♪ Bob and Brad ♪
♪ The two most famous ♪
♪ physical therapists on the internet ♪
(applause)
- Oh, we're ready to go already?
Hi folks I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous
physical therapists on the internet.
- In our opinion of course, Bob.
- Today, Brad, and we're gonna talk about
the big lie about trigger points, which are knots,
and how to get rid of them.
This is an updated one, by the way,
you didn't put that on the title.
- Oh, I'm sorry, make sure you get that on there, Mike.
- Yeah, so we did this one in the past.
We thought it was time to redo it,
maybe with a little bit more knowledge.
We've become older and wiser.
- Yep, a little more clarity, I think this is gonna be
a better, it's gonna come,
people are really going to.
- Understand it now.
- Well, it's an odd job, Bob.
- All right, if you're new to our channel,
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- Oh.
- You're gonna wanna join us on,
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- There you go, Bob.
I'm tellin ya, the SleepOvation mattress
could give some benefit to knots, trigger points as well.
- I mean, it's a great pain relief mattress.
What that wasn't good enough for ya?
- No.
- All right, let's go Brad, let's talk.
- Anyways, so yeah, we gotta get to the big lie,
'cause people wanna know, trigger points, or knots.
What, some little more detail or technical name for 'em?
Gonna say it Bob?
- They're also called myofascial trigger points,
but they're a point of hyper-irritability.
A spot.
Was there somethin' else you were lookin' for?
- Well, no, I thought we should at least say the
technical name so we sound like we know something about it.
But you know, we see 'em all the time in therapy.
People come in, and probably one of the most
common place is right back here on that shoulder,
that you get that tension spot, people say,
boy I've got that just knot is just killin' me.
- Yeah, that upper trapezius, very common area.
- Right, but you can get 'em in the low back
is very common, maybe in the hamstrings,
or in the calf, but we're gonna talk about this,
because it's prolly the most common.
- Right.
It's a good example.
- So what is the big lie, and we've got a couple different
answers for this.
- Well first off, trigger points,
it is a bit controversial.
It really is a lot of question marks out there
about what they are, and to give you a little history, Brad,
I don't think you know this,
way back in early 1920s or somethin' like that,
they actually thought it was, myocitis they called it,
and they thought it was a problem in the muscle itself.
- Sure.
- And now we're finding out, what?
- That it's a reaction from a different problem,
and we're gonna get to that in just a little bit.
But oftentimes, people think ya got knots,
you need to go to a masseuse, a massage therapist,
and get the knot relieved, and oftentimes it works well,
but it doesn't get to the origin of the problem,
and the knot comes right back and they need to
keep goin' through the cycle.
Massage therapist, masseuse, and back,
and you know, maybe some people like that
and can afford it.
- Right, but it's a temporary fix, basically,
is what you're saying.
So what we're tryin' to do is get rid of the knot
for good, rather, as opposed to having you go in
the pain cycle.
- So how do we assess?
You know what, Bob and I will do this.
Let's say someone comes in with that.
Why don't you turn around, Bob?
- Sure.
- Stand up, take a bow, I'm just kiddin'.
But right here, we're talkin' that pain here
or over to the shoulder blade, it just all knots up.
One of the things I'll do is, I'll say,
have a seat, why don't you sit down.
We'll pretend Bob's the patient
and, Bob, you know, Bob already tells me
the pain is here, it's at a five over 10 and it
goes up to an eight, nine over 10, and so
Bob can you just do a chin tuck like this.
- Okay, I go.
- There you go.
And then, oftentimes what'll happen,
I'm gonna talk for Bob, say, oh, that makes the pain worse,
but the pain often feels like it's goin more towards my
center of the back towards my spine.
If that's the case, in my mind I'm thinking already,
there's a really good chance it's not a muscle problem,
the problem is in the neck, the low neck.
Very common, oftentimes, other things I'll do is
can you look back up towards the ceiling?
And they.
- I'll even lean like that.
- What will patients oftentimes say when they do this?
- Well, sometimes it doesn't help,
and other times they'll say, oh, it starts to feel
better there again.
And the point Brad's tryin' to make here,
which I think he's doin' a pretty good job,
is that if it's in the muscle, it's not gonna change.
If the problem's in the muscle, that pain isn't
gonna suddenly go out, and go into a different area.
- Right.
- It's gonna stay into that muscle,
anyway, when you do some of these, it might even
go to the other side.
- Right, and that's not uncommon to have pain
move around just from movements in the neck
with this problem.
So if it is moving from here
towards the center of the spine,
the muscle, if it was just a knot in the muscle,
the knot in the muscle cannot move,
but you perceive the pain, and we're gonna talk about
how to correct that in just a little bit.
- Right so, if the pain moves, it isn't a muscle problem.
It is often from the neck is what sends pain
into the upper trapezius.
- Right, and often times, it's from a postural problem.
Head forward. - Very common.
- In our society, people sit with poor posture,
we look at our phones with poor posture,
computers, TV.
- Everything's head forward, and everything's head down.
And you're lookin' at your phone all day, I mean so.
I know therapists are always known as the posture guys,
but there's a reason.
We're tryin' to get rid of the problem permanently,
not just temporarily.
- Right, exactly.
So if these things change the pain,
move the location of the pain,
we will go right after the neck, okay.
So how do we correct it?
We're gonna give you a few hints.
The first one is going to be, in the seated position.
Bob, chin tucks, sometimes just chin tucks can do it.
And we've had a lot of comments on our videos,
people commenting saying, oh, the chin tucks
has helped me a lot.
- Yeah, 'cause one thing you can do throughout the day,
and you should, this is not just an exercise to be done
once a day, this is to be done like every 20 minutes,
every hour, and remember,
you're not going down like this
and you're not going up like this,
you're goin' straight back and you can even give a little
over pressure. - There you go.
- Just give it a little over pressure,
push in a little bit on the chin, you know,
goin' through the crook of your thumb there.
- Yeah, not aggressively.
- Not aggressively.
- And if this, makes it feel, every time you do it,
it feels a little bit better, and the pain seems
to move forward towards the spine, you're golden.
- If it makes it worse, if it goes even further down
into the trapezius, then you need to stop.
- Right, right.
- A lot of times, I probably have most success
using the towel. - I agree.
- Why don't you go ahead and show, Bob.
And then we're not doin' chin tucks with the towel,
we're doing extension, or looking up towards the ceiling.
- This is especially helpful with, a lot of times,
I have people try it first without the towel,
and they go oh, it hurts.
- Yeah, it's not fun.
- So then we start with the towel,
and Brad's kinda talked me into this method,
more than the, I used to go more like this,
I still do sometimes, but a lot of people seem like
they do well pushing down like this.
So I'm pulling down.
- Sometimes, or oftentimes, I find that if they
get the towel down lower on, lower the better.
- Yeah, I sometimes I start 'em up a little higher,
and then I try to have them work down,
'cause they seem to, but you're right Brad,
it's that C6, C7 that they like the support at.
- So he's talkin about low neck vertebra.
So what's goin on, what we're boiled down to
is the spine itself, and I'm not gonna get into
the anatomy and the details of it,
but it's, the problem is in the low cervical spine,
and it radiates, or refers pain,
over to the muscle, and then the muscle reacts by
tightening up.
- And once it gets into that tight position,
sometimes it's hard to break it out of that pain cycle.
So you gotta find, what do you always call it?
Directional movement, or what?
- Right, yeah, directional movements to find out
how to relieve pain.
- Right, and once you find that specific direction,
you stick with it.
- Yeah, for other people it might be side bending,
and that's where we have a lot of videos,
where we get into the great detail,
but that's a great start, chin tucks and extension
with a towel.
- Exactly, and oftentimes if that's working,
you can also do a mid-back stretch.
Now if you've got a knot, it happens to be not here
but down between the shoulder blades,
this one will oftentimes be helpful.
- Yeah, if you're pretty rounded here, too,
right up, way up in the upper thoracic, even a little bit
of the lower cervical-
- Yeah, through a hunchback.
- A lot of times the ball will work.
We've done videos on this before, too.
You can just get a ball from one of the big box stores.
Brad likes it a little bit flatter.
- I do.
You're not gonna use a basketball.
- Oh, no.
- It's gotta be, has to be.
- Its a little more comfortable,
and what's nice about this, you can, I'm sorry,
I didn't mean to cut you off.
- It needs to be forgiving or a little bit soft.
- So you can move it up and down, then.
- Yes.
- Now, I'm a little bit taller, so I can't go too high here.
Maybe you wanna do this one, Brad.
- Okay, yeah, Bob would need a taller chair.
- But Brad can go up higher into that area where
it kinda gets into that spot.
- Yeah, and then I just work it back.
And you can change positions, you know,
you can bring the arms up like this,
back like this, and sometimes I like to grab the arm rests,
and use that, use some force.
But it should feel good, if you have pain,
if it goes towards the center
of the spine with repetitions, that's a good sign.
Typically, 10 repetitions at one time is more than adequate.
- Yeah, the key is not how many you do right at the time,
I think it's the fact that you can do it throughout the day.
And that's what's nice about the ball, again,
just keep it by your chair.
If you're an office worker, every once in a while,
go head and put it back there and serve,
rip some of 'em off.
- You could do a doubleheader.
Why don't you give me the towel roll.
Use the ball and the towel.
I've gotta admit, I've never had any patients do this,
but I wouldn't.
- Just came at you.
- Yeah, I just thought about it right now,
it's like yeah.
- It actually would work.
I see no problems with that.
- It's one of those things, if it feels really good
while you're doin' it, and when you get done,
you're golden, it's gonna improve.
Wow.
- Is there anything else you wanna talk about, Brad?
- I don't know what time we're at, 'cause Mike
forgot to hit the clock.
- Yeah, Mike didn't put the timer on, so.
We better, remember Brad and I are not just pretty.
- We're pretty ugly.
- No, we're pretty handy and helpful.
So make sure you subscribe to us.
Thanks for watching.