- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- After the last video, Brad,
I noticed for somehow, my belt got way twisted over.
I realized that you wanted to be the same way, so-
- That's cool, huh?
- No, I'm gonna put it back.
- All right.
Well, anyways, what's the topic?
- Today, we're gonna talk about...
You're having some sciatic pain,
is it coming from your piriformis muscle?
So there's three tests you can do,
the tests that we do.
But there's three tests, you could do it.
And not that you're gonna be the doctor,
but you might be able to inform your medical professional
then what's going on.
- And to learn your body more.
- So, very simple.
Number one, what is the piriformis?
First, we better go into that, Brad, real quick.
Piriformis is a muscle in your butt.
It's a small little muscle, and it goes from the sacrum,
here's this bone right here,
which is right above your tailbone.
- There, yeah.
- Right.
And it goes from there on the front part of it,
and it goes out to your hip, actually,
the big bone on top of that.
Greater trochanter.
And the reason it can be a problem,
a reason why it can give you some sciatic-type pain,
is the sciatic nerve goes right underneath it.
And so it can tighten up on that,
and send pain down your leg.
- [Brad] Pinch.
- They actually call it pseudo-sciatica, false sciatica.
- Oh, yeah, yeah,
I know what pseudo means, Bob.
But the other thing, this is a small...
This is a pretty good representation.
It's a small strap muscle. - Strap muscle, yeah.
- Yep.
And it has a trigger point in it that can tighten up,
and knot up.
And it's just one of those muscles
that gets in the way a lot.
- Yeah, one of the first things that I see, Brad,
when I start thinking it might be piriformis,
is when they're not really having any problems
in their back.
Now you can get back pain along with this.
But that's the first thing I start seeing,
the back really doesn't bother me,
but I am getting pain down my leg,
and in my butt then it might be piriformis.
But the first thing we're gonna do,
is we're actually gonna try to put our fingers on that,
and see if one side hurts versus the other.
So you could do that laying down,
or you could do it sitting up.
Do you want to show them?
- Yep, so there's that bone,
there's the sacrum.
- Here's the bone right here
he's talking about on the bone.
- Right there, it's a sacrum.
So I'm gonna go right there.
Right in there.
And you're gonna palpate around.
In other words, kind of poke around on your butt.
You might pull up that leg,
and get in there and you'll fight it.
It will clearly stick out and you'll go,
"Ow, oh, that's the spot."
- [Bob] Some people feel like they're sitting
on a golf ball or something like that, yeah.
Yeah.
- [Brad] And then go on the other side,
you can compare one side to the other,
and there will be a dramatic difference.
- And that's what you're looking for,
is the difference between the two,
'cause it's very unlikely,
you're gonna have pure piriformis syndrome on both sides.
- Right.
- So that's number one.
Number two, the one that I always see on people is,
I'm gonna lay down, Brad,
if you don't mind. - Sure.
- Is that when you stretch it,
you stretch the piriformis muscle,
and you'll find one side hurts and the other side doesn't.
So first I'm gonna check the left side.
So I cross my leg over.
So the ankle's a little past the knee here,
and I take this knee now,
and pull it towards the opposite shoulder.
So I'm gonna pull this over.
And if that hurts or gives me symptoms,
or if
it really stretches.
I'm gonna compare it to the other side.
So I'll bring that one over,
pull the knee to the shoulder.
And if there's one side that's worse than the other,
the one side that hurts
then when you're palpating or pushing on,
another possibility that's piriformis syndrome.
- Right, yeah.
So you're stretching it and it's gonna be very clear.
It's not gonna be, "Well, this hurts a little bit more."
It's gonna be, "This really hurts more."
- All right, the third thing you can do,
the third test you can do,
you can actually put some resistance against the muscle,
and see if it hurts when you do that.
Do you mind putting a belt around my knees, Brad?
- Yeah.
Yes, I do mind but I'm gonna do it anyways, Bob.
- That's very nice of you.
- Yep, okay,
so this is just gonna offer some resistance.
It doesn't have to be a white belt,
it can be a black belt,
it can be gray a belt. - Right,
maybe a little tighter than that though, Brad.
- A little tighter, okay.
I'm sorry. - I gave him one job.
Look what he does.
Okay.
Well, actually I don't want it that tight.
(Brad yells)
(Bob laughs)
- 'Cause you do want to- - See.
- You do want it a little bit further apart.
He was right.
This is probably the first time in his life.
In his life, he was right. - Yeah, I'm gonna kill you,
way you deserve.
- (laughs) Okay, so you do want it far apart like this,
and now you're gonna try to spread your legs apart
with your feet touching. (shoes clicking)
'Cause you're basically going into external rotations.
For you not professionals, right?
- Right.
So yeah, we can call this the clam shell,
feet are together.
So here's the clam shell.
Clam, "Nommy, nommy, nommy, chew, chew, chew."
But anyways.
So you push out and that's gonna make that muscle work,
that piriformis.
If it's injured, that's gonna create pain.
- Exactly.
And the last test,
I don't know if you could do this,
maybe on your own too.
You're gonna bring the leg up like this,
and now you're gonna pull it out again.
And because at this point it's an abductor,
and you do the same thing.
You could try it there and you could try it there.
- Right.
It's a little easier to do with someone supporting here,
the therapist.
So that's what Bob was referring to,
if you could do it on your own.
- Yeah.
So if you're finding all three of those are positive,
there's a good chance you have piriformis syndrome.
And then you're gonna want to get onto to,
is watch our video on how to treat it.
I'll put that right here, Brad.
- Yeah, put it right there.
Put it right there. (laughs) - And if you
haven't subscribed yet,
you're gonna go right down there and do that.
- Down there.
(bed thuds) - Right.
So I really appreciate that, Brad.
Thanks a lot.
- Thank you. (chuckles)