- Bob and Brad
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the two most famous physical therapists on the internet.
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- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous
physical therapist on the internet.
- In our opinion, of course, Bob
- Today, Brad we're gonna talk about three signs
that back pains, or sciatica, is very serious.
You need to see a doctor immediately.
- Right.
- So these are something not to be taken lightly.
- Right. And you know, these are relatively clear
so it's not like, well.
And you know, we'll go through it in some detail.
So before we go on with that, Bob,
shall we invite a few people in?
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There is no doubt, Bob.
So if you've got back pain and it's pretty severe
and you wonder, do I need to see a doctor?
Do I not?
What's gonna happen.
Well, oftentimes if you got severe back pain
it's probably a good idea to see the doctor
or therapist, if you don't know what else to do.
But these are three signs that you need to get
to the emergency room and get things taken care of.
- Sure.
- Right away.
It doesn't mean, just because you have
some of these symptoms, doesn't mean
- That it is serious.
- Right.
- But it just means it needs to be checked on.
- It could be.
And if it is, you need to get in.
- We're not trying to panic you,
but there are times where you need to go in.
- Okay. So the first one, this is a big one.
It's called Cauda equina syndrome.
We're not gonna get into why they call it Cauda equina.
There's a little history about some Latin language
with the spinal cord.
But it's when pressure gets put on the spinal cord
in the lumbar area and what it does,
one of the big things that it causes,
is loss of bowel and bladder control.
Now, I've had patients that they say,
I ask them the question:
Have any loss of bowel or bladder control?
But sometimes they say, well, I've had bladder problems but
- I've had a long time.
- Yeah. I've had 'em for the last three years.
And then I say, has anything changed
as a result of the back pain?
And if they say, no, it's the same
as what it always had been before this episode, well,
- Yeah, that's not a concern.
- Right.
But you know, your back is bothering you,
you notice a change in your bowel or bladder,
you need to get to the doctor.
And along with this
oftentimes the symptoms of what we call Saddle paraesthesia.
In other words, where you sit on a horse's saddle,
that area that makes contact
with the saddle in your groin area, in the buttock is numb.
It has tingling, numbness feeling.
- Some change in sensation.
- Right.
If you have both of these,
boy you better get to the doctor and get it checked out.
Now I had one person that had this
in the last 20 years.
She went to the doctor.
It was negative.
She didn't have to.
But if it's positive, and there's a problem,
you need to have surgery right away.
Otherwise it could be permanent nerve damage.
- It's killing the nerves.
And I've had two patients, Brad
- Okay
- I'll do ya.
But one of 'em...
- But you got 30 years instead of 20.
(laughs)
- One of 'em, it was nothing.
The other one I saw after the fact, he was paralyzed.
- Oh really? So it was a...
- Yeah.
- Issue.
- He was paralyzed from the waist down,
and it never came back.
- Okay. Yeah.
- So
- So, you know, that's what we're gonna say,
the worst case scenario.
- Yeah, worst case scenario, right.
- So get it in, get it checked out.
The next one, if you have back pain when you sleep at night,
wakes you up, that type of thing.
But you get up in the day, and as you move around,
it's completely gone.
You feel comfortable all day long, but only when you sleep.
That's a big concern.
And if I have a patient that has that,
I'm looking carefully to find out,
you know particularly if the person has weight loss
- Right.
- Unexplained weight loss, you know, I call a doctor, say
get to the doctor, let's get this checked out.
This is not typical for a back problem
that's caused from twisting,
bending, some mechanical problem.
You need to find out what the cause is.
- I, yeah, I wouldn't say it's an emergency,
but if it hurts, no, I would say that might be an emergency.
But I would say if it's hurting at night consistently,
I would probably go in too at some point.
- Sure. Right.
- I mean, I wouldn't, when it's not an emergency.
- Right.
This is not one where you're gonna go to the emergency room,
but you need to see the doctor.
- You need to see the doctor to make sure that
- Sooner than later, or, you know.
Like where I live, we could go to the urgent care.
- Right.
- You know, it's not a big deal
but you get it taken care of.
- Yeah. You wanna get it looked at.
- Right.
- You don't wanna let it keep going on.
- Okay.
And number three, and this is something that Bob and I,
we are always looking for this,
and doctors are too, is loss of motor control.
Usually people with sciatica pain,
numbness, tingling down one leg,
they're the people who are probably gonna have this.
Although it could be down both legs,
which is even more of concern.
If you have a loss of motor control, you're losing strength.
There's one thing to have symptoms
of tingling, numbness, you know, that's
- Burning.
- Yeah.
- Typically a pinch nerve.
But if that nerve gets so pinched
that you lose motor control
'cause a nerve is what's making your muscle
- You're killing off that nerve, is what you're doing.
- Right.
- You're damaging it.
- So for example,
a really quick test that is done all the time.
If you've been to a doctor a number of times,
they've probably done this and you didn't even know it.
They'll say,
Can you walk, can you see this with our feet?
- Can you walk on your toe,
or on your heels with your toes up in the air?
Or can you walk on your toes
like this with your heels up in the air?
And if you have a problem
and one side you can and then fall side, it just drops down.
- Right.
- Or you cannot go up on your toes.
Now don't get this confused, particularly if you're older.
I say people usually in their sixties and older,
and you probably agree with this,
this is just anecdotal evidence.
- Right.
- They get weaker in their calf muscles.
- Sure.
- And walking on their toes.
- Yeah.
So especially if it's uniform on both sides,
- Right.
- That they have some difficulty,
and by the way you might wanna hold onto something
if you are a little
- Yeah, yeah.
Grab yourself, you know, something to hold onto.
Then there, you can do other manual muscle testing
which gets a little more, you need to be a therapist.
Usually.
- Sometimes what I'll do is just do,
if you don't mind me taking my shoe off,
it's not gonna
- Well, it's always been an issue in the past.
Let's see how it goes.
- But a lot of times I just push on the big toe,
hold the toe up,
- [Brad Heineck] Right.
- And I push on it,
'cause that's usually the first one to go.
- [Brad Heineck] Sure.
- It seems like quite often.
- [Brad Heineck] Right.
- So, you know,
and the other side holds your good leg.
- [Brad Heineck] Right.
- Holds, but this one pushes right away.
- And, you know, that's a good thing.
Compare one leg to the other.
You know, if you're at home trying to do this to yourself.
If there's any question,
you need to go in because the manual muscle
- Yeah, it's better to be safe.
- Yeah.
Manual muscle testing does take some practice.
You know, it's more for a professional, like a therapist.
But you know, a gross, you know, if you can kick
one leg up and the other one you can't get up,
you obviously have a problem.
- Right. And again, you wanna get in
on treating these things treated
before they become more of a permanent issue.
- Right.
So the nerve can revive itself
and not be of a permanent problem.
So what do you say, Bob?
- I say,
- Those are the three things and you know, be careful.
- Okay. Thanks.