♪ 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.
- Today, we're gonna show you how to use
a massage gun to treat piriformis syndrome
or what is now called dupe, deep gluteal syndrome.
- Yeah.
- Not dupe, deep gluteal syndrome.
So for your- - DTS.
- DGS.
- Oh yeah. (chuckling)
- So, what is this, by the way?
First we know...
We've known it as piriformis syndrome for 20, 30 years
and the piriformis...
Let me just show this real quick.
You have your sacrum right here.
That's a triangle-shaped bone.
The muscle, it's a little muscle that attaches
to this sacrum and it goes down
and attaches to the greater trochanter
of the hip right here.
So it's a little triangle-shaped muscle.
The problem with the muscle,
and we'll show at the end,
Brad, at the end we're gonna show,
show a diagram of these muscles.
The problem with the muscle is that it,
the sciatic nerve crosses right underneath the muscle.
- Right.
- And, over time, if that muscle spasms or tightens up
or has, I think, scar tissue,
it can scar up over the sciatic nerve.
- Sure.
- And it could send pain down your arm.
So it's go-
- Leg.
- Down the leg. (laughing)
So it's actually been called false sciatica.
- Sure.
- Because it is sciatica,
but it's not from a disc problem, so...
But now the belief is that other muscles
may also be involved in this.
And there's a lot of external rotators.
When I say external rotation, it turns the leg out.
- Right.
- And you know, the gemelli,
there's two of the types of gemelli,
obturator internus.
And they thought even the hamstrings
and gluteal muscles might be playing a role in that.
- Sure, sure.
- You know, it's,
there's a simple test to do for this, Brad.
Why don't we show this right now?
All you do is you lie on your non-painful side.
So let's say I have painful side on the right,
and I'm gonna lie and I stack my legs.
- Yep.
- And I'm gonna lift my leg up like this.
Then you have a friend push down,
I try to resist it.
And that makes that muscle work.
And if it reproduces your symptoms,
started getting pain down the legs,
there's a good chance you might have deep gluteal syndrome.
- So the piriformis involvement
versus a possible disc problem.
- Right, exactly.
And also if you have a hard time sitting.
The pain often worsens with sitting
'cause you're sitting right on those muscles.
- Pressure on it, yep. - Yeah.
So, I had a fall, Brad.
I don't know if you want this to be the same.
When I've treated this in the past,
massage has been the most effective treatment
I've had for it.
I mean, I've done some stretching
and I do all this stuff,
but, it seems like the massage, I don't know, it,
quite often, it seemed to me that the muscle had been
maybe even some micro tears in it.
- Sure. - So-
- So there probably was an injury involved in there.
- Probably.
I know, I remember one case in particular,
a guy was walking along and his foot got stuck in the mud.
He had to pull it out and think about it, you know?
- Probably- - Yeah.
- Yeah. - Went into external rotation.
So, what we generally recommend is
you'll find a tender spot in your butt.
But what generally is, we'll massage around that whole area.
- Sure.
- And then narrow into the painful spot.
- Yeah.
'Cause it's usually about the size of a quarter
maybe a little more
and it, you know, on patients, I know when I hit it.
It's like, "Ow, that's," right away they say,
"That's the spot."
- It might be too much to even tolerate massage right on it.
Start off with...
And that's why...
Now, I'm gonna tell you,
this is one instance where I'm gonna be a big advocate
for using a mechanical device.
Because this, these are big muscles in a sense, you know,
you're going through the glutes and stuff.
And I just don't know how you can do it with your own hands,
for any length of time.
- The piriformis isn't a big muscle,
but the muscle over the top of it-
- It is.
- You know, you got one of the largest muscles
in the body. - Gluteus max.
Right, most powerful muscle.
So, your hands are gonna fatigue very rapidly.
So, we recommend a massage gun.
There's a whole plethora of them out there.
- They're all over, yes.
- Now, which, which attachment would you recommend, Brad?
Because each one comes with a lot of attachments.
- Yeah, you know, I may start with the, the air-filled one,
just so you get a feel for it.
And as, you know-
- And the air-filled might actually,
you might be able to tolerate it right over the tender spot.
- Right.
So you'd be laying down and working.
So, you know, you'll know where, like we said,
you'll feel it.
So you're gonna work around it.
Around...
It should feel good when you're not hitting it.
Then you work yourself closer and closer.
And as that muscle loosens up,
you know, you can get right over the top of it,
but eventually you're gonna find
that you want a little more.
'Cause you're gonna get used to how this feels.
And you're gonna know it.
If you have that pain where it hurts, but it hurts so good.
And then when you finish with it, it really feels good.
It feels like it loosens it up.
Then you can progress probably to the round head.
- Yeah, more of a round head.
And, you know, these guns, they have percussion.
So they go up and down like this.
They don't just vibrate.
You can get into the spot.
- And that's the big advantage of the gun type.
- Yeah.
And you know, we sell this small one,
which you think is very small, but it is very powerful.
- It is.
- It's surprisingly.
And I feel like you can get good leverage with it.
- Sure.
Yeah, it's easier to hold on to.
It doesn't have as much travel or percussion,
so that's not as aggressive.
But, you know, some people...
I have a hip patient right now, he prefers that one.
He's gonna have hip replacements.
So he wants to keep those muscles loose.
And he's about 60 years old.
- Sure.
- Not a big guy, but, you know, Chris.
- Yep.
- Anyways-
- The other one, you could actually,
if you wanna get more aggressive,
you can go with the pointer.
- Oh, yes.
- And, that might be later on.
You wanted to...
I think that goes into that one, does it?
- Nope, that's for that's for the small one.
I got it right here, Bob, for this one.
This one right there. - Oh, sure.
- So these come on and off very easily
just to resistance interference fit
and there we go. - That's like a bullet-shaped.
- Yeah.
- And at once, you know, later on,
once you've kind of settled things down,
you'll wanna get in there
'cause there might be scar tissue in there.
- Sure.
- And that'll get right into that spot.
- Yeah, if you're a larger person, got a lot of muscle,
or maybe if you've got-
- A lot of bootay, bootay?
- Yeah, fat.
- Oh, fat. (laughing)
- You wanna get through that.
And this, one way or another,
is gonna get through soft tissue-
- Sure.
- Deeper, as opposed to the other ones.
- So before we show you the end,
we're gonna show you the, a little bit of anatomy.
I'm just gonna say this video
is a part of a series of videos on massage.
So go to bobandbrad.com, go to the programs section,
and look for the series on massage.
And whatever ails ya, we'll, we can massage it away, right?
- Yeah, it goes by body part by part.
- By body part. - Right.
And then go to that, you're gonna watch the video,
you'll see a button on the side that says: "PDF."
It's a printout of the whole video.
Well, it's condensed.
But so you can go back and look at the paper video
versus, you know, going to the video.
- And I have a diagram on there too, so, but, it's a deal.
Stick around, I'll show you the diagram right now.
Okay, here we are with the diagram
of some of the smaller muscles that are external rotators.
This is right here
would be the sacrum I was talking about,
that triangle-shaped bone.
And here's the piriformis muscle.
See how it attaches there.
And it also attaches to the greater trochanter.
- Yep.
So that's the ball of that.
The sock, ball and socket are underneath these muscles.
These muscles remind me of the rotator cuff of the shoulder.
Kind of small ones that are important.
- [Bob] Good point.
Good point.
Now this is the obturator internus, internal, I believe.
- [Brad] Internus.
- [Bob] Internus, yeah, I believe that's the way to put it.
Now, right below it and right above it are the
superior and inferior gemelli.
So that's all these little muscles.
You can see how they're all in the same area here.
So you can see the side nerve when it comes through.
It could actually be on,
it could be compressed by any one of those muscles.
- [Brad] Right, right.
Yeah, 'cause the sciatic nerve come from underneath there.
Right underneath the piriformis
and then you got the big muscle over the top, the glute.
- [Bob] Okay, so that far.
- [Brad] I don't know.
- [Bob] Okay.
So that'll give you a little bit of orientation
to what you're trying to do when you're trying to massage.
So we can fix about anything,
except for... - Except for...
- The way you're drawing that, Bob,
you did that...
Can you see it?
Is he in there?
There you go, that.
I have a feeling that this smart board
is gonna be the next step in solving our problems.
- Yeah, that's right.
We'll just figure it all like "A Beautiful Mind."
- Just glue it back together here.
Put some stitches on there.
- There we go.
- There we go, look at that.
- The broken heart is fixed.
(laughing)
(gentle upbeat theme)