♪ Bob and Brad, ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
But what have we got here?
- We got the famous pharmacist on the internet, Chris.
- Hi guys.
(Bob chuckles)
- And, well today, Brad,
we're gonna talk about how to promote healing
with your sciatica or if you have a herniated disc.
You know, a big part of it's gonna be the therapy videos
that we have provided you.
But another tool obviously,
is gonna be some medications that you can do.
- Right.
- And Chris is gonna help us with that.
- How are you gonna treat it?
And as therapists, you know,
we are not trained experts in pharmacy at all.
- We're like the layperson
talking to each other over the fence.
- Right.
- I mean, we don't know anything more than
- So it's nice to go back and forth with a pharmacist
who really knows what's going on.
I think a lot of people aren't aware, Chris,
and maybe you can help on that,
where people think if they have questions about a drug
or, you know, a prescription,
they think they have to talk to the doctor.
I've known you for a long time.
I know that if I talk to you,
you're gonna give me more than enough information
on how much
- Oh, much better answers.
- Right. 'Cause you actually look at prescriptions
and help the doctor out in case there's a problem.
Is that correct?
- Yeah, we're gonna help.
I wouldn't say help the doctor out.
I mean, at the end of the day,
the doctor makes the decision to write the prescription.
But yeah, if we notice something,
their profile. There's an interaction or a side effect or
you know, just something that might make this
whatever their choice is.
- Sure.
- You know, we're gonna call,
at least ask their opinion of the,
"Hey, do we wanna try it a different direction just to
make sure we can improve quality
of life or keep 'em a little safer."
- Right. So you're kind of a
- We're kind of a safety net.
- Safety net. Exactly.
- Sure. And before we go a little bit further, Brad,
let's talk about if you're new to our channel,
please take a second just to subscribe.
There's a little button over there.
Chris is gonna point to it.
- Right here.
- We upload videos every day
and we provide 'em on how to stay healthy, fit, pain free.
And once in a while, we'll bring in an expert.
- Exactly.
So this video we're talking about sciatica.
- Right. Sciatica or herniated disc.
- Right, and sciatica is referring to pain down the leg.
It's a general term, but oftentimes you probably agree, Bob,
and we don't have stats on this, off the top of our head
but it's often times from a herniated disc.
So you got the soft tissue, the herniated disc
that's inflamed. It's physically outta shape.
It's bulging, putting pressure onto a nerve,
causing that pain down the leg.
So as a therapist, we've got a number of videos
on how to change that pain, improve it through your posture
through exercises, but we wanna find out what can we do
and what do doctor's do and how do we work together
to increase this whole process so you start feeling better
with some, you know, pharmaceuticals.
- Let's talk about over the counter first.
- Sure.
- Chris, what would you recommend
if someone comes in and they have sciatica?
They maybe haven't even seen a doctor yet.
They just wanna try something.
- Sure.
- Yeah. Well, you know,
often times they do come to us first.
So I think, you know,
- Sure.
- Usually we're gonna turn around
and tell 'em to see their doctors
and see a physical therapist,
(Brad laughing)
especially if it's that bad.
But I think realistically, things
like ibuprofen or Aleve are excellent choices
because they are anti-inflammatories.
So as long as they don't have any interactions.
They aren't allergic to anything and they don't
have any health conditions that would negatively
affect them.
Go to choices: they're gonna be ibuprofen or Aleve.
And so from that standpoint or Naproxen sodium.
So from that standpoint,
it will help to reduce the inflammation.
So hopefully, you know, if it is truly the bulging disc
which I would have no way of knowing.
I just know they hurt and they've got weird posture
and a gait, you know.
We're gonna say, "well, give this a try."
We'd say probably ice it.
Use the anti-inflammatory like ibuprofen we'll pick on.
We'll say one to two tablets every four to six hours apart
with some food to protect your stomach.
Hopefully we're gonna get some good relief from that.
And if they don't get the relief, then it's gonna be
you know, make sure you call your doctor.
And they're probably gonna say treat and eval
to the physical therapists.
- So maybe we wanna talk about some
of the commonly seen medications that
people come in quite often when they have sciatica
from a doctor prescription.
- Yeah. What are some common things that you see?
- Yeah, well kind of across the board,
it seems like it's gonna be an anti-inflammatory.
So either maybe prescription strength ibuprofen, a lot
of cases, they do Naproxen, which is an excellent.
anti-inflammatory.
Usually coupled with a muscle
relaxant to help because there's so much spasming to try
and protect the body.
And so a lot of times that loosens up and it gives 'em
a degree of comfort.
- Sure.
- And then, you know, the other thing that sometimes
they may do in place of an anti-inflammatory is a steroid
which is kind of a more potent version
of an anti-inflammatory to help get 'em
through this phase.
- And that's usually a relatively short period.
- Very short bursts because that's Pandora's box
as far as drug is.
And side effects and things like that.
So you want do a short burst, but more importantly
it seems to give a lot of pack for its punch.
So hopefully it will reduce the inflammation to
give them quicker healing if they can and
and get them back moving towards wellness.
- And I think from a therapist point of view
we're thinking, you know, maybe there's a problem
with their seated posture, whatever the issue is
maybe they're bending wrong at work causing this problem.
You'll want to take these, you know,
the pharmaceuticals, ibuprofen, but you really
gotta get to the root of the problem.
- Right.
- Look at the body mechanics. Maybe it's
- What's caused it in the first place?
- Exactly. If it's from a mechanical problem,
from a posture issue, a bending issue,
lifting mechanics, that has to be addressed.
Otherwise you can continue to throw pharmaceuticals at it
and it just kind of mask that.
- Chris, can you talk about what are some of
the more common side effects
of the prescribed drugs that you just mentioned?
- Absolutely. So in the case of like any
of the anti-inflammatories across the board
we wanna make sure they're not on the blood thinners
because that can actually increase their risk
for bleeding risks.
Then once we find that that's a goal then we're
gonna look to make sure they don't have any stomach issues
which long term, or even short term use,
with a stronger potent prescription anti-inflammatories,
GI bleeds or stomach ulceration can be a factor.
So, you know, basically a lot of times doctors will actually
prescribe just a five or 10 day supply.
- Sure.
- To test this out.
And then if it's something that they tolerate, well, boom
they'll stick with it.
But if there's any mention of stomach pain or just
discomfort.
Heartburn, which is a common presentation,
you know, they're gonna be advised to see their doctor right
away to make sure they're not creating a new problem
even though we're trying to fix the problem.
- So they're getting the warning sign of some sorts.
- Oh yeah, yeah.
You're definitely because we're gonna tell you to watch
for the certain side effects, which would be
the upset stomach.
In some cases it can be even some dizziness but, you know,
the reflux or the heart burn or the stomach pain are
really the things that, across the board
with anti-inflammatory and steroids actually, like a
a Medrol dose pack.
Those are things that can really rip up the gut.
So we wanna be careful with that.
- The steroids always seem like they really work
but as people come off of 'em,
quite often the pain comes roaring back.
- Yeah. You know, and that's the thing, I mean, a steroid,
it's a quick hitter in a lot of cases.
Long term it's you know, I mean,
there's reasons for long term use
but you don't want people on it for a long period of time.
- Right.
- Steroids, I always tell patients, you know, they can solve
every problem, but they can cause every problem.
- Right.
- So it's something. Believe me.
Doctors don't choose that lightly.
- Right.
- They come up with a reason
for it and they're like, "Hey, let's see what we can do."
- That's what I've seen.
- Yeah.
- What about the muscle relaxant?
- I think the muscle relaxant is a fine tool too.
The negative thing with the muscle relaxants is
often times they tend to make you tired
so caution your driving.
- I'm was just gonna mention because
that's the symptom I see all the time
on people that are on it.
- So that's a tricky one to get around with, you know,
because we don't want 'em driving.
So a lot of times we'll advise people to take at home or
at night, you know, so they can try and avoid that.
But if they're so miserable, they can't even move,
stay home, use the muscle relaxant, use the pharmaceuticals
to at least try and improve quality of life till
they can get to a point so they can drive out
and see you guys.
- And that's the issue that a lot of people are on it
and they're like, "Oh I'm so tired",
so then you have to have somebody drive 'em in
- And it's a very real danger.
So it's something that you have to focus on.
It's something that, yeah, your reaction time is blunted.
- Right.
- Period.
- So, you know, you got all these options
and you know, I'm still, I'm one of those people.
I stay away from meds unless I need 'em.
And when there's a time, I think it's appropriate,
but I think things are overprescribed.
I don't wanna insult your
your profession or that, but I mean, in the United States
I think pain pills are maybe too much.
- Well, I think that especially
when you get to the narcotics.
I mean,
- Narcotics, we have a problem in the United States
and they're trying to address it very heavily.
And there's lots
of new changes that are going under way
with lots of doctors.
And, that's not just the doctor's problem.
But I think expectations of pain are probably
the bigger problem is we all wanna be pain free.
Nobody likes to be in pain.
And so the solution is, well, what do you do?
Well, we prescribe a medication.
It's generally speaking a narcotic and you know,
and in the United States we use like
I think it's 99% of all the narcotics in the world, so,
- Wow, okay.
- And you know, I understand from the doctor's standpoint
'cause we have people come in and they have intractable pain
meaning that it's just nothing seemed to help.
Nothing. You know, it doesn't go away.
And what do you do with this person?
They come in and they're they say their pain's
at a nine out of 10 and, you know,
and they've tried the other things and they're not helping.
- Right.
- And so then they go to the narcotics.
- But I think we gotta get back to the sciatica.
- Sure.
- Is this gonna make it better though?
Are the meds gonna make it better?
You've been doing some research.
- The anti-inflammatory I think could.
- I think the anti-inflammatories are gonna help to
promote healing because you know, when you have injury
and injury creates inflammation and again, we've kind
of chatted about inflammation actually, maybe
being somewhat helpful, but it can also
be counterproductive.
- Sure.
- So if you get that swelling that's impinging
on the nerve, shooting down the leg.
- Yeah.
- You take the anti-inflammatory
- Sure.
- To try and reduce that to hopefully free up some mobility.
- Yep.
- Take the hush off that nerve.
So, and you know, with you guys correcting the mechanics
and the modalities and everything else
that you guys work on.
- Sure.
- Hopefully get them
from feeling not so great,
back to a functional state of being.
- Well, I think the other thing
is that movement is very important
with back pain and with sciatica.
- Mm hmm.
- The right correct movement that is,
and if you just lay still in bed, you know,
and lay like a log, things are gonna get worse.
- Sure.
- I mean, you know,
that's the first thing we try to do get people
up walking and if they can't walk,
so if the medication allows 'em to walk,
that's gonna help them heal.
- Sure. Yeah.
- Very much so.
And like you say, I think when you get, when
you put the whole, you gotta have, it's a whole package.
It's not just one thing.
I don't think one aspect's gonna solve the problem.
- Right.
Right.
- So I really think that
the pharmaceuticals definitely have its place
as a tool in the shed to ultimately help promote healing.
- Yeah, absolutely.
- Right. So make sure you see your pharmacist
or use your products
from the pharmacist, as Chris mentioned.
See your therapist and you'll get through it.
The sciatica pain can heal.
This can help out. Make things a little bit faster, so
- And make it more comfortable.
- Exactly. Anything else, gentlemen?
- Thanks again, Chris, for coming.
- You're welcome.
Thanks guys.
- Thanks.