♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi folks.
I'm Bob Shrupp, physical therapist.
- Brad Heineck, physical therapist.
- Wake up, Brad.
Together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today, we're gonna talk about sacroiliac self treatment.
There's five that we're gonna show you,
five ways to do it at home, options to fix that SI pain.
- That's right, Bob.
It's, we're not only gonna show you to fix it,
but we're gonna help you self-diagnose it
to a certain degree.
And we'll talk about that
so you have a good understanding of it.
- All right. I can't wait to see what you're gonna say.
- Say no more, Bob. - By the way,
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- [Brad] That's right, Bob.
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Go to-
- Oh, sorry.
- You go to Tiktok or Instagram.
Our camerawoman's telling him Brad's mic is off.
Or, which one am I missing now?
Instagram, Tiktok, and Twitter.
- They got it.
These people-
- We've got a 60 second version of our program.
All right, enough of that.
But I'll put all these out.
- That's right.
- And you can go ahead and start.
- Okay, so SI pain or sacroiliac,
it's one of those terms that I think a lot of people
aren't really sure what the sacroiliac is.
So we're gonna go through that.
I remember as a child,
my mother talked about the sacroiliac,
and I'm sure she didn't really know what it was either.
But it was fun to say.
A lot of people think it's the back pain.
- Yeah.
And it's all related.
- Kind of.
- But it's very specific.
And it's right here, and you have two of them,
right here and right here.
Now, if we take everything off, the clothes, the skin,
the muscles and everything, we look at the skeleton.
- So he's facing this way,
or she's facing this way.
- So we got this side of the pelvis, and this side,
this is actually called the ilium.
This bone is called the ilium.
Okay, the pelvis is made up of three bones.
This is one of them.
We're not gonna get into the other two.
And then we have the sacrum.
And then there's a joint between the two
where the bones connect, but they're not fused together.
There's actually a joint there,
but there's very little movement in it.
There's a lot of very aggressive ligaments and muscles
holding this together. - Yeah, heavy ligaments.
- Right.
So sacrum, ilium, and so it's called a sacroiliac joint.
And that can be a source of pain on either side.
Again, if there is movement in there,
it's actually designed not to move.
There is a little controversy on this.
- There's a lot of controversy on this.
- But we're going to approach it with that
so it's easier to understand.
If there, and it's really hard for me to even show movement
on this model.
But if the ilium is rotated one way or the other,
it puts stress on the joint, and can cause pain.
And we need to relieve that stress.
- Right, and I think a lot of times
that movement can occur from stresses being on the ilium
for a long time.
Like if you're sitting wrong,
or it could be abrupt jarring.
- Exactly right, Bob.
Some examples, let's say you fall,
and you land on your sit bone,
which is part of that pelvis structure,
it can put that rotation on.
Another common one is like taking a step
off of a higher step, and landing abruptly.
- Yeah, really jamming,
and it's gonna go all the way through the leg,
and it's gonna move that ilium.
- Right
- Redirection.
- The birthing process really can put a lot of stress
on that joint because of obvious reasons.
I had a student in my therapy class,
she was a gymnast in the college level.
And she had continual SI pain because her land,
when she dismounted and landed,
even though there was cushion there,
repetition, and she'd been doing it for years,
and it was a common problem for her.
- Well, I'm gonna throw one in there
that could happen over time, Brad.
And that would be sitting, like, unusual.
Like, let's say you sit on one side all the time.
- Yeah.
- Like, even if you cross your legs,
and you're always got stress on, kind of, one knee.
- Yeah, like this.
- Yeah, ischial tuberosity, which pushes,
presses on the ilium.
So they're, you know, weird things like that
can also cause the rotation to occur.
- So, the symptoms, typically,
are increased pain with walking.
Usually with walking longer distances, it gets worse.
Weight bearing.
If you're standing on one leg,
if it hurts, and then you just shift to the other one,
not so bad, it feels better.
That's another symptom.
Is there any other ones we're missing, Bob?
Usually it feels better when you sit down.
- Right. - Take weight off of it.
You know-
- It might be worse with heels and steps.
- Right, walking up and down.
- Yeah, 'cause you're, again, jamming it a little bit more.
- Now, a word of caution, these symptoms
just happen to be very similar,
and they cross paths with both hip pain and back pain.
So, they are all the same area,
and they can refer pain to different areas.
So this is not a very easy-
- Yeah, do you remember that one, was it Fortin's sign,
where you actually just turn around,
and if you actually point to the spot where the pain is,
and then take your hand away, and then point again,
and hit the right same spot,
that was the sign that it could be SI pain.
- Sure.
- But it was generally, you know,
right down to the pelvis here.
- Right.
I do wanna say you can get referred pain down the leg
with SI pain. - Yes you can.
- Typically not past the knee.
If it goes past the knee, down to the foot,
then it's probably from the lower back.
- I've seen it in the groin and down the front of the thigh.
- Sure, yeah.
- So it is a problematic one.
And I think it's easily misdiagnosed by professionals
all the time.
- Oh, right, sure.
There's, yeah, you may get a crisscross diagnosis.
One thing's for sure, these treatments
that we're gonna show you, if they work,
they're gonna work, but they're not gonna cause any pain.
- Any problems.
- As long as you follow the simple instructions
that we're going to give. Should we go with the first one?
- Yeah, all these should not increase your pain.
They should decrease your pain.
They should feel good.
If they do that, you know you're on the right track.
Even if it is an SI problem,
you're on the right track then.
- [Brad] Exactly right.
- That's how we roll, right Brad?
- Exactly, Bob.
So Bob, I personally have right SI problems,
and I've been dealing with it for years.
And this is one of my go to exercises
that almost always works.
I put my foot up on a stool at home.
- [Bob] A fairly high stool.
- I've got a step, yep, that's outside
where it's kind of a brick tie wall thing
that holds in some of the landscaping.
And I go like this, and I just push.
And what that does is that puts pressure on that ilium joint
and it makes it feel better.
And I can always feel,
it always feels good while I'm doing it.
And when I get done, walk around,
it feels better than it did before.
Now, if you try this, and it seems like it hurts,
and you get done, and it still hurts afterwards,
don't do it anymore.
- Right.
- That's done, that's the red flag.
- You might try the other side then?
- Exactly right, Bob.
- But I also, Brad, would probably suggest
that doing this on the stairs with a railing
would probably be the best way to start off.
- Yeah, right. - So...
- Yeah, especially the first time you do it.
- Right.
It's gonna give you stability,
and you don't know what the pain's gonna do,
and if it gets worse.
- If you do it, and it feels good while you're doing it,
you can put a little more pressure on it.
But not a lot the first time.
- Yeah, you see that Brad's almost doing
a little bit of rocking motion there when it feels good.
- I mean, it feels good right now even when I do that.
So take your time with it.
- Just curious Brad,
so if you do the opposite leg, does it make it worse?
- No.
- It doesn't, okay.
- And I, well- - Doesn't make it better,
doesn't make it worse.
- I haven't really done the opposite leg too much
because it takes care of it, so I'm done.
- Sure, sure. - You know what I'm saying?
I've got other things in my mind.
The next one, number two, this is laying down.
- Lying down.
And this, you can do this in bed or on the floor.
Really, it doesn't matter.
You're gonna, in my case, I'm gonna bring my right knee up
because my right side is the bothersome side.
I'm gonna pull my knee to my chest.
And now, there's two ways to do this.
I wanna hold my knee, and I'm gonna push
as hard as I can against it,
so it's hip extension, not that you need to know that.
But I'm gonna hold, and it's an isometric.
This is called a muscle energy technique.
And I'm gonna hold, and push.
And hold that for about five seconds, and relax.
Now, when you do that, if it feels better,
it feels like good pressure, that's the goal.
That means you can continue.
If you do that and makes it, it irritates it, then you stop.
You're done with it.
That's not an option.
- [Bob] Then again, you might try the other side.
- Yep.
- [Bob] And see if that one works for you.
- Right.
- [Bob] Again, this is always an experiment.
We're always trying to see what works.
You know, what position works for me.
And when you find that,
that's the one you're gonna keep repeating.
- Now, the other option doing here,
you wanna grab the booyah stik,
you can use a booyah stik.
You can use just about anything.
- [Bob] A broom stick. - A broom stick.
You could actually use a baseball bat would work out good.
You're gonna put it right between your knees.
And I'm gonna push this way with this leg,
and the opposite direction with the other knee.
I'm gonna hold the stick still though
in what's basically an isometric.
It's very similar to what we just did.
It's just a different approach.
And I'm gonna hold.
Go for that five seconds, and relax.
Again, if it feels good, we're gonna continue to do it.
You may do it up to three times.
If it hurts, you're gonna stop.
If it doesn't feel like it's doing anything,
you may wanna, either way, you're gonna try
and do the-
- [Bob] Opposite side.
- Yeah.
So you're just doing the opposite forces on each knee.
- [Bob] Sure.
- So-
- [Bob] Now, Brad, a lot of times
after people have done that,
we have them also put their hands between their knees
and squeeze them together to reset the pubis.
You know- - Yep.
- [Bob] So, Brad's gonna show us.
- Have you ever done the fist?
- [Bob] Yep, the fist-
- Fist your hands, and you squeeze
like you're trying to squish your fist.
- [Bob] Just do that five seconds three times.
And, you know, you might feel a little click
in your pelvis even.
But it just kinda resets the pelvis.
- Sure.
- [Bob] So...
All right, Brad.
What's next on the agenda?
- Ah, the tennis ball,
you can't go wrong with the tennis ball.
Now...
- [Bob] We're gonna move this out of the way, right?
- Yeah.
This, you can use the floor.
Oh, I thought you were gonna do that by yourself, Bob.
The floor or-
- You can use the floor or the wall.
- Or the wall.
Now, in my case, on my right side,
if I just go up against a hard wall,
and I push the right side, right where that SI joint is,
put pressure on it, always feels good.
Even right now.
It feels good, a little mobilization.
But if I take the tennis ball,
and I put it in the right spot,
and put pressure on it, it even feels better.
And I'll roll up and down on it.
Again, the same rules, it needs to feel better
while you do it.
And if it doesn't, it's not the right thing to do.
- [Bob] This is one of the things that I have found
throughout my career, by the way,
is that I become so much better at treating a problem
when I have it.
- Yeah, exactly. - I mean, you just,
you work through every little idiosyncrasy of it,
and you figure out what works,
and you also can relate to the patient.
So, we just need to get every problem, Brad.
And that way we can learn how to solve each one.
- Exactly Bob.
I know what you're saying.
Now, you can also do this on the floor,
and I'm just gonna briefly, it's the same thing,
but you're laying on it.
You would not do it on a bed.
Has to be a hard floor or a carpeted floor.
And then you use your body weight, and that works out well.
The last thing, last but not least.
Now this option, you do need to make a purchase,
but it's a good purchase you can use.
And some people have these.
They are very popular now.
- [Bob] Right.
- These massage guns that reciprocate.
And this happens to be one we like.
We promote this one so much that we put our names on it.
- [Bob] That's right. - So if you wanna get
a Bob and Brad massage gun,
there's one right here, and they work very well.
That's why we put our names on it.
- [Bob] Very high quality
at a very good price. - It is.
Here's the little box it comes from.
It's a beautiful little-
- [Bob] I just have to repeat Brad.
When these first came out,
they were going for $400 and more,
and we would not sell them because of that.
We would not show them.
We would not even demonstrate them,
because we thought it was too much money.
Now, this is down to, I believe 130,
and that's without a coupon.
And usually we have a coupon going.
I don't know when you're going to watch this video,
but sometimes as much as $40 off.
Or $50 off even. - Yeah.
And you can use them on muscles all over your body.
But for the SI joint, it's important.
You're not gonna put this head on for the SI joint.
That's for getting into some soft tissue, some muscle.
I have the airfield tip, which works really nice.
- [Bob] Yeah, that one's a comfortable one to use.
- Yeah, you can actually push on it.
'Cause the SI joint, it's pretty bone right there.
Unless you're a pretty heavy person.
You're going through a little skin and right into the bone.
And let me get this going again.
You gotta hold it for three seconds.
So, and I'm just gonna work this right there.
Oh, it feels good.
- [Bob] So, it's right over the ligaments.
He's getting some more blood flow to it.
- Yeah.
And I'm gonna work these muscles around here too.
Again, this feels good.
While you're doing it, it should feel good.
After you're done with it, it should continue to feel good.
And you walk around and have positive results.
The nice thing about this massage gun
is you can work your SI joint,
and as soon as you're done with that,
you can go to your hamstring and work that,
or your quadricep, or any other tight muscle you have.
- [Bob] Yep, I've been using it on my legs a lot.
- Yeah.
- My arms are doing okay.
- There's a reason why these guns are becoming so popular,
because they work.
And of course the Bob and Brad one is my favorite.
- That's the best of all. (laughing)
All right.
- Anyways, very good.
Good luck with your SI cure mint.
- Cure mint.
- Is that a word?
- No.
- Oh, well, it should be.