- Bob and Brad,
the two most famous physical therapists
on the internet.
- Hi folks,
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist,
- Because we are the most famous physical therapists
on the internet. - In our opinion, of course.
- Brad, today, you wanted to talk about
how do you treat sciatica
when you also have spondylolisthesis.
Did I say right?
- Spondylolisthesis, I think.
- Spondylo- spondylolisis?
(laughter)
- Well, that along with the sciatica, or herniated disc.
Cause we're gonna look at spondylolisthesis
or spondylolysis as the same thing because,
and we'll get into that in just a little bit.
- It's a bad combination to have.
- It is, and we've been having questions about this
and I cannot answer this on a reply
so we need to make a video on it.
- Okay.
- So people with spondylolisthesis, particularly,
which is 5 to 7 percent of the people out there
according to studies,
they're the people who are really gonna chime in on this,
I think.
and just to review that, the mechanics of it.
If you look at,
Here, we have our spine
and we look at,
We're gonna look at this disc or this vertebra
and this vertebra.
They actually are going to shift.
The top vertebra is gonna shift in a forward motion.
As a matter of fact, anterior osthesis is the same term.
Someone just asked me that, are they the same?
Now, if this is one vertebra, this is the other.
- This is them lined up.
- And there's actually a shift
and it actually looks like your spine is breaking,
it's fracturing, and it kind of is
but this is happening slowly and everything adapts to it.
The spinal cord in the back somehow gets enough room.
And hopefully you don't have any parasthesis.
- The body is a wonderful thing.
It's amazing how it adapts to problems.
- Exactly.
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- Excellent.
So getting to spondylolisthesis,
one of the things, one of the big no-nos is extension.
In other words, bending backwards.
- Bending back.
- Or if you're laying on your stomach,
this is also the same thing.
If you do this or do this
and you have spondylolisthesis,
you're probably gonna get a sore back.
If you work overhead a lot,
washing a ceiling, painting a ceiling,
you're probably gonna get a sore back
if you got spondylolisthesis.
So extension motions are big no-no.
Now, if you have a herniated disc or sciatica,
let's take a look at that.
Let's just review that a little bit, Bob.
- Sure.
So we're gonna look.
- And the other thing about the two that relate
to each other is they both almost always happen
in the low part of the back.
Same area of the back is where,
- That's where a lot of the stresses are.
- Right.
So, let's see, we're gonna do a little close up here.
You got that focus, Lonnie?
We're gonna look at the same area between L4 and L5.
And this red disc is just the model
that helps you focus on this bulge right here,
which is a herniated disc.
And with a herniated disc,
not always, but oftentimes
the direction to improve a herniated disc
that's on the back side of the disc is extension.
- So when you do the extension, let's take a look.
Let's just show 'em the model, Bob.
If you look at, the green ball here represents a disc.
Now Bob why don't you push,
- First off, let me just stand.
It'd be like this.
I'm standing like this.
And that's the orientation that it is.
So normally the disc stays in place like this.
But if you, if the disc wears out after time
you can actually get to the point where it bulges out
like this, where it herniates out.
- So, you got that Lonnie?
So we're looking at this bulging disc.
Now, if you have a bulging disc,
and you lay on your stomach
and you do what we call prone press-ups,
if things are going well,
- You'll open that and it'll go back in again.
- Yep. They call it to reduce
or reduce and centralize that disc
so that it goes back not into a ball like this,
but it goes back into the anulus
where it's supposed to go.
- So as a summary, basically,
when you're doing spondylolisthesis,
you're doing flexion type activities.
That's what you wanna do.
And when you're doing,
when you're with a herniated disc or sciatica like that,
normally you wanna do extension.
So that's a problem.
- One way we want you to bend back,
one way, we don't want you to bend back.
- Right.
So if you got spondylolisthesis
and you find out that you had a herniated disc
and extension is what's making the disc better,
well it's making your spondylolisthesis worse.
So how do you deal with that?
I think your best case scenario
is see a physical therapist that's Mackenzie trained,
or another therapist that works with this.
We just are particular to Mackenzie trained therapists
and let them guide you through this.
There is one exception that both of these diagnosises
may respond to.
I say, may, 'cause not always.
And that is traction.
Traction was very common before surgeries got so good.
Wouldn't you agree, Bob?
Back pain, 30, 40, or 50 years ago,
very common to have traction.
It pulls on the spine, helps reduce
and get that bulge back in.
With spondylolisthesis,
traction can also sometimes improve the symptoms.
- Give you some relief.
- It does with me.
I'm a grade 2 spondylolisthesis,
and I can perform traction on myself,
but it's not aggressive,
and it offers relief.
So traction can be done with an expensive table.
They cost 10 to $20,000
and they can gauge how much pressure you're putting on it
and time and all this and that.
Obviously you don't have that at home.
So some simple ways you can apply traction to your back.
But the only way you're gonna proceed with this
is if you get immediate decrease in pain and symptoms.
And it should be just like that.
When you put the traction on,
it should feel good, then you would proceed with it.
- Otherwise, don't.
- Otherwise, not at all.
- Let's go with the first one.
- Sure.
- You can take two chairs.
Now I just worked with someone with this yesterday
in the clinic,
18 year old female with a bulging herniated disc.
She's actually improving quite a bit
from her extension exercises.
Her leg pain is gone.
I thought we could use traction to help further better,
but I had her do this exercise.
You lock your elbows and the key to this, this is not easy.
You have to be pretty good with your course muscles.
'Cause right now I lift my legs up
but my stomach muscles are tight
and I don't have very good traction through my back
and it's not working.
The way to do this,
Do you have something, Bob?
- Well, I was gonna say is one way is just to,
kind of just get on your toes.
- Yes, exactly.
- Is that what you're gonna show?
- Yeah, to progressively.
So here I'm just going to get on my toes,
put more weight gradually,
relax your stomach muscles.
And actually right now I can feel the traction on my back.
- So you can really keep in contact with the floor
the entire time.
- Right, yeah.
You're not dangling
Actually, I always do,
with the exception when I do my pull up,
and we'll talk about that in a little bit.
And right now I'm relaxing my stomach muscles.
I can feel the traction on my back.
It feels good.
You know, I could hang out like this for a while.
Usually, you're not gonna hang traction
for more than 30 seconds.
Your arms get tired.
- What's nice about this is you can do this
intermittently throughout the day though.
I mean you can do it every hour.
You can do a couple sets of this.
Like you go a set for 15 seconds, stop.
Do another 15 seconds.
I mean you can work a bit that way
and then give yourself some relief.
- And every time it should give you that relief.
If it doesn't, stop doing it.
The other one that I've just discovered with myself
is simply go to a pull up bar
or a solid bar overhead.
And, like you're gonna do a pullup,
but you just hang there.
And again, just let your legs bend.
Stretch and let your stomach muscles relax
and feel that traction through your back.
Again, if you have immediate relief,
the leg symptoms clearly improve,
you're gonna hang there,
and you can do it for 15, 30 seconds.
Whatever.
You can hang as long as the symptoms feel better.
'Cause you're gonna feel like,
oh, this is clearly improvement.
If not, don't do it.
- And by the way, you might get a secondary benefit
of helping your shoulder
if you're having shoulder problems.
We have a video on that,
and it's been amazing for Brad and I.
Our shoulders have never felt better
cause we've done some hanging and pullups.
- We get a lot of comments on people
specifically with that exercise to help their shoulders.
So it's not just you and I, Bob.
It's going worldwide.
- All right, cool.
- So let's see, what else did I want to talk?
- Inversion table?
- Oh yeah, the inversion table.
We do have a video on that.
I don't have one here, but it's a table.
You lay down on it and it's flat,
and they're built so that your ankles get not clamped in,
but there's a device, so it holds your ankles.
- Hooked in.
- And you can tip yourself upside down literally.
But I like to do it so you don't do a full inversion.
Although the instructions on my inversion table
said you could,
I will not do that 'cause I don't think it's necessary.
I'd go to a 60 degree angle.
And the first time you do it, don't hang too long.
You'll get a headache.
I had a headache for a long time
'cause I inverted myself at 60 degrees
for about five minutes and it was too long.
So inversion tables, read the instructions.
Bob, can you hook up that?
- Yeah, I can.
Now you said that, I'll put that video at the end.
You were saying that that helped you
for a couple years
and then it really kind of ceased to help you anymore.
- Exactly.
I'm not really sure why.
I just know that when I started invert, it's like,
It didn't start to hurt, necessarily,
but it wasn't feeling good.
So I just stopped that.
- Just two other things, Brad,
besides the traction,
I think it does still help if you can walk,
just walking gets more nutrition to the whole back
and stuff like that.
So a 20 minute walk.
And the other thing,
I think core strengthening always helps too.
- And spondylolisthesis, we got a playlist,
and I've got some really good core strengthening exercises
that will work.
And actually I don't think the way we do 'em,
they're not gonna hurt a herniated disk
if it's healed, if it's coming along,
you can start doing them as well.
- And there's some of 'em that would be good
no matter where you're at with the herniated disc.
- 'Cause we we're doing 'em in a fashion
that does not flex the low back.
- So we hopefully gave you some ideas on what to do.
It's a difficult situation
but it can be done.
- It can be dealt with carefully
and listen to the rules.
And again, the best thing is,
go see a PT that works with it a lot.
Then you can be guided by them directly
if you have questions.
So, very good.
Thank you.
- Thanks for watching.