- Hi, I'm Bob Schrupp, physical therapist
- And I'm Brad Heineck, physical therapist.
- And together we have the most
famous physical therapist on internet.
- In our opinion, of course, Bob
- Brad, a lot of people get sciatic, nerve pain
and a lot of 'em don't know where that pain is coming from.
- Sure.
- And in essence, in every case
somewhere along the line, a nerve is being pinched.
- Right
- But there's three different possibilities
of how that's happening.
And so I thought we'd go over that today.
- And I just wanna say typically
with almost always the sciatica nerve pain
it radiates down one leg or the other.
- Yeah
- Usually not both.
- Right
Unless it is one of these
second things we talk about today.
- Okay
- Yeah
So we're first, the most common reason you're
gonna get sciatic nerve pain is from a herniated disc.
- Right
- And so we're gonna show that model real quickly here
in your back, you have these bones that stack
up to make your back.
They're called vertebrae.
We've taken two of those vertebrae out and enlarged them.
- Right
- And in between each vertebrae is a disc
that disc where you've heard the term slip disc
this is actually is the same thing as a herniated disc.
And what happens the disc normally is of a normal height,
it's got good elasticity.
- Elasticity. Yeah.
It's got, it's got all, everything in control.
But after a while, if you do a lot
of bending forward or a lot of sitting what can happen
it can weaken at the backside of the disc.
- Right
- And this is what happens.
Why don't you show what happens?
- So this is just a model that's not anatomically correct
but it gives a good idea.
If the green is the disc, the red represents the nerve
and the white cups are the vertebra.
Well, look, what happens when you get a herniated disc
the disc will bulge and you can see it clearly bulging
out there's herniating and look at it
put pressure on that nerve.
- That sends down the leg
- That nerve is gonna go down the leg
and there you go.
- Right?
- A good model of a herniated disc
causing sciatica.
- Right
And what generally in these kind
of cases you can back off now, Lonnie,
back off
ah, generally
in these cases, what, where you're gonna see it.
If, if you're having a herniated disc
it's gonna be gonna feel pain in your back and down the leg.
And it's gonna be worse
with sitting and bending type activities.
- Right, right
- That's typical.
- Right
- All right a lot of times it's better with walking.
- Sure
- Not always, but sometimes it's better
with walking unless it's really bad.
All right.
The second cause of sciatic, nerve pain or sciatic
or pain down the legs is actually spinal stenosis.
- Sure
- Now in this case, it's more of an arthritis.
It's more here.
I can show on here.
- Sure
- If you have one
of these vertebrae again,
oh, gimme that back.
Actually that'll work.
Your spinal cord goes down through this hole here
on all the vertebrae, the spinal cord itself.
And this co this, this opening here after a while
with arthritis becomes more narrow.
And that puts pressure right on the spinal cord.
So in the instances where you have pain
from spinal stenosis, which is generally a
person's an older person's problem
- Right
- Generally, you know
you're gonna see it in 50, 60, 70 year old people.
In that case, you're gonna get pain off and down
both legs down, both sides.
Generally, I don't see it going down too far
but you often go down, go down to the knee.
- Sure
- And one of the classic symptoms of this is
that it actually is worse with standing or walking.
- Right
- It feels better with sitting
- And it'll sit down and it feels better very quickly.
- Right? Exactly.
They'll it'll say I can walk for a block and then
the pain gets so bad.
I just have to sit that often is spinal stenosis.
- Right
- And another term for it is actually
shopping cart syndrome, Brad
because you still got me Lonnie?
You take a shopping cart.
- That's not a shopping cart, Bob.
- Isn't it?
- Oh well
- We don't have one here, but it's the same concept.
- Same concept.
You lean on a shopping cart
and it feels better if they stand up straight
it bothers 'em and might even send pain down the legs.
If they lean forward, it actually feels better and, and
or a Walker or something.
And so that again would be a sign of spinal stenosis.
All right.
A third reason why you might be getting sciatic
nerve pain is, Piriformis Syndrome.
Now Piriformis, and we actually got rid of
this didn't we, Brad?
- Oh, our model, yes.
- Yeah. Piriformis is a little muscle in your butt.
Yeah. Let's use that.
- And let's use this for the nerve.
The nerve actually goes right through this area.
- There you go.
- Okay.
- And the muscle runs from here
which is the sacrum over to here, which is the hip.
So I'm this finger is the muscle
and it's pushing down on that nerve.
- Ouch, ouch
- Sending the pain
- Ouch.
- Down there
Now we just did a video on how you can do
three simple tests to determine whether or not
it's your piriformis muscle.
And I'll put that up right here.
But the other thing to keep in mind is generally when you
you have pure Piriformis Syndrome, you generally
don't have any back pain with it.
- Right
- It's it's just it, the pain starts in the butt
and goes down the leg.
So those are the three ways you might pinch a nerve
in your back or pinch your, your sciatic nerve
and send pain down your leg.
- Right
- So keep that in mind when you're trying to figure
out how to treat this because each one involves
a different treatment.
- Sure
- So, and if you haven't already, Brad.
- Subscribe
- Yeah
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- Because we have a lot more information
like this and we've really working
on our homework and we did our homework for this video.
And Bonapart over here is given a high five
- Low five
- They're probably not listening.
- All right
- So thanks a lot.