♪ Bob and Brad ♪
♪ The two most famous ♪
♪ physical therapists on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist
- And together we are the most famous physical therapists
on the internet
- In our opinion, of course, Bob.
- Glad you were chiming in there, Brad.
Sometimes you get a little silent on me.
- Well, it happens.
- Okay. I don't know why I even said that.
Today, Brad, we're gonna talk
about 10 causes of pain down your leg.
A lot of people think automatically
they get pain down their leg, "I have sciatica."
- Exactly.
- I just had a patient like this.
"I think I'm getting sciatica down my leg."
- Sure.
- And actually there's a lot of reasons
you could be getting that pain and we're gonna go over them.
There's 10 of them at least.
And we're gonna go over the these
so you can kind of maybe even somewhat assess it yourself.
- Sure.
- We'll give you a hand here.
- Gives you something to think about anyways.
- Yeah.
And I see, Brad, we have a couple new people
- Yes there are. - that just walked
right in here. - there's three out there, Bob
- Yeah. Thanks for coming.
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- Yeah.
- Yeah, we've got that- - Complex.
- Yeah, complex we need to get over.
- Yeah. - So help us out.
- All right, today, Brad, let's talk about the first one.
The first one that quite often causes pain down your leg
is simple hamstring injury.
- Sure.
- And you can can see why that is, Brad.
- Right here.
- Hamstring attaches to your sit bone right here
and it goes down and attaches to below the knee.
- Yep.
- So you can see, if you're getting pain down here,
how that could easily cause a pain like sciatica
sending it down there.
But it's not sciatica.
- Yeah, it's a muscle injury.
- So let's show you just one simple test, Brad,
maybe with you sitting.
- Yeah, Sure.
- So you can bring the leg up like this
and then just have him push down.
- Yeah, so just a muscle strength test.
Make sure the person's sitting up with good posture.
That will be helpful.
I'm gonna pull my foot underneath the table
as hard as I can.
- Pull, pull, pull, pull.
- Ow, that hurts, Bob.
- Yeah
- That might be indicative it's a muscle.
- Right.
- And then maybe if we stretch it the other direction
I stay relaxed and give it a stretch once.
Go ahead.
Go ahead, Bob.
And if that also hurts, as well as the pulling,
that's also indicative.
- Yeah, because you're stretching the hamstring.
- Right, right.
- But you wanna have good posture then.
You don't wanna be slumped over,
because that gets confused with another test
we're gonna come into just a little bit.
- Well, why don't we do that next, Brad?
- Okay, then.
Say no more.
- The next one is a herniated disc.
Now this would be sciatica.
- Right.
- Okay. So you have a disc that's pushing
on the sciatic nerve or the nerve root.
- Sure.
- And it's sending pain down the sciatic nerve.
And a very simple test for that
is the straight leg raise test,
which you can do it two ways.
Probably the best is laying down, wouldn't you say?
- Well, that's the way I always do it.
There's one point I wanted to bring up.
If it is a hamstring injury,
almost always the pain is not gonna go below the knee.
- Right, Good point.
Very good point.
- It's gonna stay from the knee up.
So that's another little clue.
There's a lot of little clues.
People Take some notes, people, if you're into this.
Get your notepad out.
If it's not going below the knee
it still could be sciatica
but it's starting to think about other things that possible.
So why don't you lay flat, Brad?
- Yeah.
- On your back.
Sorry. No pillow.
- I'm good at that.
- That's all right.
- I feel good.
- So very simple.
You're just going to go ahead and the side that it hurts
on you just go ahead and lift it up like this.
You gonna have someone lift it up for you.
You can go up to the point where you start to
feel resistance and now I bring it down, just a hair.
And then I go like this.
Now he's gonna feel stretching here in the calf.
But if he feels pain in his back and down the leg
now we're starting to think that might be a positive
for a sciatica or herniated disc.
- Right. And I've had people where I do this and they say
I feel it right back here.
And then you know it's related
to the nerve one way or another it's probably.
- Yeah.
And Brad I'm sure you've found this too.
Brad is a lot of times you just even go up this high.
- Right.
The chances are, you're not gonna go that high.
- Yeah. If you're not gonna go that high
and then you'll find out you can go higher
on the other side because that one's fine.
- Exactly.
Compare one to the other.
- Yeah. It's very, it is usually pretty evident right away
if it's sciatica.
- Do I have to get up?
- You can get up.
- Oh the rest.
Okay.
- Now this one, this next one
Brad is a little more difficult.
It really takes more of a therapist to diagnose it.
- Yeah.
- But sometimes
after you had a herniated disc and it's gone away
- Right.
And you still might have some scarring on the sciatic nerve.
- And it happens if you look here up in here typically.
- Right.
- But that nerve comes
up and it binds down in that nerve.
A healthy nerve needs to be able to move up
and down slightly.
And if it gets bound up, then that nerve gets stretched
because it's hung up in that scarred area.
So we need to break that scar tissue up.
But the tests are a little
- A little bit beyond I, you know
what I would say is
that a therapist would've to diagnose,
and in that case, then you do what is called nerve flossing.
- Sure.
- Which believe it or not
that it sounds kind of funny, doesn't it?
- Yeah.
- Like it flossing your teeth
but you're breaking up the scar tissue.
So that that's another possibility.
And that is more of a sciatic problem, you know
was kind of a sciatic.
- Right.
Like after a back surgery
and the person didn't rehab properly
that's a classic case of having that problem.
- Another common cause
of pain down the leg is stenosis.
Now this is very common is as the back starts to degenerate
there's less room for the spinal cord.
There's less room for the nerves to come out the side.
I don't know.
Do we need to show all that or not?
- Well, actually let's go on because there's
we gotta get through all 10.
- Yeah. We gotta get all 10.
So, you know, one of the
one of the big signs of stenosis
is it's called shopping cart syndrome.
So if you're this isn't
or you could also use a Walker to do it, but if you're
if you're back feels and the leg pain feels a
lot better leaning forward.
- Right.
That's generally this.
That's the first question I ask people, you know
does it feel better when you're in the grocery
store and you lean on the shopping cart, they go, yes.
And it's worse when they stand up right straight.
- And when they sit down, it goes away quite quickly.
- Right. That's the opposite of sciatica.
Sciatica is usually worse sitting.
You know what I mean?
Because you get a hernia disc.
- Right. Exactly.
- But stenosis, it's gonna be
feel better sitting right when you're flexed.
- Yep. Exactly.
- So, all right.
The next one, Brad is regular old hip arthritis or hip pain.
- Yep.
- Can go down your leg.
I mean, you, quite often, you get in the groin
down the inner thigh right down the back.
I mean, there's just a lot
of different ways you can be getting it.
- In this
I don't think it's common, but I can think
of one case where a patient had it all the way
down to the foot.
- Yeah.
- And it was classic sciatica and we worked on it.
It worked on it because everyone thought it was
from the back, the hip was bad too.
And she ended up getting a hip replacement
took care of everything.
- Wow.
- It's these things aren't easy all the time.
- Yeah. It's weird.
How much pain from arthritis from like a joint
How far it can travel
sometimes I've seen it in shoulders too
go all the way down to the hand.
- Yep.
- When it was a shoulder issue.
- It's called referral pain.
It refers out, usually downfall the nerve.
That's why this is not easy.
You know that's why we do go
to school for a little while.
- I think the hip pain, a lot of times
what you're gonna see is, you know, if you, especially
you only have it one side
you're gonna see the one side does not move as well.
If it is arthritis.
- Sure.
- So if you bring this one up
this one goes up this far and this one only goes this far.
- Right.
Or if you cross your legs, this one goes
up way like this and this one goes way down like that.
- Sure.
- You know, there there's indicators
you can even do an internal rotation like that.
- Right. So again the big thing is hip can refer
down the leg and mimic sciatica.
- Right. Next one is the IT band, Brad
- IT, does that band?
- Oh, IT band.
- Oh, I thought it was it like those computer people.
Yeah. Yeah.
- Brad's gonna show you real quickly
How to how tight band, the band runs all the way
from here all the way down to the knee.
- Right.
- So it's the iliotibial.
- So we got the ileum, the, the Thilia down here.
Now the test is, we have someone laying their
side like this.
Bob, can you scooch back to the edge of the table?
You can do this on a bed
but it's much better on a firm surface
like this.
- Just don't fall off.
- So here, that band is represented by his clothing here.
And if it's tight, it's like this and it tightens
up more.
- Lot times you hold right here, Brad, don't you?
- Yeah. But I want..
- You don't wanna be in the way.
- Yeah. I don't wanna be in the way, if you put your hand
you're like, I would have my hand over there.
- So I'm holding the pelvis.
- And I'd be like this
but so you can see now, if it's not tight
the leg will go, go down way down.
If you got a tight it band
- And you let go it'll hang up.
Right. Like right there.
- And the nice thing about this again, is flip the person
over test both sides and see how they compare.
- Yep. That IT band though,
it can give you a lot of pain down, even in the knee, right?
In the knee area where it attaches.
- Right, exactly.
- Next one is the pure performance muscle Brad.
That's a small muscle
in your butt, the buttocks, Bob, the buttocks.
- Yes.
- And it can cross over the sciatica.
It's actually called false sciatica sometimes
because it can send pain all the way down your leg.
- Oh yeah.
But the muscle crosses over.
Sometimes the static nerve actually pierces through it.
- Sure.
- And I'm gonna show you just a quick test
for that, Brad.
- Sure.
- In fact, there's two, usually one, if you like
let's say the pain is on this side, Brad, generally
if you bring the knee up and cross it over,.
- So like your right knee is going
towards your left shoulder.
- It's going to feel real
tight.
And it may even hurt a little bit compared
to the other side and that one should be better.
- Right.
- That's how it is with a pure form muscle.
The other thing you can do is you can actually get yourself
in what we call the clam shell position here
knees together like this, and you do these.
- Yep.
- And if you do a repetitive, these
and it starts hurting down the leg.
- Yep.
- You're putting pressure
on that pure performance muscle.
It is an external rotator.
- Sure.
- So that's one
those subtle little ones that kind of contest.
- Yep
- Next one.
Sacroiliaca.
Brad, do you wanna pull the spine out here?
- You're getting a workout today.
Alia pulled whatever.
Let's take a look at that scacroli
This is a sacrum, the illum
So they get an SI joint here
and one right here, solid bone right there.
But it, that joint is..
- That can send pain
down your leg and into the groin.
- Right.
- And a lot of different way rule
of thumb that I've always has heard and go with.
Is it doesn't go past the knee typically.
- I don't think I've seen an SI go past the knee.
- Yep.
- I see it a lot
of times in the front thigh and, and in that area here
one simple test for the SI Brad is just a lay down
cross the leg over like this.
You push down here and push down here.
There, here.
- Gently push, gently push too hard.
- And a lot of times that puts pressure on the
the SI and it'll hurt on that side.
- Yeah.
- Next one.
If you have arthritis in your back, believe it or not
that can send pain down your leg.
- Sure.
- Just plain old arthritis.
And it can go
but generally that will not go past the knees either. So
- You know, if that's developing
into that kind of a arthritis could develop into stenosis.
- Right.
- And so these things tie together.
It's just not, that's what makes it a little
more challenging, but you know, that's the way it is.
- The last one I mentioned, Brad is knee pain.
Sometimes knee can refer up.
It tends to refer down.
But I don't know
that I've ever seen a case that was real bad.
That went up.
I mean, I've seen it
and we almost always knew it was the knee.
- Right.
- Yeah.
- But I think that's more
more of a rare one, but you do read about it.
- Well, we needed a 10th one in.
- Yeah.
We needed a 10th one.
So we kind of stretched a little bit on that possible.
All right.
- Thanks. But you're never gonna get referral pain
down the leg from that the broken heart syndrome.
- Remember Brad and I can fix just about anything
- but the broken heart,
- but we are working on it.
- We're not gonna give up.
- Thanks for watching.