♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most fabulous
physical therapists on the internet.
- Well, in our opinion, of course Bob.
- I was throwin' somethin' new in there, Brad.
Okay, today we're gonna talk about sciatic pain.
And it's really important to know where it's coming from,
isn't it Brad?
- Right, and what the cause is
but I think one thing about sciatic pain
or sciatica is people really don't know
what that term means.
- Right. - So let's define that first.
It's just a general term,
so why don't you stand up Bob, once?
Yeah, turn around, show 'em everything you got there.
Is one leg, it's almost always one leg,
has pain, numbness, tingling,
burning down one leg is sciatica.
What it's from could be a number of things.
- A lot of things and that's what we're gonna cover today.
Some of the things that it could possibly be.
- Right, and the two biggest things are, is the--
- Herniated disc. - Herniated disc,
which is a big one and the other one the piriformis.
- The piriformis syndrome, yep.
- Right, I got some numbers on this
that make it interesting on the piriformis syndrome,
300--
- 200,000 cases a year.
- Right, but let's go back,
sciatica is estimated three million cases of that,
and this is in the United States.
- That's a lot.
- Right, per year.
But only 200,000 of 'em are piriformis syndrome,
so that tells you a pretty small percentage
is piriformis syndrome.
- More likely than not, if you are a betting man
it's gonna probably be more from a herniated disc.
But we're gonna show you some things today
to try to distinguish between them
because if you try to treat piriformis,
or a herniated disc, like you would a piriformis syndrome
you're not gonna have any success.
- Right, exactly.
And I think this model we have
pretty much explains it very clearly
in a couple simple tests.
- Alright.
- So this is for the piriformis.
- Right.
- I'ma just get this outta the way.
- So the red tape here represents
- The piriformis muscle. - the piriformis muscle
It's a wide, flat muscle goes
from the greater trochanter to this,
to the sacrum here.
The blue stretch band here represents the sciatic nerve
and it goes right through this area.
When this muscle tightens up
for whatever reason it pushes down on that sciatic nerve
and anything that interferes with the nerve
at this point will send that pain symptom,
pain, numbness, tingling
- [All] Down the leg.
- And as a point of interest Brad,
by the way, sometimes it actually goes through the muscle.
- Right.
- And sometimes above the muscle.
- Sure.
- It's just depending anatomically where it lies.
- Unfortunately, we're not all anatomically perfect.
- That's right.
So by looking at this
you can kinda tell where your symptoms are gonna be though
if you have piriformis syndrome.
- Right.
- You're gonna have 'em...
Can I jump into this?
- Jump in, jump in Bob.
- Alright, you're gonna have pain in the butt
and going down the leg
but you're not gonna probably have pain
in the back at all.
- Right. I mean...
- So that's a big sign.
- Yeah, maybe it could be further up that way
but this is where you've gotta work with a little bit
but we'll show you some tests
that can help eliminate that difference.
- Right because I also should say too
you could have a herniated disc
that hurts down here
and doesn't hurt up here.
- Yeah, it gets a little tricky.
- Yeah, it does
so that's why you got therapists around,
right Brad?
- Exactly.
- Do you want me to lay down?
- Go ahead, go ahead. - Okay.
- You take the nap.
- Alright.
- I'm gonna need you on your stomach.
(Bob groans)
Prone position, Bob, prone.
- I'm prone to not listen to you.
(Brad laughs)
Okay, what are we doin' now?
- Lay flat, Bob, we need you flat.
Look at the camera, we've had some viewers say
we're supposed to look at the camera more.
(Bob chuckles)
- Okay, so I'm gonna, right here's the sacrum
that bony prominence and here's that hip.
You don't have to do this
but I like to find out where the two points are
and then right about in here,
if you push around in there,
if they got piriformis,
a tight piriformis it sends 'em through the roof.
(both chuckle)
They're not happy with that at all.
- And what you wanna do is definitely compare sides.
- Right. Yep.
- Because generally you're gonna find
the one side is much different than the other.
You can poke around on yourself even too
- Right, right. - And feel.
The other thing is quite often I've found, Brad,
sometimes the muscle was actually tore too.
- Sure, yep, it could be.
- And it's kinda scarred up over the piriformis
and the sciatic nerve.
- Yeah, so you're look in here
and you get in there.
I usually go like this with my knuckles
and I'll get in there, start out slowly
and if it's hot, other words tender,
it doesn't take much
but I'll get in there and push around just to make sure
and then I'll go on the other side and work that.
There's always a clear difference
from one side to the other,
very clear if you got piriformis tightness and pain.
- I thought you were gonna buy me dinner
before you do this, Brad?
- Oh no, forget it Bob.
(Bob chuckles)
- Okay.
- Alright if you keep talking smart I'll take care of ya.
- Alright.
- Alright the next thing is if we bend the knee here
at 90 degrees and we rotate the femur internally,
in other words all you do is take the knee and go this way.
Okay, that tightens up the piriformis
and then you compare sides.
- Oops, sorry I didn't mean to hit ya.
- We've got a bad angle here
but lets say this foot only goes out to about 20 degrees,
maybe a little pain up in the buttock with that
and this one drops way down,
lets get this foot out of the way Bob,
drops down, no pain, everything is very relaxed.
That's another possible sign, indication
that you got piriformis.
So if you got tenderness here
you do this test and it's tight with some pain there,
pretty good indication it's piriformis.
- Yeah, if you even do this
you might even get more pain when you go this way
cuz you're putting a stretch on it.
- Yep.
- Didn't I say that Lonnie?
- Oh, maybe she, maybe you did already.
(Brad chuckles)
- Okay, the last one.
Do a press up Bob and back down.
If you can do these, go ahead again,
and it doesn't affect anything
that's an indicator that it is piriformis,
but if you do this,
and all of a sudden you get pain shooting down your leg,
gets much worse and alls we're doin' is working
with the low back, that's an indication it's not piriformis
and probably, you know.
- If it gets worse or gets better.
- Oh yeah, it could be either direction.
- Yeah, if it changes it really.
Right.
- That's when you have to start thinking that it
no, no maybe it's herniated disk.
- Yep.
- So these are tests you can do yourself.
You can lay down like this and go, Brad,
like this and see how they're doin'.
- Just don't kick anyone.
- You can do these. Yep.
- So you can do all these basically.
You can palpate your own butt.
(Brad snorts)
- Oh, palpate, yeah.
- Palpate means touch.
- Yeah, forget about it.
This is a family show here.
Alright let's go on to a herniated disc.
How are you gonna find out if it's a herniated disc
from simple tests?
- Well some of the things herniated disc,
it tends to be worse
with any type of bending or flexed position.
- So sitting.
- So yeah, prolonged sitting tends to make it worse
although piriformis can be bad if you sit on it.
- Yeah, yeah.
This is where it gets a little touchy sometimes.
How about this one?
When you stand, often time a herniated disc
when you stand up, this motion from here to here.
This is how the person will look.
(groaning)
- Yeah. And they get up slow, slow,
but after you get up
and you start walking around a little bit
it loosens up and then it can be much better.
- So I'm thinking guys that we already alluded to Brad, too
if flexion tends to make it,
when you bend your back forward
like laying on your back even
and bend, like if you do repeated flexions like this.
- Double knees to chest.
- Yep, and this starts making your back worse
and the leg pain worse - Mmmhmm
there's a chance that that's a herniated disc then.
- Right. Yep.
- So the other one you talked about is
just plain tenderness in the back, right?
- Right. Exactly.
And this one you can kinda check yourself,
I think it works better if you're layin' down flat
and you have someone else
because then the muscles are relaxed
and you can get in there and work.
And usually you'll feel one side or the other
or some gentle pressure in here is gonna say ,'Ow'.
And the person's gonna know that.
Right.
- So you have to be careful.
- Quite often they're very sensitive
- Right.
- If it's herniated disk. - Exactly.
It doesn't take much at all so.
- So now that we've completely confused our viewers.
- That's right.
(both laughing)
- So I mean, you know
if you're really having a lot of back symptoms
I'm really leaning towards herniated disc.
- Right, right.
- If it's a lot that just staying in the leg
I'm more leaning towards piriformis.
- And we do have a nice video on piriformis stretching
and you could do that.
- Yep, I'll link that at the end here so.
- And that's not gonna make the disc worse.
- Right, yeah give it a try.
- Yeah, you've got nothing to lose.
- Alright, thanks for watching.
- Have fun besides.