(upbeat music)
- Hello, I'm Bob Schrupp, physical therapist.
- And I'm Brad Heineck, physical therapist.
- And together we are
the most famous physical therapists on the internet.
- In our opinion.
- Well, it's important though, Bob.
I think we should feel good
about ourselves. - That's right.
- And about our information.
So, what are we gonna--
- [Bob and Brad] Talk about today?
(Bob laughs)
- We're actually gonna talk about pain in the butt
and that's not the anatomical phrasing.
- The buttocks.
- Yeah, but here we go.
- But this is for the person who's--
- Bob, did you get that?
- Yeah, I got that.
Ah, it's funny.
- No pun.
- This is for the person.
who's feeling some pain in their butt
and maybe some referral of the pain down the leg.
Okay. - Right.
- Now, along with this
I wanna make sure you're not having back pain with it.
'Cause if you're having back pain with it,
there's a good chance
it might be coming from your back.
So this is what we're gonna talk
about specifically is actually called piriformis syndrome.
And so we're gonna talk
about the Piriformis muscle
and we lost our camera woman. (chuckles)
(Nancy coughs)
That's all right, we'll keep talking here.
The piriformis muscle actually crosses over
the sciatic nerve.
- From here over to here
and that's the area we're lookin' at
and that's that butt pain.
But it's really that muscle that's located there.
- Yeah, we'll show 'em the spine here.
- Yeah.
- All right.
Actually, you know
we have two students here today, Brad.
- Right.
- Yeah, why don't they come out?
'Cause they're gonna tell us...
I want to see if they know their anatomy at all.
- Exactly.
- If they don't, that's all right.
We'll help you out.
- Britney, why don't you come up here first?
What school do you go to, Britney?
- We go to Yellow Cross.
- Get Sam out here too.
Let's get 'em both.
- Well one at a time.
I didn't know.
- No, they both can fit out here.
Come on. - Okay, all right.
- Say, hi. (chuckles)
- Hi. (chuckles)
- Okay, where's the piriformis?
It actually starts.
I'll give you a clue.
It starts...
Any clue...
Any comments here?
It starts on the sacrum.
I think up on like what would be S2, S3.
S1, S2, S3
and it actually inserts on the greater trochanter.
Okay?
So what it does...
I'll send this along.
Thanks girls for your little cameo there.
Can you focus up on here now?
- Bob, did you say where it ended up?
- [Bob] Yeah, on the greater trochanter.
- [Brad] Oh.
- [Bob] On the hip. - Oh the hip, yeah.
Right there.
Thank you.
- [Bob] So can you see that Nancy?
- [Nancy] Yep.
- All right.
And as you can see, it crosses over the sciatic nerve.
What is interesting is also sometimes
the sciatic nerve actually splits through the muscle
or sometimes the sciatic nerve splits around the muscle.
It actually does a lot
of different variations anatomically.
But the problem is is if this muscle spasms
or tightens can you see how
it'll put pressure on that nerve?
And it'll send the pain down the leg.
So Brad, I don't know
that I really wanna touch your butt, Brad,
but watch your face there.
- Well, my wife will get a little excited.
- Yeah.
Oh my God.
Anyway, right here is the sacrum and it attaches over here.
So we're talkin' about pain right about
in this region here.
- This reminds me a lot
of people say I got sciatica.
Well, this is the sciatic nerve
that it actually is impinging.
So another common name
they got sciatica super piriformis syndrome.
It's similar.
- Right.
Actually and what we're gonna do today
is we're gonna show you one stretch that you can try.
And even if your back was involved, I mean, you know,
and you weren't feeling any pain there,
this is a safe stretch to try.
- Right, right.
- If you have piriformis syndrome, you can try this.
You can try a few of the things that we said.
If it doesn't get better,
then you're gonna have to see your doctor
or see your physical therapist.
I mean, we're not trying to diagnose this 'cause
it is quite often a difficult diagnosis to make.
- Right, right.
- I've had while four of these patients this year
and they aren't that common.
I mean more often I would say it's back pain
that's causing this than...
- And referring down the leg. - Referring to low back.
- Right, exactly.
- All right.
So another sign that might be evident
is that this muscle actually turns your leg out.
So if you walk with your leg turned out
and the pain feels better,
that's a possibility again that
it was the piriformis muscle.
The other thing is Brad,
why don't you go ahead and lay down now?
Okay.
This is the stretch we're gonna be doing.
It's called the FAIR stretch.
Flexion, adduction, and internal rotation.
You don't need to know that.
All you need to know is let's say this is the side
the butt hurts on.
On the left side.
Brad's left. - Right.
- All right, what he's gonna do, he is gonna flex the knee
and he is gonna pull it
to the other shoulder.
To the opposite shoulder.
Yep.
That's really all you really need to know.
I don't wanna make it any more complicated than that.
And a good what one- to two-minute stretch, Brad?
- Yeah, and I'll even start out with less.
And like you had said before,
I'll say can you stretch this side
and then compare it to the other side
and see if you notice a difference.
And if the one side where you're having
the symptoms is much tighter,
and I have patients say that too, you know.
Oh yeah, that's definitely tighter.
You know, it's another indication you're going
after the right muscle.
- That's exactly right.
That's a good possibility
that that is the problem muscle.
So you want to go ahead and do that stretch.
Work up to a couple of minutes.
The other thing is because of the location of this muscle
and the location of the sciatic nerve,
if you were a guy
or I guess even a girl,
if you wear, you know, put a wallet
in your back pocket, you're gonna wanna stop doing that.
- Right.
- Especially sitting on it.
I mean, it's just gonna--
- You (indistinct).
- I actually when I was younger, I stopped doing this
'cause I remember my leg turning numb one time
when I was driving and I actually
had trouble putting the brake on (laughs)
'cause my leg got turned up.
So yeah, it was kind of dangerous.
But anyway, so you wanna stop that.
The other you could try
is you could try getting some massage
from a masseuse or whatever. - Sure.
- Or a partner that could try to massage that area.
'Cause that often helps.
Ice, heat.
All of those things are also very acceptable.
- Sure, right.
- But again, we're not trying to diagnose this for you.
So you're gonna wanna go to a doctor
or a physical therapist if this problem persists.
- Exactly.
Just a simple stretch with
that FAIR test that we call it
or knee to the opposite shoulder
while you're layin' on your back.
Do it gently.
Don't get too aggressive with it
and anything else, Bob?
- That should do it.
- Okay, thank you.