♪ Bob and Brad the two most famous ♪
♪ physical therapists on the internet ♪
Hi Folks
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
Today, we're going to talk about Brad, do you have fake sciatica?
You know piriformis versus a herniated disc, is that like fake news? Getting political here
Yeah, actually if you have
What's called piriformis syndrome, that's also called pseudo sciatica
Which means fake sciatica, okay, so there's also some other things that can cause pain down your leg
I think a lot of people get pain down their leg and they think right away
I have sciatica
exactly
But there's a lot of other things that can cause it so we're going to show you some tests to try to help you determine
What you have and that's what the rest of this video is about, but if you're new to our channel
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Exactly
moving on the most common cause of
Sciatica of course is a herniated disc sure, herniated or bulging disc and you did a video one time, where you
Cited a statistic that there was usually 3 million cases a year
in the United States of sciatica
Of a herniated disc. And a small percent was from the piriformis right 200,000 from the
Piriformis so let's start off with the most likely cause which would be true sciatica
So with that one the first thing you do is
The gold standard is the straight leg raise Brad, so if I'm laying down
And you could you could almost even do this on yourself
If you bring the foot up and bring it this way and it starts hurting bringing the pain down
This is the side that has the pain on it sure but why don't you show how you'd do it on somebody, in the clinic
I'll put this have them put this leg down lay and you have have the person relaxed
But I usually put a pillow under their head but for Bob I'm not going to worry about that
I have the person just relax and I'll have them come up
until they feel a little bit of a stretch pain and when I get to that point
I'll dorsiflex or bring the toe in this way and if the person says oh that hurts and
they say well the pain is just here. It feels like a muscle stretch
That would be negative, but if you go like this
And they feel pain or symptoms
Numbness tingling whatever up past me particularly up in the low back of the buttock area that would be positive for a straight leg raise
Yeah and positive is not good that you do have you know a
Problem as far as probably a herniated disc or don't things pinching in there?
yeah, the nervous irritated one way or another [let's] let's slide the table down Brad and show a
Slump test you're Gonna have to move that wall now let's move the wall all right. This is the slump test. [okay], Lonnie over here
All right, so with this one
It's kind of similar actually brad and your slump
Right which is putting a little stress on the spinal cord sure and then you bring the foot up like this
Let me get over and I bring the toe toward you right so it's almost like the straight leg, raise. That's one
You could do yourself and then while you're doing this even bring your head down like this, right?
One thing you want to think about is we go in that position again
Bob if you think about the mirror which they actually do the nerve will come here goes around the ankle all the way up
to the spinal Cord
And then the spinal cord actually goes up to the neck so when you put your head down it
Pulls a little bit on the nervous system, so that it makes it all taut
And if there's a problem when you put it all in that top position you have symptoms
You're going to do again. You might feel stretching here
Which is common?
But when you're trying to recreate that pain going down the leg when you have a nerve being pulled it's a very distinctly different
Feeling than pulling a muscle exactly you know brad
Do you want to show just getting up on the toes getting up on that sure heels this is one of those
tests that all the doctors yeah, and they'll say [it'll] simple to do if I get up can you walk on your heels and
There's a good reason for their checking out
L5 nerve root [working] the Dorsal Flexors, and then they say up on your toes, and if you can do this
That's just a good sign that you [have] good that the nervous a good signal [to] your money
You're looking for it
you might not be able to do it because it's weak or you might not be able to do it because it's painful right a
Positive side would be like this, [ya]
Can't lift up the one side, and then it'll plop down or something of that nature [alright]
So let's say all those are fine or [even] if they're not fine
You want to maybe check and see if it's your piriform is is involved, the piriformis is a muscle. Here's Napoleon Bone-aparte
Napoleon's facing away from us, and there's a little muscle that runs from your sacrum
Or what do people call it, tailbone, right above the tailbone
And it attaches into your hip, the greater trochanter, so this blue
Represents the muscle and sometimes this muscle gets tightened or even torn
Sometimes and the sciatic nerve is right underneath that muscle, and it can tighten up over it, and it can send pain down the leg
Right so here's the sciatic nerve comes from the low back. It's a bundle of nerves actually and it goes down
all the way to the toes actually so
this one little muscle can cause problems
all the way down just like a problem in the low back, and this nerve can actually go through the muscle too Brad
For some people, some people have what we call an anomaly so
What I've seen a lot of people who had this is
A lot of people who sit for a living sure and they're sitting right on that muscle where they irritated it, I had a couple of accountants
that had it, this is where a lot of people say don't wear your wallet in your back pocket
Very good point, people like me I got that big fat wallet that goes in there
Yeah, because he never spends any out of it that's why
All right, so the first thing you want to do is, is that muscle actually tender, so you can actually palpate down here
And you know especially the muscle is more tender on one side than the other, that could be a sign
You know your hip is right here, and you just follow it right in there, so it should be somewhere in this range here
I always do the thing where you move your leg like this
And you'll feel that bony thing moving back and forth is your greater trochanter
And you just go right in there and dig in there, and you'll feel one side to the other, right and there's a difference
That's one sign that it could be piriformis
Another one is that you can just do a regular stretch
You stretch the muscle, so if I lay down I'm going to stretch this one
I'm going to bring the knee over and the hip up like that
And I'm stretching it, you can see
This is one thing that therapists when I had in school was to say look at your clothing
If the clothing is being stretched
The muscle underneath it is likely to get that stretch
So I'm bringing it to the opposite shoulder
Now what the tell-tale sign here for me, Brad that I often see on people is that you compare the two and they go yeah
Maybe that's a little tight and you go like on this side and go
Oh that other side is tight, or it is really painful
Tender, it's like they don't want to pull it much further, right
The other thing is you can actually
Make the muscle work once and see if that hurts, so one way to make it work would be to do a clamshell
I mean because it's an external rotator Brad, so the clamshell, you can't see it from that side of the video, but
Well let's test this one
So I'm going like this
Big clam shell opening and closing now if you give a little resistance to it Brad
Yeah, and push on it and then try it, that's really making it work
It's also a bit of a hip abductor Brad so even if you do these with a little resistance and that hurts
That's putting the piriformis under tightness
and if you're at home doing these the nice way is to just
Do both sides and you'll see that the good leg compared to the other side if there's a noticeable difference
It will show up if you have that piriformis, again always compare one side to the other so that's kind of the piriformis test
Is it tender?
You stretch it, does it hurt, and if you put it under stress does it hurt, all right now
We're going to the third possibility that could be pain
Spinal Stenosis, now in this case you're getting pressure right on the spinal cord itself
And these are really telltale signs, I have a patient who's coming in today that has it, I can tell over the phone
And I go did they tell you you have spinal stenosis? Yeah, they mentioned that and because I could tell one thing is
They have both pain that goes down both legs and usually to the knees
I don't usually see it much further than that, but it goes across their back and down both legs
It feels better when you're sitting, much worse with walking
Usually their walking gets interrupted to the point they can only walk so far and what they call it is shopping cart syndrome
This is not a shopping cart
but it's the same concept if you're holding on to something and
They walk and they just lean forward or go like this a little bit, makes a big difference on how it feels like you know they
can walk around a much further distance with this a little bit of motion a little resting on the shopping cart or their walker
As opposed to a normal upright, a lot of times people who have spinal stenosis cannot stand up straight
They can't get all the way straight up. So that would be possibly spinal stenosis,
Again at the end of the video here I'm going to show you how to treat sciatica
Piriformis spinal Stenosis and even the next one which is a hip problem
Your hip can also send pain down the leg, sure
At the end I'm going to have a list of videos playlist
So you can just click on that go to those videos for more information
So for your hip problem one thing you're gonna find out is that generally if it's coming from your hip
Your hip often lacks range of motion on that side so one thing you can do is cross your legs does one
You know go down further than the other, does one stay way up
Can you go this way, can one go much further than the other, bend one further than the other, knee to chest
Yeah, and if they don't that might mean that you have some pretty severe arthritis in there that's sending pain down the leg
The last thing Brad is sometimes people are surprised that just
Regular back pain can sometimes send pain down the leg, not very far, to the knee only. But just regular old
arthritis can send pain down the leg
From the SI joint you have SI pain that can refer down to the knee
Like Bob said typically to the knee if it's going down to the foot or to the toes that's almost a certain sign of that nerve
Being impinged so I hope some of those tests
You know kind of help you narrow it down obviously you go see your doctor and get it
But I mean you can kind of come in with a little
Bit of knowledge, right you can relate to them maybe have some questions
To come back with, so watch the videos at the end here. They're going to help you out with treating these things so
We're getting really good at this sciatica for helping people out a lot of comments, but we're still working on this one Bob
Right here. This is just broken heart. We can fix just about anything
Except for a broken heart, but we're getting at it. Well let's break it. No no no no
I want to save it for another video. I got another idea. All right thanks.