♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous
physical therapists on the internet
- In our opinion of course, Bob.
- Yes, we are.
It's funny the second time.
(indistinct)
Okay, today, we're gonna talk about how to avoid sciatica
and herniated discs from returning.
Okay, you know, hopefully you're fortunate enough
to have gone through your treatment
and your herniated disc and sciatica have gotten better.
- Right.
- And now we're gonna make sure
it doesn't come back again, right.
- Exactly, and this is something we have not really,
you know, did on a video,
we haven't approached this yet,
but you know we get people saying,
"Boy, you've really helped us with your sciatic videos."
And, but then we're, you need to look at this so that-
- Because the last thing you want
is this to come back again
and your habits may be such that you,
it may come back again.
- Exactly.
- Because it came once.
It can, it can happen again.
- Right, so let's do review things
a little bit first Bob.
- Sure.
- So, with sciatica, pain down the leg,
oftentimes to the ankle, usually on one leg
and oftentimes probably the majority of the time
from a disc issue.
- From a herniated disc.
- Exactly, and it's in the lower disc.
So, if we pull out the spine again
and I know this'll review,
- Your lower back, yeah.
- Yep, and for, Bob, aren't we gotta mention
about the new people that are watching.
- Oh, that's right.
In case you haven't already, you know,
if you're new to our channel,
please take a second to subscribe,
our button's over there somewhere.
We provide videos on how to stay healthy, fit, pain free
and we upload every day.
- You better believe it, so,
- okay.
- And if you haven't watched,
you know, we've got some videos,
if you have watched that show really clearly
on the bulging disc,
usually between four and five
or five and S1 right in here.
If we blow that up and magnify it
for a good model of what a bulging disc looks like.
- Bulging or herniated disc.
- Yes.
- I think quite often,
more often it's a herniated disc Brad,
for that's pushing on the nerve.
- Sure.
- The bulging can, but...
- So, my understanding, it bulges first
and then goes into that full herniation.
- The herniation actually gets a crack in the,
the disc and some of the material comes out.
- I thought that was sequestered.
- That's another name for it.
There's a million names for herniated disc.
- Yeah, one way or another,
the nerve is getting pinched.
- Yeah.
- And it, but a slipped disc really is not accurate.
We'll settle that right now.
So, here we got the disc
and here is L5 and L4,
the disc in between.
And look, can you get a good close up of this?
'Cause if you get a good visual of this
and you imagine this is what's going on with your disc
and that disc is bulging out,
pushing into that nerve,
causing that pain down the track
and the nerve, all the way to your ankle,
we need to get that to centralize,
go back in where it belongs.
And then the pain is gone.
- And then heal.
We need to get scar tissue to heal over that.
Which takes some time,
it's not gonna happen in a day or two.
It may take a few weeks.
And that's the point, what we're gonna talk about now.
- Right.
- It's centralized.
The pain is gone.
You're feeling pretty good.
This is where the yellow light comes on, caution.
Don't go back into your bad habits.
We actually need to do something to strengthen
the scar tissue and stretch it a little bit.
So you have full range of motion without irritating it.
So, wow, that was a mouthful Bob.
- You got it done though Brad.
Well done.
So, what's the next thing that we're gonna start doing Brad?
You gonna start with the chair exercise or?
- Well, actually, no, I always like to start.
- Oh yeah.
You want me doing that or you gonna do it?
- I'll do it Bob.
I had in my head,
how I had it planned out.
I've been working on this for a couple days Bob-
- All right, do you want a pillow?
- No, no, no pillow today Bob,
I'll fall asleep.
So, we need to start bending that spine
reflexing it and stretching out that scar tissue
that's formed and is feeling good.
So, the first thing you do is simply double knees to chest.
- Which is unusual by the way, because this is
the last thing we wanted you to do earlier on.
- Yeah, because it typically irritated it.
- Right, and made it worse.
- Right.
- And if this does make it worse,
they have to stop, right,
- Right, yep, if this creates back pain
or particularly anything down the leg at all, it stop,
- How many, I'm sorry.
- You're not ready for it yet.
- How many days do you want them to be symptom free?
- I'd like to have, I'd like to have my patient symptom free
for at least a week.
Possibly two is even better.
- Okay, so they have no symptoms, no more pain.
And now you're gonna start with this knee to chest.
- Right, but in the meantime
you're still doing the press-ups.
- [Bob] Okay.
- Just to maintain it.
- [Bob] So, you're still doing the press-ups
and to maintain.
- So, let's say you're two weeks symptom free
and you really want to get on with your life
and get back to your old ways.
Well, we're gonna start doing this one
and assuming no pain at all.
You do 10 of 'em,
then you always have to finish up with your pres-ups.
- [Bob] Okay.
- And you gotta do 10 of these.
Okay, that's why you wanted to do this Bob.
- So, knees to chest first and then press-ups afterwards.
- Right, always finish up with the press-ups, okay?
- Okay, making sure you're preventatively.
- Exactly, so, you gonna do,
- Do you want me to grab a chair Brad?
- Oh no, not yet Bob.
- Okay, what's next.
- Then you'll do that, at least three days,
completely symptom free.
And you do it a couple times a day.
- Okay.
- Okay, double knees and chest.
Roll over, do your press-ups.
Do that in the morning.
Do that in the evening.
At least three days, feeling good.
Then we can get the chair.
- Okay, do you wanna use this one?
- Yeah, I like that one.
(chair rattling)
- All right.
You want me to sit?
- Yeah, go ahead.
- Okay.
- From all the progression?
- Right, because you're gonna find yourself in the chair.
You're gonna bend forward to pick something up,
to tie your shoes.
Those are the activities that likely influenced
or caused the disc problem.
But it's not like you're gonna quit doing that forever.
So, now we want to-
- Do it under control basically.
- Exactly.
- Right - Right.
- So, am I just bending forward to start off with Brad?
- Right, bend forward.
You can go like fingertips to your toes
and then back up and just see how it goes.
Zero pain, zero symptoms.
It feels like the good old days.
Go ahead and go up to 10.
As long as it feels completely symptom free.
Now, so you don't sit there getting bored watching us,
let's say this is 10.
- All right.
- No problem Bob?
- No problem.
- Now, you have to finish up.
- Yeah, doing my press-ups, again.
- Yeah, now Bob was being nice to me
because he was gonna offer to do this
because I got spondylolisthesis
and these exercises actually aren't real comfortable for me.
So, I'm glad he's doing 'em.
- So, always finishing up with the press-ups.
- Yep.
- And if you were having pain
with the flexion in the chair,
you would stop immediately.
- Yep.
- Right. - Exactly.
- I mean, you don't want to re-injure it or re-
- Exactly.
- But we're just gradually having the disc
get acclimated to a little flexion
- Right, exactly.
In a, in a reasonable progression,
so that you stretch it out
so that its maintains its integrity.
- I know with some people, you know
like if you have some scar tissue on the nerve, you know
they actually had us pull down like this Brad,
even pull down a little bit.
- Give it a little extra stretch.
- Yeah, give it a little extra stretch.
- Sure , yep.
- And you know, like grab on your ankles,
pull down a little bit, even further.
- Right, right, sure.
- But that was a more accountable
specific circumstance, so,
- Right, and then plus you can pull your socks up
when you're down there.
- There we go.
All right, what's next Brad?
- Okay, now this one is what we talked about
as being a little controversial,
but I think it's an okay thing to do within reason is
to do a standing fingertips to the toes
because you're gonna do that inadvertently
throughout the day.
- You may, you may be forced to it sometimes.
We don't want you doing it.
- This is something you certainly don't want to do
as a stretch.
Like, you remember (indistinct),
stretch out your back and your hamstring.
So, start doing this stretch again,
not at all.
We're just doing this to make sure that you can do this,
- Controlled.
- Right, and after you get done with that,
always you're going to finish up with extension
and standing.
Okay, so that we get that normal range of motion.
And we get that disc able to move
in all normal ranges without re-injuring.
- And that's a recommendation Brad will make,
after you do lifts or anything like that,
after you've hurt your back
and you're healing
is that after you do a lift,
even if you do it properly,
stop and do a back extension.
I mean, that's a good thing.
I do these all the time Brad right.
When I lift a patient, I stop.
That's the first thing I'm doing,
is I'm doing some press, back press-ups
- I'm gonna make an exception for two groups of people.
If you got spondylolisthesis or
- Spinal stenosis.
- Stenosis, then you don't fit in that category.
Most people will though.
- All right, then beyond all that, Brad
we wanna change the habits of people.
We wanna make sure they're sitting right, yeah.
- Tall.
- And still probably using the lumbar roll, right.
- And I was gonna grab one of these before
and our famous towel roll lumbar roll
that doesn't cost anything.
So, you're gonna use that when you sit.
As a matter of fact,
I'm working with an 18 year old
that has severe bulging discs from the MRI.
So you got symptoms down the leg.
She is responding to these exercises incredibly.
she's 45% better after the first day of doing these,
it's really fun as a therapist
to work with something like that.
So, I put the towel roll in there
and she's using a towel roll just like this to sit up tall.
I talk to her about bending like this and not like this.
- Well, we should show the lifting methods right?
- Oh, sure. - Yeah.
So,
(chair squeaking)
let's say I'm gonna lift that stool Brad.
- Yep, normally a lot of people will just go over
and pick up the stool kind of like this,
but with good habits,
- Yep, and what you wanna show is when I'm lifting,
- Want me you hit you with this Bob?
- Yeah, that's what I want you to do,
to make sure I'm gonna do it right.
But I think this is a great visual,
is that if you do it right,
everything lines up.
Everything is right in a straight line.
It's like, this is in a cast
cause you can bend your knees and still lift wrong.
- Right, see the head's too far away there.
- Yep, look at, there's just one point of contact now.
- Right, and it's actually rocking back and forth.
- Yeah, now it's still straight up and down.
- Exactly.
- This is gonna keep your back out of trouble.
The other thing is that you really wanna be careful
about prolonged drives.
- Sure.
- That, we saw a study where people that tend to
re-injure were the ones that had long commutes,
- Right.
- They had, - Two hours per day.
- Yeah, two hours per day, hour each way
- I fit into that category Bob.
- I know, you gotta be carefully.
I mean, and you want to get out of the car
as much as you possibly can.
If you can break it up
'cause that will certainly help, so.
- I use my lumbar support.
- And that helps too, yep.
- So, this is incredible news Bob,
and this is something we had not yet.
So, people with sciatica,
I really wanted all those people to make sure to get this.
We should have said this at the beginning of the video.
- Yeah, let's not have your sciatica come back, so.
All right, thanks a lot.