♪ 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.
- You know, this is a case
where we have our ugly mugs on a mug.
(both laughing)
- [Brad] Can you zoom in on that a little?
- Yeah, yeah.
Should I be a little closer?
- Well, this is a nice one.
It says today is a good day to have a good day.
- All right, let's go into our topic at hand here,
sciatica that doesn't improve.
If you have sciatica that's just not getting better,
you must see this for success.
We're gonna give you really kind of the routine
that you go through with patients.
- Right.
- When they don't get better, the steps that you go.
- Yep, those secrets.
This is my, you know, I would say, it's my own.
- It's your secret sauce.
- Right, there you go.
It'll give you a few options.
- Pearls of wisdom. - There you go.
- By the way, if you're new to our channel,
please take a second to subscribe to us.
We provide videos how to stay healthy, fit, pain-free,
and we upload every day.
Brad needs to follow our own advice with his painful hip.
Join us on our social media channels,
'cause we're always giving away something every week.
Right now, we're giving away, once again.
- Oh, yes.
- A mattress by SleepOvation,
and it's got 700 tiny mattresses.
This is just a cutout of a portion of one of the mattresses
that we could use as a sample.
- Right.
- It's got airflow channels. - It does.
- But we're giving one of these babies away.
- You better believe it, Bob.
- All right, you wanna go your way?
- [Brad] Yeah, let's go my way.
Yeah, Bob, I had a little cross-country ski accident
this weekend, so my hip's on the fritz.
So you're gonna be the.
- All right, I'm gonna be the patient.
- Why don't you stay standing, Bob.
- Okay.
- And then face that direction, there we go.
So sciatica, we're talking about back pain,
but it needs to radiate down one of the legs,
and oftentimes, below the knee, very commonly to the foot,
and sometimes all the way out to the toes.
So if we imagine Bob's been having,
and it's not just pain, always.
A lot of times it is numbness, tingling, cold sensation.
- And if it's really bad, it could be weakness.
- Yes, right. - Foot drop.
- If you're getting foot drop or weakness,
then it's time to go in. - Yeah.
- Don't even work with this on your own.
But if you're living with it, you have some of these
symptoms, it's not too serious, and you wanna get rid of it,
the first thing that I'll do oftentimes with the patient,
I'll have 'em lay down on their stomach,
and right there, I'll ask 'em how it feels,
and sometimes, just laying like this typically
feels better overall, and that's a good sign,
if you lay on your stomach and it feels better.
- Tell 'em what you're looking for,
Brad, what you want the pain to do.
- Right, we want it to do something we call,
I'm gonna give you this to put
your forehead on, Bob. - Oh, sure.
- 'Cause you don't look comfortable.
This works better than a pillow
so you can keep your head level.
Is that too high, Bob?
- No, no, that's fine. - That's okay?
Otherwise I can give you this one.
You can.
- No, that's fine, Brad, I'm good.
- So we're looking for the pain or the numbness,
the symptoms that are there that are going down the leg,
we want them to centralize
or go up this direction towards the back.
So if you lay down like this,
and all of the sudden, your foot starts to feel
a little bit better, that's a really good sign.
So I'm just gonna have the person lay there for a while.
If nothing happens, but it feels okay,
then I'll gonna ask 'em to do some press-ups.
- Before we do that, Brad, we might mention
that some people can't lay in this fashion,
and sometimes they have to lay with a couple pillows
underneath to start off with. - Sure, yep.
- And in that case, so they might start off
with even two pillows and then work their way down to one,
and then work their way down to zero.
- Right.
- So, and then at that point you could try,
like, prone on elbow, or do you want press-up?
- Well, that'll depend.
Go prone on elbows, and if that feels better.
- It's kind of a prop.
- Yep, if you can stay like that.
Sometimes, people respond well to this, but sometimes,
they may actually need the motion.
So if that's not working.
- So hands underneath the shoulder.
- Yep.
- And I'm gonna start just pressing up.
The key here is that you do not
lift the pelvis off the table.
- Right.
- The pelvis needs to stay on the table,
so that means the motion needs to occur in the back.
You need to be arching the back a bit.
If you're going up like a board like this,
that means you're really tight, and you need
to work into these smaller oscillations right here
and start getting some movement there.
- Sometimes I'll put my hand right here just to cue 'em.
I'll make sure it's glued down to the table,
and sometimes I'll say, make sure you go all the way down
so they're flat, just so you get some more motion
if they're not responding well,
and if they're going up like this, and each time,
it feels like it's getting easier and they're going higher,
that's a really good sign, and along with that,
if the patient reports, boy, my foot and my calf
are feeling better, they feel normal like the other leg,
boy, then it is centralizing.
Then you know you're right on the money with this.
- Yeah, it's a great sign. - Right.
- And you wanna go further and further.
You wanna go as far as you can go.
I mean, eventually, you wanna get up to here.
- Sure.
- You wanna get all the way up
and even bring your head up if you can too.
- There you go.
Now the next, if that's not working
and they're doing the press-ups, they do four or five
and things are not getting well or getting worse in the leg,
then I'll definitely stop right there,
and then I'll go into the banana, what we call the banana,
and if you're looking from the top down,
I'm gonna shift Bob's hips only,
keep his shoulders and his knees where they are,
and if the pain is going down the left leg,
I'm gonna shift his hips to the right.
So now, he's got this banana shape
if you're looking from the top down, and at that point,
I'll leave him to lay there for just a minute or so,
maybe even less, and sometimes,
just doing that can improve symptoms.
- Yep, I've seen that. - Yep.
And then, I'll have to do the press-ups at that point.
If nothing is getting worse, but it's not getting better,
now I'll say, let's try some press-ups,
but let your body be in that banana shape.
- And generally, it's a little harder
to do press-ups when you're in the banana shape.
- Yep, it is.
- So people don't go up as far.
- Right. - But that's all right.
Again, what you're looking for is that your symptoms
be improving the further they are away from the back.
So, and the calf and the leg, are they getting better?
- Moving up this way, starting to feel normal down here.
On the converse, if you do these and for some reason,
they make it worse and go down the leg,
that's a red flag.
You're gonna stop immediately.
- That's always the case.
No matter which one of these you are doing,
if it makes it worse going down the leg,
you need to stop immediately. - Right.
- And try something else. - Right.
So then, I'm gonna go to the next one
if that one's not working.
Why this is named roadkill, I really am not sure,
but I got this name from one of the McKenzie instructors.
(Brad laughs)
- Well, I think it looks like roadkill.
- I guess so.
So I'm gonna have the person going this way,
and I gotta tell you, Bob, I've had some pretty good luck
with, when the other ones aren't working,
I'll ask 'em to go in this position,
and if they immediately say, boy, that feels kind of good.
- Yeah, without even doing press-ups, right?
- Right.
Then I'm thinking, oh, we're hitting the button right now.
- So you see what I did there?
I just took my leg up,
and you can put your foot almost on your knee.
- Yep, right there.
- And you bring the knee up,
and so if you look again from the top down,
from the ceiling down,
I look like I've been killed on the road.
(both laughing)
- Whatever, we're gonna call it that.
- Hit on the road.
- This is the position. - Yep.
- If it feels better this way and the leg starts to improve,
then I'll lay there until the progress doesn't,
say it goes up to the knee, but it stays at the knee,
then I'll say, why don't you do some press-ups.
Now, you'll see.
- Again, more difficult to do in this position.
- Yeah, you're never gonna get as high in this position
as you are with the one we first started with.
- Okay, what's the next one, Brad?
- And if it continues to progress,
we'll have 'em do 10, and from all of these,
no matter which one you do, when you start getting
centralization, I have 'em do 10, and then I'll have 'em
repeat that at least five times a day, sometimes more,
every hour if it continues to improve.
- Yeah, and some people may complain about that,
but really, it took a long time for you
to develop this generally, and to get rid of it,
you need to do some due diligence,
and you need to spend the time.
I've had people that worked at factories
that actually put cardboard on the floor
and would do these every hour.
- Sure, yep.
Now, if this one's, now, this is
the third or fourth one we've done, third one.
Then I'll have the person lay on their back.
This one is kinda hard to do by yourself.
I've had patients do it by themselves,
but I have to instruct 'em, and what I do
is I go up to this position and keep the knees together,
and then I'm gonna roll this direction.
Can you take that hand and put it across your stomach?
There we go.
And then I'm gently gonna go this way,
and then I have to slide the hips this way.
Now, there's a way I have the patients do this at home,
and I'll show you in a bit, but if we go in this position,
and all of the sudden, his right leg pain and symptoms
are improving, then you know you're gold.
If this becomes painful and not tolerated right away,
then we're just gonna stay away from it.
I don't know, I have success with this one not a lot,
but when it works, it works pretty darn good.
- It works real well.
Yeah, yeah, this one, Mulligan taught this one too.
- Oh, really?
- He would again have 'em go like this and like this,
and you almost have to hold on with your hand on this side.
Otherwise you could roll right off.
- One little thing I'll have patients do
is I'll say, just bridge up a little bit,
and now shift your hips that direction,
away from the pain, and then I'll have 'em do it.
- Sure, then have 'em do it.
- Sometimes that helps.
- They're already in the right position.
- And then you'll do that and you'll just lay there,
and again, as long as the leg is feeling better
and that betterness moving up towards your low back,
we'll do that, and this, I won't have 'em do
10 repetitions, 'cause it takes a little more effort.
So maybe three or four repetitions,
as long as it continues to centralize.
Now, if all these are making things worse and not
progressing, then I'm gonna go to some self-traction.
- Gotcha.
- So, in the clinic, I'll use parallel bars
or possibly a walker, but what you can do at home,
you need to get some nice, solid chairs.
- Or you could have one chair and one countertop.
- Sure. - I mean, if they were
about the same height. - Yep.
Two solid surfaces, about your waist level.
So, if Bob does this, they should be taller chairs,
and this is one I can do.
And it's nice that you can lock your elbows out,
'cause then it doesn't take much arm work.
So I'm gonna lock my elbows out,
I'm gonna come up on my toes.
These chairs are just about perfect for me.
And then I need to relax my trunk,
and then I'm gonna unweight my toes.
Now my toes are just barely touching,
and what that does is that put traction
through the lumbar spine and it decompresses
or takes the pressure off that nerve
being pinched, creating the pain and symptoms down the leg.
When you do this, you should immediately
feel relief down the leg.
If you don't or it makes it worse
and it becomes very uncomfortable, you just stop.
When I add this with patients,
and they go like this, and they put a smile
on their face right away, then they're gonna do it at home,
but if not, and they're doing this, and it's uncomfortable
or they're having a hard time unloading for whatever reason,
then we stay away from that one too.
And if none of these work for you,
you might wanna go see a therapist.
- Yeah, and I would say also with this, Brad, if this
starts to work, you do it quite often throughout the day,
then eventually go back to the press-ups again.
- Exactly.
- Try to do the press-ups again,
because you always wanna see if you can get back to that.
- Yep, that's a real good point.
- So, and you could also hang on a pull-up bar.
- Yeah, right here.
Well, we got out bed in the way.
But a lot of people don't have 'em,
but if you happen to have a pull-up bar, you know,
this will give you that lumbar traction as well.
- By the way, I know the question that's gonna come, Brad,
and somebody's gonna say, what about an inversion table?
- Sure.
- And you did an inversion table for years,
and it did help you, and I would say
in this case too, it possibly could help.
- Right, right.
- I would like you to try one somewhere
without having to purchase one,
because they're quite a bit of money.
- And sometimes, they don't work.
And we do have a video with complete details
on how to purchase, what to look for.
- How to purchase and how to use.
- Right, exactly.
- Oh, it is that late already.
- It is late, Bob, we gotta get going.
- Thanks for watching.