♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- And I'm Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, today you wanna talk about
best positioning for sciatica.
Also, kind of as a bonus,
hot pack, cold pack while you're in those positions.
- Right, this is a lotta things that
we get a lotta comments from our viewers,
as well as in the clinic.
You know, what should I use, hot pack or cold pack?
And then what position, or how can I get this better?
- It's amazing how critical this is,
because if you kind of put yourself
in these positions that help the back heal,
that alone can help really start tamping down the pain.
- Exactly, I really think the position you're in
while you're using the hot pack or the cold pack
is more important than-
- Than the hot pack or cold pack itself.
- Exactly, so we're gonna combine that
together. - We're in agreement, Brad.
For once. - Okay, so-
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- Okay. - All right, Brad.
- What do you use, the hot pack or the cold pack?
I am in the opinion that
you use what makes your body feel the best.
However, there is a rule of thumb
that pretty much everyone agrees on
throughout the medical community.
If it's a very acute injury,
it just happened, it's very tender,
almost always use the cold pack.
- First 48 to 72 hours, they almost always say.
'Cause you think about it,
there's probably some damage,
and there may be some swelling.
Even a back.
I mean, there's swelling in the back.
You may not see it.
And so the ice can help knock that down
and keep the pain off. - And then
after, let's say 48, 72 hours, go to hot pack.
I personally don't agree with that.
I think it may be true,
but I personally use cold packs a lot more in the clinic
than I do hot packs.
- They go a little deeper,
and they seem to last a bit longer.
They work better for spasms, I think, back spasms.
- And there are some people who just do not tolerate cold,
and heat is what works good.
And whatever works good for you, use it,
and go with what works best for you.
I just wanna give you a couple benefits of hot packs.
Number one, they almost always feel good.
So you put it on and it feels.
I've got one right here,
and as a matter of fact,
I'm gonna put it right on my leg there,
and (chuckle) it feels real nice.
My hands are getting warm now.
The other thing is they do increase blood flow.
The vasodilation opens up those vessels and blood flow,
more circulation, which is a good thing, okay?
And the low cost.
It's not a big expense to have a hot pack.
You can buy on the kind you put in the microwave,
you can buy an electric one.
One of the dangers of hot packs,
particularly if you have a electric plugin heater,
you might turn it up on the warm side,
put it on your back, and then fall asleep.
And after six hours later,
you can literally burn your skin.
Now, it's typically not like a match burn,
but the skin can get red hot
and you can get blisters with it.
And particularly people, you know, in the older population,
their skin's more frail.
So you always need to watch out about overheating-
- Yeah, the thing about hot packs too,
which is a little deceiving,
when you lay on it, the blood's not flowing as well.
So you might be able
to put a hot pack on you when you're sitting up
and get away with it, and it won't burn you.
But as soon as you lay on it,
there's that much more possibility of burning,
because the blood's not taking the heat away.
- Exactly, good point, Bob. - Dissipating the heat.
- Cold packs.
One thing that nice about cold packs
is there's no negative effects.
Unless, with the exception of
putting it directly on your skin,
you could get frostbite superficially.
That's really the only thing
you really have to be aware with cold packs.
Always put a layer- - Yeah, especially if
you went right on the bone, like right on the patella,
where there's not much skin layer there, no fat.
I mean, you could burn yourself,
and you could also freeze yourself.
- Exactly.
With cold, think of it this way.
Inflammation, things are swollen up, okay.
And now if you think of a balloon, it's this size.
If you put a balloon in an oven that's not too warm,
it's gonna expand even more.
If you put it in a refrigerator,
the balloon will decrease in size.
This is may not be what's happening,
but this is how I tell my patients for an analogy.
Put a hot pack on something that's inflamed.
You got your cells,
and everything's full of fluid, and packed full.
You know, it's just painful.
And then you put some warmth on there, and it even-
- Expand even more. - Expands more,
like that balloon,
making everything more tight and more painful.
So that's the analogy with the cold pack.
Now, as far as-
- Are we gonna go into positioning, Brad?
- Let's do that.
- Well, sometimes some people do heat and cold.
Contrast. - Contrast, yeah,
that's a good point.
And this is something I personally have not done.
I've been trained in it.
I just have good luck without it.
But I know particularly in athletics,
they probably use this more than other places,
where if you got that sprained ankle,
you put it in that warm water,
maybe the warm jacuzzi they have in the fitness center.
Then you take it out and put it into a bucket of ice water.
And we have a video on contrast.
I don't want to get into the details on that,
we don't have enough time,
but it is an option, and it's out there.
- Okay, well let's get into positions, Brad.
- Yeah, the most important thing, like we mentioned, for,
let's go to back pain, because it's so common.
- You want me to start prone, Brad?
- Sure, go prone.
Now, if you can lay pro on your stomach
and your back feels better,
that's a really good sign this is what you need to do.
- This is gonna be for sciatica now, Brad,
we're talking, right? - Right, for sciatica.
Let's say you lay on your stomach.
You're having leg pain.
But when you lay in your stomach,
the leg pain and or the symptoms actually improves.
This would be a good position.
And if you want the hot pack, we're gonna put that on there.
How's that feel, Bob?
- Oh, it feels great. - Good.
- But now, can I make a slight suggestion, Brad, too?
- Please. I mean,
if this doesn't feel that good laying this way,
you might just try shifting your hip this way.
Or maybe you're shifting your hip the other direction.
Quite often, if the pain's down this side,
if you shift away from it, it often feels better.
You make your body kind of into a banana, you know?
- Right, he's if you're looking from the top down,
the pain is in his right leg,
you're gonna move your hips slightly to the left.
- So my feet are to the right,
my shoulders are to the right,
but my back is to the left.
- And you'll know if it's the right position to be in
because it's clearly gonna feel better in the leg.
Very clearly, okay?
- Yeah, we're looking for that position
that's taking the pain outta the leg.
- How's that, Bob? (chuckle)
- Actually that contrast isn't that bad, Brad.
- Yeah, I just put a cold pack on him there.
- That actually does work.
- Now, I used to be a really nice,
treat my back with back pain years ago on my stomach
was very successful.
And now that I've developed a different diagnosis,
I always have to lay on my back.
So should we try that position once, Bob?
- You want me just to flip over?
- Yep, flip over, Bob.
You're probably gonna get a pillow.
Again, when you're doing cold packs and hot packs,
being completely comfortable and relaxed is critical.
It's very important to the whole treatment process.
Are you gonna fall asleep, Bob?
- I'm thinking about it. - All right.
Oftentimes, a couple pillows under your knees.
I'm just gonna put one there, Bob,
just cause it's easier for the video.
Does that feel a little bit better, Bob?
- A little bit.
I could use more. (laugh)
- All right, all right, we'll give you another one.
Big baby. (Bob chuckles)
I'm just kidding.
Actually, you do whatever it takes-
- This feels a lot better.
That makes a big difference.
- Now, I do this oftentimes,
I keep walking in front of you, Bob,
I hope the people aren't worried.
Yeah, I'll get a cold pack
underneath their back in this position.
And initially it kinda goes, ooh.
But after about a minute, you get used to it.
And some people like it right away.
They say, boy, does that feel good.
15 to 20 minutes on a cold pack.
Now, in the clinic, I will always use the leg wedge,
which we've done some videos on.
And almost always people are very-
- Yeah, this is really nice.
- This is deluxe.
I just used one of these with a patient last week.
She went out and bought one for home that day.
- I don't doubt it, Brad.
I mean, it's hard to understand
why this is so much better than pillows.
'Cause we also have people sometimes just lay on the floor
and put their feet up on the couch.
You know, or something.
Which is good too.
And certainly, but I mean, this really,
I don't know what it is, but it just really feels good.
- And it has to have this angle here,
and it needs to be a firm dense foam.
The density of this is just critical.
We can't talk more about how nice these are.
You can get 'em for about 20, $30 online.
- I think it's the support all the way along
that makes it good.
I'm not sure, but-
- I think you might be right, Bob.
Okay, now, let's say you don't have all this.
One other position that a lotta people have at home,
and I've used this oftentimes, is,
we don't have one here, but a recliner.
And on the recliner, it's very important.
I'll just try to work through this.
Is you're gonna recline back.
And you have to have support in the low back.
- Right, so you're not in that rounded out position.
- If you got a really soft, cushy recliner,
it's not gonna work unless, sometimes-
- Like a throw pillow works out really good on those.
That's what I do.
- Yeah, a throw pillow,
or whatever it takes to fill that gap
so you can feel good support.
And you'll know what's right, 'cause it's gonna feel like,
oh, that feels like really good support.
And then take your cold pack and put it there.
Woo. (chuckle)
Oh, now it's good.
- I know a lot of people, Brad,
and we've had this discussion before,
they have back pain,
that they honestly cannot sleep in their bed,
and they have to sleep in the recliner.
I don't like it.
I'd rather have them sleep in their bed.
But they can't.
- I know it.
- And so what I try to do is have them compromise
by putting the throw pillow behind them in their back.
But there must be, you know,
it gaps the back a little bit, I think,
and it gives them enough that they're not getting
that pressure on the disc or whatever.
- And some people, when they turn to the sides, it's worse.
And nice thing about a recliner is
you cannot turn to your side.
So it eliminates that side position, if that's irritant.
And this feels really good, Bob.
Now, the other thing about when you do this,
you get yourself a nice book to read, you watch TV,
or you just take a little nap.
And the thing about a cold pack that's really nice
is they just warm up after a while.
And it's not like a hot pack where, you're not gonna-
- It keeps getting worse. - Right, it's just there.
And then you just take it off.
- You know, again, make sure that this is helping
take pain outta the leg.
Every position,
we wanna see if we can take pain outta the leg.
- Exactly.
- All right, remember, Brad,
we can fix just about everything.
- Except for that- - Broken heart and sciatica.
No, we can fix sciatica.
We can't fix the broken heart.
- We're coming a long ways on sciatica, Bob.
Wow. - Thanks for watchin'.