- (upbeat music) [Announcer] Bob and Brad
the two most famous physical therapists on the internet.
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- Hi there, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- Well, in our opinion, of course, Bob.
- This is kind of a nondescript title.
Pain here? Question mark. How to fix in three steps.
So we're talking about pain in your butt.
- Ah, yo buttocks.
- If you looked at the thumbnail,
we actually have an arrow pointing
to the pain right in the butt.
And this used to be called piriformis syndrome
because there's a little muscle
in your butt called the piriformis.
We're going to get into this, during the show.
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- So again, it used to be called piriformis syndrome.
It's a little muscle,
it crosses over the sciatic nerve.
So the sciatic nerve goes all the way down your leg
and it can sit-that muscle can cross over the nerve
and actually cause pain all the way down your leg.
A lot of people think it's sciatica
because it's actually sciatica.
But you don't feel any back pain along with it.
- Right. So they could sometimes called it fake sciatica.
- Right, exactly.
Now as progress would have it,
over time now they think
that maybe more than one muscle is involved.
- I wonder who 'they' is.
- Yeah, I don't know.
- That 'they'.
- But there's other muscles,
the gemelli, obturator internus, your hamstrings.
- These are all little supportive muscles
around your hip joint
that are really critical for supporting
but they can cause problems.
- So now they call it Deep Gluteal Syndrome.
- Ooh. Good, good choice.
- So a simple test.
I'm going to show you a simple test, Brad,
on how to determine whether or not you have it.
- Alright.
- One anyway. So you would lie on your side.
Let's say I'm having the pain on this side.
- Sure.
- So I'm going to do a clam shell.
- So you're sidelined.
- Yup I'm sidelined.
The pain, you feel it right here.
I lift up the leg.
And you're going to have a friend help you.
Brad, cause you're going to push on that.
- I don't have any friends.
Well I'll get my wife, she'll help.
- Maybe a dog.
- So I'm going to push here and feel resistance?
- Yep, exactly. Go ahead, push.
- I'm pushing. (groans of effort)
- And if that increases the pain
or maybe even send symptoms down your leg,
it's as a possibility.
- Right, it doesn't mean you definitely have it.
So this is why you don't say yes, positive.
- Yup. And you could actually push on the hip
and find a spot that's really tender, very common.
I always do this one too, Brad
where I just have lie-people lie down
on their back and pull the leg across.
- Yep, so like, that knee to the opposite shoulder.
- Right, and it always feels tighter,
it seems like, on that side.
- So you compare one to the other.
It's a noticeable difference.
I've done that with many patients.
- Yup, it seems like it's pretty consistent on that.
So the other thing is you might have a hard time sitting,
because you know, you're sitting on that muscle.
And, in fact, the last person I saw that had this,
she was an accountant and she sat all the time, of course.
And the pain was a, of course, worse was sitting.
So the first thing you're gonna want to do is, actually,
you're going to want to decrease the pressure on the area.
So, when you're sleeping, I would sleep on the other hip.
You know, take the pressure off it.
When you're sitting-
- How about sleeping on your back?
- You can sleep on your back,
although you're kind of hitting it, fairly close.
- You'll know, if you're laying there
and it's irritating it,
and you want to sleep so it's not irritating it.
You may need to put-
- Karen's gonna be mad at you.
- Did I say lay-Oh shit.
- You're lying.
- I got a check mark.
- Yeah, that's right.
So it was sitting.
You can, a lot of times, if you sacral sit,
you know what that is, Brad, of course?
- On your sacrum. So you're slouching.
- Yeah, you're slouching.
But if you sit up straighter,
you can maybe keep the pressure off that area.
- Once again, posture, posture, posture.
- So, and then of course standing.
Don't put all the weight at one side, you know, don't-
Yeah, exactly.
So we have found massage to be almost,
I have anyway,
to be the most effective treatment for this, Brad.
- You can combine it, I think,
with the stretching.
- Yeah, with the stretching, we'll show you stretches.
But-and I have found,
generally, you can't do it with your hand, it just fatigues.
- Well, it's a large-you got to get in deep,
cause you're, you're going through your gluteus maximus
and your hands fatigue pretty rapidly.
- Yeah, and generally what we do is we start
with a wide target around the whole soar area.
And then we eventually narrow into the tender spot
as you can tolerate it.
Now we've got a bunch of massage guns here
that work really well.
This is actually a little tiny one that we have
that-it's very powerful.
This, this past weekend, I had a bunch of friends
at our cabin and these are big guys, some of them.
And they all loved this.
They were all passing it around.
- But you had this one too?
- That-no, I didn't have that one.
I only had this one.
- Oh, no wonder they loved it.
- The only reason they loved it.
- I have a patient with a hip problem right now,
and he prefers that just be-
over this, because it's easier-
- The leverage.
- To grab onto that kind of a thing.
Especially if you have-if you happen to have a hand problem,
arthritis in your hands of something that niche.
- Yeah, if you get a bigger one, that's not-
this isn't that big either.
- We didn't come up with the big Bertha, you know.
- Do we have the big Bertha here?
Here it is!
- Oh yeah, that one.
- This baby.
- You know if you're a younger person
and you're pretty built and whatnot,
you definitely want to get a bigger one.
- If you've got a lot of muscles.
You want to use that one so...
Now you can lie down and, you know,
put a pillow between your legs
and make yourself comfortable,
and just work that area.
You will find the spot.
- You're going to do what's most comfortable.
I've done it this way where,
if you flex the hip a little bit,
it kind of allows you to get into that area better
and work it here.
So this leg is completely relaxed right now.
And you can work it and you get up.
I really enjoy getting around that SI joint area.
It's always been a problem of mine and that's very close.
So you're going to work what feels good on that piriformis
or that-the part we're talking about.
Like Bob said, you get right over that sore spot.
It might make you jump.
Go around it and work your way into it.
It may take a few days before you-
- Exactly. But again, I don't know.
Sometimes, I wonder, Brad,
if that muscle has been torn a little bit
and maybe there's some scar tissue.
- It's possible, yeah.
- It seemed like that was the case with some of my patients.
And then you're going to stretch the muscle too.
So, um, I want you to-
one way you can tell, Brad,
whether or not it's tight or not,
is you externally rotate your legs.
And if one turns out more than the other,
like you just sit there and go like that.
Now look at mine.
- Well, your left toe is going out this way
and this one, not so much.
- Yeah, so my, I am a little tight into external rotation,
my external rotator is pulling me out a little bit.
- Well, yeah, either that, or you got tibial torsion.
- That-that's true.
- So what I meant is you can't always say that's it.
But you gotta look at it and combine these tests.
- Right, right.
So what you do to stretch it, there's a couple ways.
So, for you therapists out there,
beyond 60 degrees of flexion,
the piriformis is actually an internal rotator.
So to stretch it, we're going to put it into extra-rotation.
So you do a figure four stretch.
You bring this leg up, I'm stretching this one on the left.
I'm going to bring-and we're gonna cross the-
my ankle over my knee.
And I'm just going to press down like this.
- This should not create any sharp pain.
It should just be a stretch,
feel like the muscles are stretching the hip joint.
- Now the muscle's also an adductor.
So I'm going to stretch this way too.
I'm just going to pull it over like that.
- Lying on your back or seated up.
- Yep. Oh, I'm sorry-abductor.
So it's like this, Brad.
- Yeah that's-I was kind of wondering.
- You were wondering about that.
- But I thought, well, he'll correct-
- Yeah, I'll correct myself.
So I'm stretching this one again
and stretching it by pulling over.
- You could, sometimes I'd pull with the other arm.
- Oh yeah. Like that.
- Yeah, you can do the pretzel too.
- With both. Keep good posture.
- Sure. Yep.
There's a lot of different little things you can figure out
as you do it, you'll know cause it'll be stretching it.
What about the seated one? Does this count?
- Yeah, cause you're in 8 grade right around fifty-
sixty degrees of flexion, so-
- Sometimes we can do a little bit of that.
- Yeah. That's probably the easiest one to do is just
to go ahead and do it that way.
- When you put your shoes and socks on,
give them a little stretch.
- Give them a stretch.
Alright, massage, stretch
and hopefully it'll go away on you.
- Oh yeah.
I have had fairly good luck with this.
- I have had too and it's always been massage
that's been helping these people, in my mind.
So, remember Brad, I can fix just about anything.
- Except for-
- A broken heart.
- Yes, but we're working on that and I don't know.
- Massage, maybe it'll help that too.
- They could make a gun for that, that would be good.
- A love gun.
- Wow!
- Yeah, that's good. (upbeat music note)