♪ Bob and Brad ♪
♪ the two most famous physical therapists ♪
♪ on the internet ♪
- Piece folks. - Oh wow.
- Hi, Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- We've got today five critical questions
to ask a low back patient, which could be you,
to fix your pain fast, to fix it fast.
- Right, and Bob,
these are five questions that you and I
always ask every back patient.
And we kind of go through
I mean, we jot down in our notes
and that information can be very critical.
- Can help you direct right treatment.
- And be a very large part of the treatment program,
therefore getting things to fix fast.
- Speaking of back pain by the way
this week we're giving away some
hanging handles.
And that could be very helpful for people who are having
sciatica or actually regular back pain.
So go to bobandbrad.com ,go to the giveaway section
and just sign up.
It's a form of decompression or traction.
Very can be very handy.
Bob,I did wanna say one thing
I remember one of my better back courses
I went to after being a therapist for a number of years,
the instructor said,
listen to your patient
because they will tell you the answer
- They will direct you. - They will direct you
to the problem,
but listen and ask the right questions.
I will never forget that and it's very true.
So these questions ask yourself,
or as you get a piece of paper down
and you may not have the answers right away
and we'll explain a little bit about that,
but write the answers down
and it's gonna help you treat yourself
and get you better
and get you going the right direction.
So, the first question,
was there an obvious cause for your back pain?
For example, did you fall?
Did you twist really quick while playing a sport?
Oftentimes actually probably more times
than not people say no obvious cause,
it kind of came on gradually.
- And in those cases,
usually his posture and usually with the posture
is putting tension on the tissues,
abnormal tension, and so
we wanna correct that obviously
if that's the issue.
- So I think one of the big things to get is
if there was no obvious cause
don't get too excited about or think that's odd,
'cause it's very normal.
- Very normal, majority.
- So question number two.
What specifically makes your pain worse?
Now I can't tell you,
Bob and I both agree with this,
how many patients if asked this.
- Say everything.
- Everything makes it worse and it will seem like it.
But once we get into asking few more questions
and they start telling us
some things about how their day-to-day life goes,
they'll say, and then this makes it worse.
And then it's like,
oh, so something does make it worse.
Now, we've got a hypothetical patient here.
We're gonna say this person said
after getting around things,
sitting in certain chairs or for a certain length of time
makes the back patient worse.
- Something you may wanna do is throughout your day,
pay attention.
Have a little notepad and write down,
oh, I guess that did make it worse.
- And you know,
I always had patients make mental notes
or actually write it down so you remember
because especially if you get a little older.
- Memory is faulty.
- Exactly, now the third question is just the opposite.
What specifically makes your back pain better?
Very common of the cheap answers.
Nothing makes it better, it always hurts.
But then oftentimes if you start thinking about it,
you realize maybe sitting makes it better or standing,
or maybe walking hurts at first,
but after 20,30 feet,
it starts to settle down and then it feels good for about...
- Or let's say your pain is at an eight out of 10,
and it goes down to six out of 10,
that's better, you kinda make note of that.
- Exactly, so anything that consistently
even drops a few levels
as opposed to making it disappear
I mean, sometimes that happens,
but usually not particularly.
- The first thing I'll say to people
they say nothing makes it better and I go,
so you're in pain 100% of the time?
And usually people will say no,
I mean, there's this most of the day
where I don't have pain.
- So you have to think about
what are you doing at that time
or just before that made it better or worse
and write them down.
- Really important to know this.
- And now in this case, and this is kind of common,
it feels better but after they walk 100 feet or so,
but if they walk up four or five blocks
and it starts to hurt again,
so there's a period of walking
that maybe helps this person,
and this is kind of a common scenario.
Does the pain, next number,
does the pain or numbness or tingling symptoms,
does it run down one leg
or both legs or maybe it doesn't go down.
And actually what I always do is
I have a stick figure
on a piece of paper and I'll draw,
if the pain goes down this leg,
but it stops about right here
and it never goes down to the foot.
So I'll draw that because I can't remember that
so when I see the patient the next time,
I'll ask them does it still go down the leg that far,
And they'll say, you know, it doesn't,
it doesn't even go down to knee anymore,
but they kind of forgot about it cause it's gone.
- People have a faulty memory
in knowing that they're getting better.
And unfortunately when they start getting better,
they start doing more things
so that may send them back again.
- Right, so yeah, all these little things
are really critical.
And then this last is a really general question,
fits into number four actually.
Does your back feel better in general
when you're up walking
or when you're sitting for a length of time?
And usually people can pick that out pretty good.
If it feels in general, yeah it's better,
more moving, better when I'm down sitting.
In this particular case, again,
the person says, yeah,
it's better when I'm walking after a bit,
but only for certain times.
- Let me say this Brad,
if you're trying to treat yourself,
these questions can help,
you may wanna go to our program on bobandbrad.com
go to the program section,
we have a free program on sciatica.
And we don't ask for an email,
we don't ask for anything,
you can just watch the program
it has got a free PDF you can print out
and it'll help you decide what videos you should watch
and which exercises you should do.
- Right, so you're not wasting time searching internet
there's 40 different videos just on back pain and sciatica.
You don't watch them all,
you only pick out the titles that pertain to you.
Maybe only two or three of them.
- But if you are getting treatment,
if you pass this information onto your therapist,
it's gonna help them.
So it's good information to have.
- It is very convenient.
Now let's go to the treatment section for this person.
First thing we're gonna do
because sitting irritates this person,
we're gonna to look at seated posture,
which is very often a problem with back pain.
And it's very problematic that the person is slouchy
and they don't have lumbar support
causing the back to round out irritating symptoms.
And it may even feel good to sit down at first,
but after you've been there for a while,
then the pain creeps up on you.
So Bob, the first thing you do.
- So if you're in a couch or a recliner,
you absolutely wanna take a throw pillow
and put it on your back 'cause if you don't,
you're going to be rounded out like this.
If that rounding out makes it worse
that is something you wanna avoid obviously.
So you just take a pillow, throw it in the back,
I do this all the time,
I don't sit on a couch without doing it,
And it puts me in a good posture.
- And it may even be lower than that down.
And you know, the size of the throw pillow
makes a difference.
You'll figure it out,
it should feel like good support.
Now some people,
it feels okay when you're sitting there,
but when they get up, it really hurts to straighten up,
and there's a good chance that's from poor lumbar support.
- Right, and you know, in your car,
you may wanna use a rolled up towel
or maybe use a lumbar support that you purchase.
- Towel is a good one to start out with,
because you don't need to buy anything
and they can work good.
I've used a coat and I've rolled up a coat
and put in at my back - I've done the same
in movie theaters, taken my coat and rolled it up.
- Not your wife's coat.
- No, she won't let me get to roll it.
- The next one, avoid movements
that irritate the back pain
as much as possible, in other words,
if you find that every time you bend forward it hurts
well you need to start doing this
to pick up everything. - Bend correctly.
- Yeah, bend correctly.
Your back is gonna tell you when it's irritating,
no pain no gain,
is not what you want with back problems.
- You wanna find the triggers.
What's setting it off?
And you wanna avoid those triggers.
It does no good to keep testing your back,
does that hurt?
Yes it does.
Does that hurt? Yes it does.
I mean, it's just gonna make it worse.
- So if this hurts
and you find out that going this way
feels a little bit better,
especially if you don't go too far
and then as you do more it even feels better,
then you're gonna start doing motions that feel better.
Lumbar support,
some stretching this way.
I'm not gonna get into all the details,
again, if you go to our website
and you go to the back pain section it's very clear.
- Sometimes just tightening up your abdomen
can make a big difference,
So let's say a pain when you roll out of bed,
try tightening your abdomen first
and then roll out of bed and quite often
that will decrease the pain.
- Sure and go back to walking.
If you walk and you tighten up your stomach a little bit
and your core,
all of a sudden you can start walking further
with less pain so that's another little tip.
Oh Bob, did you wanna, let's take this pillow.
One thing that works for a lot of people
is to lie down to relieve pain
lets put typically you need more than one pillow like this,
but even this may take the pain away, versus this.
- And even lying on your side,
if you lie on your side,
if you don't have a pillow,
its kind of twisting your back.
So putting a pillow between your legs
can make a difference like that too.
- Makes a big difference.
When you get good sleep,
things are gonna heal better, rapidly,
much better than, than if you're not sleeping.
And again, a walking program
now walking helps, like in this person,
they could walk after 100 feet, but after five blocks,
you're gonna walk on the flat,
not on uneven surfaces or up or down hill
and go as far as you feel comfortable,
don't push it,
and you'll find day to day that walking distance
will likely improve as your back improves,
and it kind of works together.
- And you should do it multiple times a day,
Stuart McGill a PhD out of Canada,
big researcher into this area of back pain
has studied it for 30, 40 years
and he would recommend walking four times a day
for at least 10 to 15 minutes, so very important.
- Yeah, whatever your back tolerates,
when you start out, maybe only a few minutes,
but you're gonna progress as you get better.
- It's honestly the first thing I would recommend,
if you can tolerate, is walking.
That can make a big difference in getting some blood flow
to the area and helping your back heal.
So it's nature's bomb remember.
- Bomb, I didn't like that word.
- Soothing.
- Yeah, soothing.
Anyways, the five critical questions
that's what you need to ask.
- And it can help it you treat your back if it's just you.
Or if you have a doctor,
they're gonna ask you these things
and you should know the answers.
- So again, the questions
and we gave you the treatment to follow up on them.
Hopefully this helps .
Good luck with that back pain.
(speaking in foreign language)
Oh really? - You're German.
- I know, but I don't even know what that means for sure.
- Till we see you again, I don't know.
- Cut, cut.