♪ Bob and Brad, ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Apparently, we're better than good,
and together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- It's jaw dropping.
- That wasn't supposed to happen.
- All right, today we're gonna talk about disc bulges
and included in that would be disc herniations.
- Right.
- I mean, pretty much any problem you have with your disc,
and if you're getting pain from down the leg,
we're gonna show you some possible treatments.
- And it's specifically, boy, I feel bad about this.
Sam, you know, he's got no jaw anymore,
but anyways, so the levels
that are most usually involved with a lumbar-
- Very common. - Yeah, is L4, L5.
So that would be, we've got this red tube here
representing that between these two.
- [Bob] The nerve, yeah.
- [Brad] Yeah, between these two vertebrae.
And then the two here,
we got a yellow nerve showing that location.
So it's low, close to the sacrum,
that takes most of the-
- [Bob] Stress, yeah.
- [Brad] Stress, particularly in your bending
or sitting with poor posture, causing that disc-
- It goes right up the chain.
I mean, as you bend forward,
the stress is first gonna be felt
to the lowest level.
And then you go further up it goes further,
the stress goes further up.
- It's as simple as that. - Yeah.
- And that's all we got, Sam, sorry about the jaw.
We'll fix it later.
So what we're going to do is we're gonna take information
from three different sources, Bob.
We're gonna take it from Dr. Stuart McGill,
who's got books and studies and...
- PhD, yeah, out of Canada, yeah?
- Yeah.
- And just terrific information, right?
- Yeah, he's studied and he's got research,
he's got books and...
- He's got the book, "The Back Mechanic" for the layperson.
And you really should check it out, I think it's one
of the best books out there.
- Sure.
And then Robin McKenzie, you know, he's been around for,
actually Dr. McGill and McKenzie collaborated,
and they knew each other when McKenzie...
They had a lot of respect for each other.
- McKenzie has since passed, but he has quite a legacy
and his exercises are practiced in what, 34 countries?
- I think it's over 40 countries now.
- Really, wow.
- I'm pretty sure that I saw the number is 40.
And then, of course, not least or last,
but our experience in the clinic over the last, you know,
combined of 50 some years...
- We mix it all together.
McGill, McKenzie and Heineck, Schrupp.
- There you go.
(both laughing)
Now they're gonna start tuning out.
Anyways, we're gonna get on with this.
Here's how we're gonna start.
If you've got those areas involved,
you have the sciatic symptoms down the leg
and very possibly past the knee down into the ankle,
which is very common with sciatica.
We're gonna start you out with lying on your stomach.
So Bob, you wanna be the-
- Right and you wanna give me a couple of pillows?
Now, the thing about this is you really want to know,
is it getting better?
So if you're getting pain down your leg
what we are looking for is that the pain
down your leg gets better first.
- Right. - Not the pain in your back.
So why don't you throw a couple of pillows
on up here, Brad?
- Oh, you may not have to use the pillows,
but it's probably a good way to start.
- Yep, for some of you it's gonna be too uncomfortable
to start right on your stomach.
- Yeah, without the pillows, right.
It's gonna be very uncomfortable.
- So you probably just want to start by lying there
for a few minutes and see what your symptoms do.
- Bob, I'm gonna give a little one
of those little pearls that may help some people.
You take a towel roll or something.
You put your forehead on that so you can relax your neck.
And now if you lie like that, I should,
Bob, did you want to continue on?
- No, go ahead.
- I know I interrupted, it was my fault.
No. Okay, I'll take it then.
Now we're gonna take, here we've got this white line
of Bob's we'll say that's the pain.
Okay, and he lies like this.
He can lie like this and after about 30 seconds
or so it starts to feel better.
Now watch what happens.
I say this to Bob, "How is your pain feeling?"
He says, "Well, it feels good."
You can see the line only went down to his knee now.
I'm not gonna...
- I don't feel, my foot feels better.
- Yeah, so things feel better down here.
- I don't feel symptoms in there.
- That's a positive sign.
- It might be just a numbness and tingling are better.
- Right. Exactly. - I don't know.
- So the next step would be to take one pillow out.
So Bob's gonna slowly get up.
And then all of a sudden,
I don't know a lot like with my patients or myself,
when I've dealt with this
when you take one pillow out
it's a little more uncomfortable
for the first 30 seconds or so,
but then it settles down and the leg pain,
it starts moving up this way again.
- This might occur over a period of days.
You may not get there in the first session.
Sometimes you do.
- I've had patients where I started with two pillows,
and at the end of the session we were down to no pillows.
That's fun, but it doesn't always happen that fast.
And the goal is to get down to flat.
You want to do this on a firm surface.
You could do it on a bed, a firm bed,
but a softer bed
or a worn-out bed's not gonna work well.
- Now this is where McGill
and McKenzie disagree a little bit.
McKenzie, he believes in actually going to the point
where you start getting some movement.
And McGill says, no, you don't need to.
In fact, he says, maybe take your fist like this,
put your chin up on there,
and then eventually put both fists underneath your chin.
- Right. - Like that.
- You could actually go to put a pillow
underneath your chest and make it a little more comfortable.
And then we got a static motion.
McKenzie likes to do the press-ups.
- And he likes to prone prop,
where you just gets up on your elbow.
But then he has the press-up
where you actually take your hands,
put them underneath your shoulders
and you start doing what we call mini press-ups.
So you're not pressing all the way up yet,
but you're just doing a little bit.
And you see if that affects the pain.
- Yep. Going down... - Possibly.
- Yep, if the leg pain continues to go up or dissipate
or go away, boy, I mean, that's where if I'm working
with someone, I'll do whatever makes the leg pain,
whether it's a static McGill thing or McKenzie thing,
I follow the symptoms, let the symptoms be your guide.
If the leg's getting better,
and actually it may get to the point
when you're doing press-ups or holding it,
if the pain is just right here and all the leg
and buttock pain is gone, boy, you are in good shape.
That's a really good sign you're going to progress.
And I think both McKenzie and McGill agree with that.
- You know McGill what he said is
that this McKenzie technique can certainly work
on people who have most of their disks left.
You know, if it's still, and that makes sense.
If you're working on the disc and if it's already wore away,
you can't really change it.
- Right.
- But anyway, another technique is you want
to make sure you're doing these quite often.
Maybe every hour, you know, the first day.
But you could do it four to six times a day, 10 repetitions,
maybe 20 repetitions.
And you can get to the point
where you actually go all the way up like this
If you can. - Right.
- You want to make sure your pelvis isn't coming
off the mat like this, that would not help.
- Yep, as a matter of fact, when I have patients,
I'll put my hands right here just to give them information,
pull this down.
- You can also just take a belt.
- Oh yes.
Now Bob mentioned doing these so many times a day.
You're gonna do that only if they responds positively,
if the leg pain continues to get better all the time
and the back pain too as well.
- So the purple represents a belt.
- Yep.
- It's actually one of our bands
and you can press up like this.
This actually works really well, Brad.
- You know, that's what I was thinking
because it has some give to it.
It's kinda grips on to your clothing.
- I like this. - Yeah.
Just another use of the loop bands.
- Yep.
Or you can use a rolled up sheet or something,
which puts a little pressure on it.
And again, if you get stuck, that's what you want to try.
- Yeah, that can get you over the hump
and into the next rehab.
- So what are some of the other things we can try
if we get stuck, Brad?
- Right, well, the next thing, if things aren't working,
you can try the roadkill, which is a weird name,
but you know, somebody thought of it.
- Let's say the pain's on this side.
I would put leg up like this.
I actually have the one foot touching my right knee.
- Right here?
- Yep.
And then I try to do a few press-ups,
not real full press-ups after that,
but some micro or mini press-ups while I'm in this position.
- It's basically the same protocols when you're straight.
The only difference is that you bring the knee up
and with this, with patients that I have done,
typically it responds quickly.
Otherwise I will have them put their leg down.
- Or the banana.
- Yep.
- So the banana, you want to show the shape, Brad?
- Yeah, so if I'm looking straight down,
you're shifting the hips.
If the pain is down the left leg,
you'll typically shift the hips to the right.
And so now here's the banana shape.
- The feet go to the left, the head and shoulders go
to the left, the hips go to the right.
And the same thing, I try doing a little press-up
in that position.
- Yeah.
And again, only continue if the leg pain's startin'
to feel better, overall things are settling down
and then continue.
You may start with the banana, and then after a couple
of days you'll go to inline straight again.
- You eventually go back to straight.
- Right, right.
- So I think, Bob, we're getting into the next phase
because once you get to that point,
you can do your press-ups and your range of motion is good,
the leg, the pain in the leg is improved.
Then you go to the walking program where you can start
to walk on a flat surface, no hills, no uneven surfaces.
And you're gonna get yourself in a good posture,
make sure you're in good posture, tighten up.
And this is where Dr. McGill really talks about, you know,
tighten up the core, get yourself so everything feels good
and then maintain that and then walk.
And walk, not real slow, but actually a little faster
and only go as far as tolerated.
You're not gonna walk for a mile the first day.
It may only be a block,
and then progress each day if you can.
- The reason we have you walk faster, is it actually,
they found there's actually less stress
on the spine when you pick up the speed.
- Sure.
- And the other thing Dr. McGill had people do, Brad,
is actually you can grab your hand like this,
and it straightens you out.
- Yeah, it helps
that posture. - Posture, right.
- Yeah, 'cause if you can't see yourself you don't know,
but if you do this it automatically builds
that posture where you want it.
- You can try this day one, if it feels okay,
it doesn't make your pain worse.
If it makes your pain worse, maybe try the other stuff.
- And I've had patients say, "It's terrible
when I'm sitting, but I get up and walk,
you know, and I feel great."
- And that's a good sign.
- Yeah, then you're gonna have walking as part
of it right away.
- Maybe try to take shorter strides.
Fast, but short.
- Yeah, so you're not reaching out in front of you.
- Yeah, putting stress on that nerve.
- Yeah, exactly, Bob.
So overall-
- We threw a lot of ideas at you.
But we know you're smart.
- Yep, and just go back and repeat
and watch this video over and over and over and over again
until you get it memorized.
(both laughing)
- They're going to be very happy.
- Or you can just fast forward
through the parts or whatever.
One way or another, it's really a good program.
- Brad and I can fix just about anything-
- Except for - a broken heart.
- That's right.
- We're trying to fix backs right now.
- Yeah, backs and the heart, no, there's no crossover.
- There's no correlation.
- Thanks for watching.