♪ 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 internet. - In our opinion, of course.
- Bob and Brad.
Now Brad is gonna say these words
and we're gonna see if he says them correctly,
'cause I don't know how to say them so.
(Brad laughing)
- Okay, these are diagnoses of back problems,
and they're actually quite prevalent across society.
But the thing is, is when a doctor says this to you,
you're gonna say, oh my God, I have this.
We're gonna explain to you what you have,
it's not as bad as these words are.
- Right.
- The first one is spondylosis.
- Spondylosis. - Spondylosis.
The second one is spondylolysis.
- Spondylolysis. (Brad chuckling)
- And the last one is spondylolisthesis.
- Spondylolisthesis.
- They say D, the- - They do?
- T-H-E-E, desis. - Spondylolis-desis.
(Brad laughing) Wow.
- Anyways, you can Google it,
and they'll actually pronounce it for you.
- They all sound like they're almost the same thing,
but they're all really quite different
to some extent, actually, Brad.
- Right, right.
Especially the first one
to the last one that we talked about.
So let's do that, let's just go through them
one at a time, in case you have this
and you're kind of wondering what do I have?
My, especially the first one, spondylosis.
- Right.
- It's no, that's such a- - It's not a big deal.
This is what, really, almost probably everybody has
to some extent as you get older.
- Right.
- It's just regular wear and tear.
- Wear, if you look it up it says wear,
normal wear and tear on the back.
An interesting thing is spondy, that,
I believe it's Greek or Latin, it just means vertebra.
- Oh it does. - Right.
So that's a, they're talking about,
that's why all three of these have the first part-
- And also this is like just an abnormality,
isn't it somewhat? - Right.
Yeah, if you break these words down it becomes not so scary.
- So that one is really not a scary one
because, again, like I said, almost probably everybody has
a little bit of that as you get older.
- Right, when you get over 60 years old, you probably-
- 50 even, I would say.
- Yeah, I'm definitely (chuckles),
I've got all three of these (laughs).
Okay, and so we're gonna talk about some exercises
for all of these at the end,
but let's go through them first.
- Well, before we go too much further back-
- Good point, Bob.
- If you're new to our channel, which a lot of you are,
please take a second to subscribe.
Our subscription button is over here besides Brad.
- Probably down there or up there.
- Yeah, we provide videos on how to stay healthy,
fit, and pain free, and we upload every day.
- Right, and we're gonna do a lot of education
in this video that's gonna enlighten you with these terms.
Now the second one, spondylolysis.
- Spondylolysis.
- Okay, this one's a little more technical,
and this one I gotta get the spine out for you.
This can happen in the low back or the neck.
Usually it's the low back,
so we're gonna look at the low back,
and it's typically in the lower lumbar vertebra,
oftentimes at L5, the lowest one.
Okay, 'cause that's where most of the stress is.
We're not getting into that, you'll just have to believe us.
So that makes sense.
Now what it is, is I'm gonna show you,
where did my pen go, Bob? - Right here, Brad.
- Oh, good.
This is-
- Wanna show it on there or on that one?
- Yeah, well we're gonna do both actually.
There's a structure in the back called the pars articularis.
This is one I had- - Pars articularis.
- Right, I remember from school but I don't use it
very often in the clinic.
Okay, but I know where it is.
It's, we're gonna look at it here,
if I could pull these two vertebrae out
so it's easier to see, we have this.
- You wanna go up there, Brad?
- Yep.
I gotta get my glasses on 'cause this is a smaller area,
but I have it highlighted.
Now if you look at, here's L5 and L4,
let's say we have, in this case it's L4,
here's a disc in here, this I put in there
just to represent, that's where the spinal cord goes, okay?
- [Bob] Okay, and there's room down there for it.
- [Brad] Right.
I know someone might get technical and say
the spinal cord doesn't go before L1,
and we're not gonna get into that.
This red mark right here on this part of the bone
is the pars articularis.
- [Bob] Sure.
- [Brad] And that is usually, it becomes a stress fracture,
and it can actually become more of a stress fracture
and break apart, but when it starts to do that
it progresses to spondylolisthesis,
which we'll get into-
- [Bob] Which we'll show a bit next.
- [Brad] Right.
So right there can cause problems,
and you look at the nerve right here,
if this inflames because of the stress fracture,
that nerve can get involved and that can cause more pain
and symptoms that you wanna avoid.
- [Bob] Well, you had some interesting statistics
on this, Brad, that I never knew.
One, that it actually happens in young adults, boys.
- Right, adolescents, you know,
usually in the early teenage years,
often associated with active people that are in athletics,
contact sports, or repetitive motion-
- Which makes sense.
- Things where they extend, because that puts
a lot of pressure on that part of the vertebra
to cause that stress fracture.
- So you really think of,
I think of young girls as far as gymnasts,
because they're always in that hyper-extended position.
- Not only that they're in hyper-extended
and then they land with a tremendous amount of force
to just jam that.
- I'm shocked that every one of them doesn't have this.
- I know (chuckles), it really is-
- But it is more common in males, and-
- This is an interesting fact, 50%, they estimate,
50% of all back pain in that age group
is from this diagnosis, okay?
- So if you're having back pain at that age,
this is one of the things you should consider
as a possibility, and x-rays would pick that up.
- And there's a special test, and I'll show you,
it's a simple one, okay?
And we've done this on another video quite a while ago,
is you stand on one leg, and then you bend back
and to one side, and if that consistently flares it up,
'cause you're stressing that stress fracture, that's-
- You can do it the other way then too, Brad, right?
- Right, yep.
Stand on the opposite leg, and if I'm on my left leg,
I can go back and to the left side.
- [Bob] So you're looking to see whether or not
the pain on the left side, on this one, is being enhanced.
- Right, exactly.
If you do that and you have pain with that,
that's not 100% certain that that's what you have,
it's just an indicator.
- It's just one more possibility, you know,
of pushing towards that idea.
- Right, right.
And they estimate 6% of the population have this.
- Okay.
- Which isn't a lot, but it's-
- It's a fair amount, when you start looking at
thousands of people or millions of people.
- Oftentimes associated with genetics, you know?
And then we talked about the other activities.
Now let's go to the other one,
which is probably more problematic,
and that's spondylolisthesis.
- Desis.
- And they say T-H-E, desis, I have a hard time with it.
Your daughter's a speech therapist,
maybe she can come and help us out.
All right, so spondylolisthesis is usually in L4 or L5,
or L5 and S1.
And the big difference with this is,
I cannot show you on this model, but let's look at this one,
'cause I have this diagnosis and actually
my L4 shifts over my L5
in the anterior or forward direction.
So like, here Bob is showing-
- So here's normal, and here's putting forward.
Now normally there's a disc between there.
- Right, exactly.
- But you no longer have a disc between yours.
- No, my disc is completely gone, and it looks like,
according to the x-rays, the bone has fused together
and that's what I'm hoping for so it's more stable, but-
- It's funny how the body is,
I mean a lot of things the body will heal if you let it.
- Yeah, if you give it time and you treat it properly.
So we're gonna talk about treatment for spondylolysis
and spondylolisthesis are very similar.
- Right.
- You could do the same exercises
and probably get similar results.
- Sounds good.
- Each individual's a little different,
but that's how we're gonna approach it.
- Probably the first one we have everybody do
is knees to chest, wouldn't you say, Brad?
- Yeah, now big thing about spondylolisthesis
is you wanna avoid extension,
actually with both of these, extension exercises.
So you're not gonna stretch out like this lot.
I'll do this a little bit,
but I'm not gonna repeat it very often
'cause it, my body's talking to me about it.
Activities, if you're gonna wash the ceiling,
have somebody else do it.
- Yeah. - I've tried that.
- Trying to go up.
- Yeah, it hurts for the next day or so.
So avoid things like that.
But one thing that it does do well with is flexion,
and that's doing double knees to chest.
- [Bob] You could start off single if you wanna first,
just to stretch a little bit.
- Yep, that's a good point, Bob.
You can start out here.
I wouldn't do more than 10,
I think after 10 you're stretched out enough.
Sometimes I will hold this because it feels really good.
And this is usually after I've been standing
and I'm, you know, in that, more of an extension mode,
but I won't hold it for minutes.
Usually, you know, 20, 30 seconds at the most.
When it gets done feeling good, then I'm back to here.
The next thing you wanna do
after you get that range of motion
is some strengthening exercises to strengthen the abdominal,
the core muscles in the front.
The core muscles are all the way in the back,
but this is what you wanna really become dominant
so they protect those vertebra from shifting again,
and I've been doing these for,
let's get the ball, could you, Bob?
I've been doing these for approximately five years now
on a fairly consistent basis,
and actually I've improved quite a bit from four years ago.
- [Bob] Yeah.
- To having back pain every day,
to now just when I do silly things and abuse it (chuckles).
But I'm trying to avoid those things.
Sorry, I got my brown shoes on today.
I usually have my black shoes.
Some commented on that, Bob, they were not happy with that.
- [Bob] That's not good. - Yeah, I know it.
- [Bob] That's bad (chuckles).
- I'm sorry, I'm sorry, I was in a hurry.
But this is a great exercise right here.
Forces a low back and a good posture,
it really works the abdominal muscle as well,
and you get some hamstring
and some hip strengthening as well, okay?
And then I'll just go in this position,
and this just feels good,
and I'll work the core from this direction.
And if you're starting out with these,
probably 10 will be good
and you're gonna get some sore stomach muscles.
You know, if you're fairly fit, you know, you'll build up.
I usually do 50 of these, and then I stop,
and I have a little more of a routine than that.
Then, the third one I do is here and here
and I double it up, the double crunch.
And I'm thinking about lifting my buttocks up in the air
because that will help flex that low back,
those low vertebra,
and get those muscles in the front strong, okay?
And then the final one, this is one of my favorites
because not only does it strengthen your core,
and you get the oblique muscles on this one,
but right here under your back, with me anyways,
it scratches my back and it really feels good.
So I do the (groans), the criss-cross,
elbow to knee, opposite knee,
and you do those until you get so,
your muscles get fatigued, and those are a wonderful tool,
and I really am an advocate of using the ball
because it protects your back from overdoing it.
- Yes it does.
- Otherwise your back can arch in the opposite direction.
It will not do that with the ball.
- We got a little bit of squeaky bench here, Brad.
- I know it, wow.
- And remember, Brad, we're not just pretty-
- We're pretty ugly, Bob.
- No, we're pretty handy. - Oh, that's right.
- So again, make sure you subscribe.
Thanks a lot for watching. (Brad chuckling)