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 opinions of course Bob.
Today we're going to talk about how and when to perform self massage for sciatica and we're talking about
herniated discs versus piriformis syndrome and you need to kind of know which one you have because it's going to change
what we do, two different treatment protocols, right. By the way if you are new to our channel,
please take a second to subscribe to us
We provide videos on how to stay healthy, fit, pain-free, and we upload every day, also go over to Facebook and like us because
we give away stuff and also
we like to be liked, all right Brad you did a video in the past where you're talking about sciatica and
you were describing what it is, so it's pain, numbness, tingling
Typically down the leg, typically one leg, right, past the knee down into the foot, even into the toes and you can get weakness from that
you can get drop foot from it and if it's down both legs it may be something else
It could be still sciatica but less likely to be and you had come up with statistics
on this Brad, and you've found out that normally from sciatica
3 million Cases a year are from a herniated disc, so that's the disc
that's in your back
between the bones here, and it's bulging out or herniated out and it's hitting one of the nerve roots
I just want to show this real quickly,
So I don't know if you can see that red right there, it's pushing against the nerve root,
this nerve root actually extends way way down to the leg so
Yeah if you irritate the nerve up here you're gonna get symptoms wherever they go
So if you get a new massage for that there's one type of massage
we do, but if you have a different kind of problem, which is called piriformis syndrome
Which is also Known as fake sciatica
So now the piriformis muscle Is a little triangle-shaped muscle, I don't know we indicated that that
well here, but it comes from the sacrum, in a little bit in the notch here and
attaches right from this bone all the way down to the greater trochanter which is on the hip
Now the sciatic nerve
comes down right underneath it, or it could actually pierce through it even, but it comes down through that
and if you spend a lot of time sitting or
What I have found on some of these Brad is they actually tore the muscle and then it as it healed it tightened up
Over the
sciatic nerve, so this muscle can squeeze over onto the nerve
Kind of pinch on it and cause pain down the leg. Right so the symptoms are very similar
It's just whether it's up here or just a few inches below, that's where the
impingement or the lesion is, but it's critical to know which one is which, because this treatment is way different than this treatment
so we're gonna show you three quick tests, so one of the tests Brad is very simple,
So one thing you're gonna do is you're just gonna try to find that spot
so if you go to the point of the hip and
here's the sacrum, so the muscles right in here, if you're tender in here
You know you push on here and compare one side to the other
That's one sign indicating it might be the piriformis muscle
You'll feel there's a
bony area and that's that greater trochanter and you can feel it and then
the sacrum is there and that's how I determine, I go from there to there and right in there
Yep if you rub across there and again you should see a difference from side to side, yes, so you compare one side
will be very tender the other side, oh
Now the other one you can do is you can go ahead and stretch the muscle and see what happens
so I put my ankle a little bit beyond my knee here and then I'm gonna pull this up like this
So right knee toward his left shoulder, across the body, and this is one where I have almost
universally seen this in Brad, were the ones that have piriformis syndrome, they do this one, and then they do this one
and they can really see a difference. I mean it's very noticeable right away
So what was the third test I wanted to do I was gonna do
trunk, oh, I was gonna, this Is more to see if it
is more from the the sciatic nerve itself, if it's a herniated disc
from your back, a lot of times if You bend forward like this
Or if you even extend back, any movement of the back tends to make it worse,
And you know of course there's a straight leg raise one too
That might be positive with piriformis, yeah that could be
What about the one laying prone, where you do the
internal rotation of the femur, that's a possibility too, actually Brad I think the better one is actually doing this
Bring it down like this and you bring it up like this and now you're tightening up the muscle of the piriformis and
so you bring your leg over
you put this to your knee and you bring it up like this and that tightens up that muscle and that causes
stress over the piriformis, so if they had piriformis, one leg would be
obviously tighter than your other
Using that, and one leg would bring on the pain, all right let's start to talk about massage, yes do it
Alright let's first talk, again if it is piriformis muscle
You definitely want to do some massage because it's gonna definitely help, so what I like to do is
I'd like to, if you're gonna do this yourself, get yourself in a good position and
I like to put the muscle
a little bit relaxed and it's an external rotator Brad
So I'd like to put two pillows between the legs, okay and you kind of
lock up the ankles together like that and now this muscle Is a little bit relaxed, now there's not tension on it and
You can start off with just your hand if you want, again you're gonna find the spot, you'll know
cuz it's gonna hurt, and you can rub across it like this, and you can also do circular motions
You're gonna get in deep. Bob's just going on the surface but you are really gonna want to, you can use your knuckles
Yeah
You got to get through some muscle and some soft tissue before you get to that piriformis and
it just needs some pressure, and that's often why
we recommend you might want to try some of these things, do you want to grab one of the tools here Brad?
Well which one should we start with Bob?, We got like torture tools here don't we
I hate to use that word torture,
Either one of these is fine. There's the Theracane
Or the Back Knobber
They're just shaped differently, and this one comes apart easier a little, maybe to take on a trip
but this one you can really get in there and
You can really start doing some
Not damage, get some work done, the idea when that
piriformis is tight, that muscle becomes contracted and
basically knotted up and if you get pressure on it for a period of time, usually 30 seconds or so, that'll allow that muscle
to release and once that release is, you get circulation, you get the pressure off the nerve
Life is much better. Exactly. It may take a few sessions, or should I say precisely? Precisely yes
We're trying to get away from the "exactly". Never did I dream when i grew up that
I'd be massaging my butt in front of people, all right, This Is weird Bob, I know all right next one
Oh yeah, there's the tennis ball you can kind of lay on that but
I was going to show this one in this position and you show the tennis ball yeah?
So this is the Purewave. We've mentioned this many many times.
Just one more instance where I think this really pays for itself, because this is a hard area to massage
Now I'm not even pushing that hard and it's getting in there and it's got the percussion so it's
It's really sending Bob for a loop
It's funny but yeah it's doing a good job Brad. All right so why
don't you show the tennis ball, this is a family show Bob, okay
This is the way I usually like the tennis ball, you can use a lacrosse ball, it's a little firmer
I'm gonna find that bone right there in the sacrum
and even a healthy
piriformis is a little more tender
than that, so it's a tender spot yeah so I'm gonna get right on it right there but boy I tell you
I'm putting a fair amount of weight through this arm and my legs and I'm gently working down on it and then you roll
Nobody can see that ball under there and you'll find it and then you work it
forwards or backwards, right to left circles, whatever seems to work good and again you're gonna do this for 30 seconds to a minute
or so depending on how you respond
The only precaution I have here with this is if the nerve is fired up a little bit and
you go right over that nerve with the ball
It could make things worse,
I don't want you making the pain worse, if the symptoms down your leg are getting worse while you're doing this
or as a result, it's too aggressive. I always found the ball it's a little harder to direct to the spot
You know with these you can put, you can go around the spot first and then if there's a
tender spot that sends the pain down you can avoid it,
When you're doing that you gotta be pretty mobile and have some upper arm strength and control to get what you want
Not to rain on your parade Brad
I don't want to get rained on. All right next up if you're gonna do massage for a
herniated disc, first off, quite often I think Brad and I would agree, you don't need to do it.
I mean a lot of times
We recommend doing the extensions instead, yeah directional stretching
But if you are, we've had people that are so tender when they come in that
We have started a massage, like I've had people start by
in somewhat
maybe even almost an
elevated position like this and then a couple pulls, pull them up, and then having someone massage them
themselves, so then, we're working the muscles not over the piriformis, although you could, it may be tight there as well, but working the muscles
around that vertebra there, because they can tighten up as well from the pain and they just are natural tightness so again
we recommend it more often, is this extension program which
We've outlined in many of our other videos but if you are going to try
some massage yourself, this is about massage Brad,
You could try
some standing massage
for your
sciatica and what you could do is, you could you could take your knuckles and rub right up the muscles like this
on both sides, that's what your knuckles are for, yeah I didn't know that, well Bob
So here's my knuckles the other hand is gonna help
for us and a nice thing about this, I get some extension
Extension, that's what I was gonna say Brad, you can actually even work into extension a little bit, again, don't make the pain worse
But if it actually feels okay and maybe it feels a little bit better
This is a great one to do and then of course you can use the back knobber
I like this one for this, not for sciatica but just for my back when it gets tight
I just rub it along there
Another homerun huh Bob?
There you can see the difference between the two, it isn't much, you have different handles
Yeah so all these are options, it doesn't mean that they're all going to work
equally, you go through and find which one really does the job and stick with it and then
you can do this one too, you can go back and do extension while it's doing the Work for ya
Going along the pelvis there so
Again to sum up here Brad real quickly, if you have the piriformis syndrome
you definitely want to do the massage
If you're having sciatica from a herniated disc, not as as needed normally but you certainly can try it and it certainly won't hurt
Thanks for watching.