things
we can come back and give a little information
on how to remedy this.
The next one is carrying heavy loads at work.
You know, this is again the study was towards the workplace.
And that's pretty clear.
It's like, yeah, that makes sense, they're lifting.
- Everybody knows inherently that that's the problem.
But when you combine the heavy lifting with sitting,
that's when it starts to become killer.
- Right, you drive an hour to work,
you work with heavy weight,
you sit in your car again and drive back.
- That's the recipe for getting
a herniated disc or sciatica.
- Just beating up that disc right and left.
The other one is they have a high level
of psychosomatic issues.
In other words, with pain it can really change
how you view things.
And we're not gonna get into that heavily because,
- It's not a strength of ours, going into that area.
- It's a psychologically,
psychology part of it, and we're gonna cover that,
there's books written on that,
and we would take a whole video to cover that.
And the other one is, if the person had sciatic symptoms
in other words, pain down the leg for a year or so
before the incident that put 'em outta work,
that was another factor that they all had in common.
- It means they had it for a long time.
They've been working on this for a long time.
And I always tell patients Brad, that,
this problem took a long time to develop,
it's not gonna get better overnight.
That's why I try to tell people to invest in
making the changes, and it may be slowly,
but look for what the changes happen,
where they are positive.
- Exactly.
So let's go back and see how we can change
some of their habits so this does not return.
Can I have that chair?
- Talk about the driving first.
- Yep.
All right.
So have a seat there, Bob.
- You got the roll right there Brad, if you want it.
- Yep.
Okay, so in your car
if you've got a lumbar support automatic button,
sometimes there's a button here or knob you can twist,
but there's gonna be a support right here in the low back,
and that's gonna arch your back,
and that's gonna help eliminate putting that stress
on that disc like we were showing.
- Again, this is gonna put stress on that disc,
the whole drive.
So you want to have your car seat fairly upright too Brad,
you don't want to have it back like this
'cause you're gonna round out like this if you do.
- Reaching for the steering wheel.
So as a basic posture issue one thing you can do,
is you can just do something simple
like taking a towel roll, tape it up,
the diameter is gonna vary on the individual.
If you're a large person, usually a little bit bigger one,
if you got soft, cushy seats, a little bit bigger one,
if you got firm seats, skinny person, smaller one.
- You might even keep two sizes in your vehicle.
- Yeah, that's what I do in my car actually.
But, just to give you an idea
you're gonna put it right in there,
and you're gonna lean back,
and that should feel like good support.
If you put this behind your back and say,
"Boy, that feels good."
And you drive for 20 minutes and you say,
"Man, I wish I would've had this 10 years ago."
I mean, right there is a clear, clear reason.
- Now that felt like too much to me Brad,
but I do always use the support in my car,
just a smaller one.
- You can buy 'em like this, this is a Mackenzie support,
which Mackenzie's really big into back pain
and lumbar supports.
And it's gonna be a little cushier
and these are more comfortable.
- Yeah, that is better.
- Yeah, doesn't that feel better Bob?
- Yep, yep.
- And there's different sizes of supports too.
This is a smaller one. - Sizes shapes,
it's got everything.
- You can you just look it up on Google
and you'll see all kinds of lumbar supports.
- The other thing, if possible
if you can break your drive up,
I know that may be difficult Brad,
but if you can, halfway through the drive,
get out, walk around the car, you know
maybe have your daily routine routine
where you stop at a gas station
and pick up a cup of coffee or something.
But even when you stand up Brad,
a lot of times it's helpful to do some of these back bends.
'Cause you've been flexing like this all along.
Go ahead and take your hands and go ahead and
do a couple stretches like this
which helps balance things out and put it the other way.
- Absolutely.
Now let's go to the lifting aspect.
Okay, they talked about people who lift a lot at work,
and there you go.
Bob does the classic bend from the back,
all the stress is going here.
- Knees are straight.
- And go ahead and lift it up Bob.
And you know, you can do that,
Go all the way up Bob,
there you go, and then down.
But he's up in a nice posture here,
which is good for carrying it.
Now demonstrate a good, healthy lift Bob.
There.
- One thing I tell Brad is
I always look down at the object,
but then once you're grabbing the object
actually keep your head up.
'Cause if you pull your head down
the back rotates down too.
- Let's take a look at,
this is what we like to use,
he's got contact here, here, and here,
keeping a straight back, okay.
Now do do it wrong again Bob,
and we can see what happens to that.
There you go.
You can even bend your knees Bob,
you can bend your knees,
- And still be doing it wrong.
- Exactly, some people see think
because they bend their knees, they're lifting right.
- Yeah, we always give the cue,
like you may want to think about your upper back
is in a cast,
so that when you go down you'd break the cast
if you were lifting wrong.
- Exactly.
So watch that,
again that combination, sitting for long periods of time
with poor posture, and lifting.
Or even just bending over brushing your teeth.
It's amazing what that'll put stress on your back.
- If you can try to temper those two issues,
you're gonna do a lot better
and less likely to have your sciatica come back.
- Absolutely.
- Or stay around.
- Right, exactly.
- So thanks for watching
- God you're thinking good today, Bob.