♪ Bob and Brad ♪
♪ the two most famous physical therapists on the internet. ♪
(Bob claps)
- Yippee ki-yay. - Yippee ki-yay.
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We all are the most famous physical therapist
on the internet.
- In our opinion, of course, Bob.
- This is the number one thing you should do
after a corticosteroid injection.
How is that for being enticing? Huh?
- Right. And where are we gonna get this injection?
- Well, from a doctor or you don't do this
on the street route is same to get from your neighbor.
- Right? So you may get it
in your back, your knee, your hip there.
- Oh, I see.
Is that what you're talking about?
- Right.
- Yeah. Don't matter where the location is.
You, you know, if you're having some pain and inflammation
what we're gonna recommend is that you first
try conservative treatment first, you know--
- Therapy. - Yeah.
- Yep. Some things recommended by us or other therapist.
- But there was just a guideline put
out by the Royal Academy of GPs.
That's general practitioners in Australia.
And they definitely recommended
that this is something you should try
or could try as a corticosteroid injection again
generally after you've tried other things.
- Right. And this is oftentimes done
with people who have severe arthritis in the hip
or the knee, or--
- Or, you could have a meniscus problem.
- Sure. - You could be.
I mean, shoulder.
I mean, it, it is just anywhere.
It's amazing.
Sometimes what you're trying to do is break the pain cycle
but I'm getting ahead of myself,
before we do that. - You are, Bob.
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All right. So we're going back to what I was talking about.
You get the corticosteroid shot.
You're knocking.
What you're trying to do is break up the pain cycle.
Cause quite often what happens, a joint will hurt.
And so you don't move it
and then you brace it and then it starts hurting even more
because joints want to move.
- Right, that's how they get their nutrition
through movement. They get fluid coming in.
- Synovial fluid. - Right.
- Gets propagated.
I mean, it, it helps with everything.
So, you know, if you just took your arm right now
and held it like this for a long period of time,
it would start to hurt.
- Right. And then it would hurt when you initially
moved it. - Yeah.
- But once you got it moving
then it gets back into that movement cycle.
Life is good again.
- So the number one thing you need to do
after a cortico, corticoid, corticosteroid, I'll say it,
injection is you start, you wanna take advantage
of it and you wanna start moving that joint.
- Right.
- So no matter where it is, let's say the shoulder--
we're gonna go over all the different joints
and what they should do. - Sure.
- The other recommendation we're gonna make is
if you have an injection into your back,
I would recommend that you get the image guided
lumbar epidural, - Right.
- corticosteroid injection. - Right.
And you know, you can ask your doctor about it.
Everyone knows it's, it's where they actually
can see the needle and guide the needle. So it gets--
- Yeah, they use X-ray or CT scan.
- Right. - I, Brad and I are old enough
that we remember the days where they, you know
you come in and they go, ah, your back is hurting.
I'll give you an injection.
And they almost never worked.
- Right? Yeah. You really need to get the,
the injection, the fluid of the injection
to the correct area. - And the spot.
- And the doctor who does it, they,
they know what they're doing.
- They know what they're doing.
And I just see so much better results now, Brad, with these.
And I definitely see, you know
sometimes I've seen it where, you know
someone can buy another year or two of pain relief.
- Sure. - When they get an injection.
And so let's start off at the shoulder.
So the shoulder's kind of a good one, because quite often
I don't even know that you need image guiding
'cause they know they can get it right
in the shoulder joint itself. - Right,
and it may depend on the person if, how their muscles are,
there's, what kind of tissue there's around it.
- So we're not gonna go into great detail
but we're gonna show you this one exercise that you wanna do
after the shoulder has been injected.
You wanna go ahead and do the Codmans.
- Right. So this is a simple general exercise.
You just lean over--
- Supposed to call it pendulum exercise.
- Yeah. Yeah.
And just let the gravity flex that arm forward here
and then get your body moving, get your arm to move.
You can go forward and backwards,
right to left with it.
You can make circles.
And it's a real gentle
relaxed way to get the joint moving right after
something like that. - Yeah.
- It's very common after surgeries and injuries as well.
- Exactly. It's just a great starting point.
So then we're gonna go to the
let's say the hip or the knee, or both even.
But if, if you get those injected
you're wanna gonna start getting some movement.
A good one to do is just plain old walking
is a great one. - Right, right.
- If you're still getting pain with that
we're gonna recommend like a bike
or what we have here is the elliptical
that we use in our therapy department.
That's why it's so beat up.
I mean, we probably have had this one for three, four years.
- Right. And it's used daily every time there's someone
in here, typically they're using this
for a part of their treatment.
- Yeah. And we like these.
I mean the disadvantage is
they're pretty heavy. - Yeah.
- This, this is the part that you buy right here.
Brad made this one because usually you have to put it
up on a two by four or something like that.
- Usually, you want three inches
because these are actually made
for standing, is what they originally made for
but we found that, if you can sit down and
you can pedal with it, get really good ankle
knee and hip range of motion
without the weight bearing pressures,
which is, in this case, what you want.
- So it's the InMotion E1000, again we've bought
a ton of these, - Right?
- Cause we use 'em all the time and,
and they move very smooth.
Again, the only disadvantages they're very heavy.
You're not gonna move it around the house very easily
but look how smooth this works.
So you can just easily start getting some
knee motion and hip motion.
- Well, I mean, even the ankle, we got knee, we got hip
and you can vary how much you flex as far as how close you
move the chair to it. - Right.
- Or if you slide the chair back, if you're in a wheelchair
this is excellent way to get legs and hips, my arm moving.
If you're unable to walk and you are in a wheelchair
for that reason, so.
- And we got these listed below in our
favorite products on Amazon, - Right.
- And then we're also gonna have to put out,
the advantage of, and this is the knee glide,
the advantage of the knee glide,
and Brad and I invented this by the way,
created it. - Right.
- And, it is so lightweight. - Right.
It's lightweight and it's just versatile.
You can take it with you.
We use these all the time after for knee--
- After knee replacements.
- A lot of times for knee replacements.
- Yeah.
- ACL, meniscus injuries, all works really well.
- My wife, yeah,
hurt her knee. - Yeah.
- And, and we had her using this and she,
she didn't like how much the ankle stress it had
when it was flat.
So she would flip it up on the, we have a little, little--
- That little stilt will get an incline.
- And so now this was a lot easier on
her ankles then. - Right, yup.
- And then she could easily work the knee.
- Right. And it does make the quadriceps work
a little bit more that way.
And if you wanna flip it this way
it emphasizes the hamstring effort and strength.
And it's amazing that doesn't look like much.
But when you do that--
- I'm feeling a hamstring.
- Yeah. You definitely, particularly
if you've got an injury or something,
you'll definitely feel a hamstring working harder.
- And then eventually you can add a little weight to it
even, you can put a ankle cuff around it.
- Yup, and then you can easily just put it in the closet,
hang it up and it weighs all of 2.96 pounds or something.
- Well, I always like to show how I can do a curl with it,
Brad, I can do a one finger,
- A finger curl. - One finger curl.
Look at that.
- Yeah. You could do one finger curls
and get that index finger going.
- All right. Not the middle finger, you didn't say,
the index finger.
- The pointer finger, Bob. - Okay. All right.
Just, this is a family show. - Exactly.
- All right, next thing.
We're gonna talk about the back itself.
Let's say you get a corticosteroid injection into your back.
You definitely wanna start walking.
- Sure. - I mean, that's,
that's the number one thing
but there's a lot of different exercises
you can do on laying down.
Do you wanna show the rotations and the knee to chest, Brad?
- Yes I do.
- And then I'll, I can show the extension.
- Excellent. Yeah.
I mean, sometimes walking may not be an option.
Maybe it's winter time.
You cannot get outside.
You live in an apartment,
but you can still get some good range of motion.
Particularly, I have people before they
get outta bed in the morning.
- [Bob] Yeah, absolutely.
This is a great one to do right before you get up
for a lot of people. - Right, sure.
- [Bob] Even if you haven't had an injection.
this is a great one to do. - Yeah.
Both knees up, feet together, knees together, gently
and I always say, just pretend your legs are
like a windshield wiper on a car going right to left.
And this is just breathing relaxed,
nothing stressful on this.
If it hurts one direction, don't go that way.
Just go the direction that doesn't hurt so much.
Work in a pain free range of motion
and gently as you work it more.
Particularly after the injection,
you should see that range of motion improving.
And then the next one you bring a knee to chest.
You might just start out with one knee
and you can use your hands obviously to help that knee.
And I like 10 repetitions on all these exercises.
And if one's going good
check the other one, do 10 repetitions.
If it's feeling good, then it's nice to go to both knees
and work that. That actually flexes the back even
a little bit more, help those facet joints
get some movement and get that mobility moving again.
- Again, it should all be pain free.
If it bothers you to lift both of 'em at the same time,
don't do that one. Cause it could, it could hurt your back,
to do both. - Yup.
Sometimes that is uncomfortable. Pretty common.
- So, I'll do the extension, Brad.
- Oh, sure.
- So for a lot of people, you know of the population
especially if you don't have spinal stenosis
or spinal osteitis like Brad does.
What you, the movement will go on into your back
to try to get some extension
because this is a movement that a lot of you are
gonna be lacking. - [Brad] Yeah.
- So you put your hands below your shoulders like this
and I'm pressing up and we've,
we've emphasized this one a lot.
I do this one, at least three sets of 10 a day. At least.
- [Brad] Now Bob's pretty old.
And even though he's like an old man.
I'm just kidding, Bob. He's only 50 something.
Look at the range of motion in his back.
This is incredible.
- I can go way up that high, so.
- [Brad] That's really good, helpful.
- Yeah. And a lot of people, what happens is,
their pelvis starts coming off the bed
cause they don't have enough mobility.
So you wanna work again in the pain free zone.
You wanna make sure that you can eventually over time,
get further and further.
And, and a lot of times your pain levels will coincide
and go down at the same time. - [Brad] Right.
- So where are we at, Brad? Oh, in the neck.
We're just left with the neck now.
If you got a cortisone jaw,
I don't know how often they give shots in the neck.
I guess they do, don't they?
- Yeah. It, it's not as common as the other places.
As far as my experience.
- So, yeah, with the neck
you're just gonna make sure you have really good posture
and you're gonna just, you know, just like the back,
you're gonna start some rotations.
- Some people, you think rotation in the neck and they're
moving their shoulders. - Right.
- You're gonna stabilize or think those shoulders
are grabbed by two big steel claws.
That's what I tell my patients.
And it's holding you there gently and then it's just.
- You tell your patients a lot of weird things.
- Well, you know, those things stick in their heads, Bob.
- I agree. - They like it.
They smile, they laugh.
- So yeah. Rotations and you could even do side bending too,
if you want to throw that one in there.
- Sure.
- And extension probably. Right.
- Yep. And, and all these you're gonna do 'em
in that pain free range.
Maybe a little stretch pain a little bit.
But if there's some sharp pain, for whatever reason,
that's a red flag.
- I always tell my patients to bump up against the pain.
- Oh, bump into it. Yeah.
- But don't go into it, just bump into it.
- Bump into it. - Yeah.
- Bump, bump, not.
- All right.
- Visual, Bob. I'm a visual person.
- I think we've talked enough now.
And so again, remember subscribe to us
if you haven't already.
- Once again, we can fix just about anything but--
- A broken heart. - There you go.
- But we're working on it, say no more.