♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, 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- - Brad,
today I wanna talk about,
is your back pain actually coming from your SI?
- SI? - Sacroiliac.
- Okay- - Joint.
- Yep. - And it' really
important to know this, Brad,
because the way you're gonna treat it
is gonna be a lot different, if it is coming from this.
- Sure.
- This is important to know.
And before we get started, Brad,
we see some new people out there.
- Oh, absolutely.
I see lots of 'em.
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We provide videos on stay healthy, fit, pain free,
and we upload every day. - Excellent, Bob.
- Damn hard working, Brad. - You better believe it.
- All right, SI.
So, very simple.
Brad, you wanna stand like this thing is standing?
- Oh, okay.
- [Bob] So it's like that, okay.
So right here, you got the pelvis,
which we call the iliums.
- So that would be- - That's on both sides here.
And this triangle shaped thing,
this bone right here, that's the sacrum.
And in between them, between the ilium and the sacrum
is the SI joint. - Right.
- On both sides. - Right there.
- [Bob] And quite often,
one of the problems that happens, Brad,
is these ligaments get stretched out here.
- Mm-hm. - And one of these joints,
or one of these iliums might get rotated.
- Right, because this joint is not like an elbow joint,
where it's made to move- - To move, right.
- It's stable. - It's supposed to be
a stable joint, exactly.
So, and if this gets rotated, it can give you pain.
And so what you'll see manual therapists do
is they'll actually rotate it back,
back in place, and often that relieves the pain.
- Exactly. - The other thing
that sometimes helps out,
if this is kind of unstable, these ligaments,
is if you squeeze these, the pelvis together,
and hold that joint in place.
- Mm-hm. - And there's less pain there-
- Right. - And we'll talk
about that later as a treatment.
- [Brad] Sure.
- So, all right.
So what are some of the tests, Brad?
Let's start off here.
Well first off, let's talk about
what are some of the things that you might see.
First off is that,
it can a lot of times be worse with walking, and stairs.
- Right, weight bearing activities.
You bet. - Especially,
you know, when you're going on one leg more than the other.
You know, I'm saying, like a stairs.
- Right.
Yep, uneven, where things aren't smooth,
and that foot comes down, puts some more pressure
to that SI that's inflamed,
can make you jump, hurt a little more-
- And the pain tends to be on one side, Brad.
- Yep. - And it doesn't,
it doesn't tend to be a cross.
Very common with pregnancy. - Right.
- We see that quite often- - Right.
Those ligaments get lax, and it causes problems.
- Yeah, there's a chemical that causes the ligaments
to get lax during pregnancy.
Did you know that? - It would be a hormone?
- Yeah, I think so.
- (laughs) Okay.
(Bob laughs)
- We're learning as we- - We're going out of our...
(Brad chuckles)
- Quite often what you will see with somebody,
very often to see,
is that they have a leg length discrepancy,
which means one of their legs is longer than the other.
Now, the way I measure leg length discrepancy,
is I just,
we look at Napoleon here.
You can see his pelvis here.
Yeah, get his arm out of the way.
So, if these are level,
if you put your, you know,
stick your fingers in here,
and you find the top of your pelvis.
- [Brad] Here, we can't see it, Bob.
- [Bob] And you might have to have someone
look at it for you. - There.
- [Bob] Or look in the mirror.
If those are level, and your legs are straight,
then generally, your legs are the same length.
Not uncommon to find a quarter inch difference.
- Mm-hm. - Sometimes even a half inch.
- Sure. - Because
somewhere along here, then,
something is longer, you know...
It could be your knee wore out or something on one side.
- [Brad] It's possible you're born that way,
and you've been that way all your life-
- [Bob] Lot of people are born that way.
- Sure. - But that's gonna throw
the pelvis off.
Can you see how that would throw the mechanism of it off?
- Right.
It's all a chain, and that works up into the SI joint.
- All right, let's start off
with the most simple test here first, Brad.
- Okay. - It's called
the Fortin finger test. - Oh.
- Fortin hears a who. (chuckles)
- Okay.
- So, all you're gonna do is,
you're gonna take your finger,
again, one-sided pain,
and you go ahead, and you find the spot where it hurts.
Now, if there's a real localized spot,
and you can point right to it,
that means that this might be positive,
that you might actually have SI.
And then let's say you do,
you know, you come back later,
and you can put a piece of tape there.
- Right, so if I'm the therapist,
I'm gonna say, "Bob, show me where you feel that pain.
Is there one spot?"
And Bob points, right there.
Okay, take it off.
Now, I know that I'm a half inch over
from his belt loop, and I'm gonna memorize that.
Or I could put a piece of tape there.
I'll go through more of the evaluation,
10 minutes later, I'm gonna say, "Bob,
can you point to that again?"
And if he puts his finger in that same spot,
and he feels very confident about it...
- That could be SI problem.
- Right.
- It's leaning towards that.
How about the Patrick test, Brad?
The figure four? - Yep.
- So, very simple.
Go ahead and gonna cross this ankle over the opposite knee.
- So you're just above the kneecap there.
This, we call the figure four.
If you're looking down, it looks like a figure of four.
You're, Bob's gonna relax- - Right-
- Relatively.
The knee is gonna drop down like this.
That puts pressure on the SI joint.
- You might feel it already, just getting in this position.
- Right.
And it might flare it up.
I may put a hand here and here.
Gently push- - You push down.
- A little pressure on there. - Yep.
- And if it makes his eyes open up and say, "Ouch,"
(chuckles) then- - So my last SI patient,
who we're treating right now,
that's the one that was positive on it.
- Sure. - That again, pointed to...
And you'd check on both sides. - You bet.
- Obviously, you'd- - Compare one side
to the other. - Yep.
And that's always a good thing to do.
- Yep.
- So we can go right to the next one, Brad.
The Gaenslen.
I think that's how it's pronounced.
You're gonna put one leg off the edge.
- Mm-hm. - You're gonna bring
one leg up like this, and you're gonna push,
you're gonna stop this one from going up,
and this one from going down.
- Right. - And you give it a push.
And you see if that irritates it.
- So, I'm gently pushing here,
and supporting here.
And that's rotating, has a tendency to-
- Right. - Rotate that pelvis.
If you're actually going in the right direction,
and putting it back into place,
someone could say, "Oh, that feels good"-
- It might actually feel good, right.
- If it feels ouch, then you're not going to.
You go after it. - Right.
All right, next one is,
we're gonna lay on our side. - Oh.
- I'm gonna lay on this side, Brad-
- I'd better get out of the way-
- Mic here. - Of course.
- Now this is where we're gonna need help again, Brad.
Because you gotta push on my pelvis here,
and tell me if that actually hurts.
- And actually, I'm gonna move the table a little bit, Bob.
Because I'm shy. I'm just kidding.
So yeah, right here.
I'm gonna push down on here, and that's gonna
put a little pressure.
It'd be like right here.
I'm gonna push right here,
and that's gonna compress the SI joint.
If they're irritated, it's gonna be painful.
- And then there's just the simple,
sacral thrust test, Brad.
Where you actually have the person lay flat.
- Mm. - And you're gonna push
right on that sacrum. - Right.
And you wanna get in the middle.
And this is where you need to know some anatomy.
So if you're not a therapist,
or not really familiar with anatomy,
this may be difficult for you to know where to push.
So, I don't know if the layperson
will be as good at that one.
I don't know, what do you think, Bob?
- I don't know.
We'll have to, you know,
I'm not sure what capability- - We're gonna be
making therapists out of all these people.
(Bob laughs)
- But the other test that I do, Brad,
and I just did on this lady, and it worked,
was I actually, there's two ways to do this, Brad.
Let me grab the, this again.
- Sure. - The spine.
So if you'll, if you can hold this up like this.
- I will, Bob.
I will hold. - So, one thing,
sometimes just by squeezing the pelvis together,
and you're keeping the joint together-
- Yep. - It actually feels better.
So let's say they normally have pain with walking.
- Yep. - And I walk behind 'em,
and I actually squeeze like this.
- And you're following 'em.
- And I'm following them.
It's kind of a goofy looking thing.
- That'd be a good video in itself, Bob. (laughs)
- The other one that I do, Brad.
Sometimes I'll actually take,
and this is beyond the capability of,
people out there. - Sure.
- Because I actually take it, and I rotate it back.
- Right.
So you're putting a torque on it-
- Right, putting a torque on it
one way or the other, and see if that makes a difference.
But, generally what I've found is,
you know, if I just push on someone like this.
And walk along with them,
it often makes the difference.
Now, another thing- - Then you have to
hire someone to walk behind 'em, and...
(Bob chuckles)
If you get their spouse or husband,
I bet ya he would probably do it.
- You wanna put this on, Brad?
This actually would be a better test, actually.
If you had one of these around her.
I guess you could take a belt, maybe.
- Well, I've used a gate belt.
They work, kind of.
Not as good as one of these, obviously.
But anything where you compress, and-
- Compress it together. - Usually an elastic belt
is not tight enough, it has too much give.
You need something that has a more positive,
wouldn't you say?
- Right.
- Okay, so here, this one,
you can see it goes both directions.
I'm gonna lock this one down,
then I'm gonna cinch this over.
And you cannot go too high on this,
because if you go above the iliums,
if the belt is up here,
then you're just squishing the person's stomach.
- Right.
- You would need to get below it-
- Yeah, you're down below the belt line here.
- Right. - And pushing along here.
- Right.
And I can definitely feel this support.
It actually feels kind of good right now. I like that.
- So, if that actually makes you feel better,
then again, that's gotta be a SI problem.
- Right. - Because it's not gonna
make a back pain feel better, to have it-
- Right, because you're not doing anything
with the lumbar spine with this.
- Right.
Now, one of the things is,
with SI problem,
quite often what they find out, Brad,
is it's caused by people sitting in a weird position.
Let's say, if they tend to sit like this all the time.
Can you see how that kind of throws-
- Right. - The joint off.
- Yep. - But another one is if,
like women, when they,
I can't do this, but they'll sit on their leg.
- I think that's kind of sexist, Bob.
- (chuckles) No.
Well, it's mostly women.
I've seen have done it. - Well, of course.
- Can you see how that would, over time-
- Right. - Throw the pelvis off?
- Right, right. - So these are things
that you're gonna wanna pay attention to
if you do have the SI problem.
As you know, what positions you are in
throughout the day. - Sure.
- But if you tend to even lean on one side,
or be on a soft couch all day long.
- Right.
- That's gonna throw you off too, so.
- I know there's one thing, with me personally.
If I sit down, because I'm sure my right SI's
got a problem.
I'll sit down, and I'll lean on my right side,
and the pain goes from to here-
- Down to here- - Yep.
Yep, and actually, right now it feels better.
So, carry on. - Do you normally
sit one way or the other?
I mean, before that happened?
I'm curious if that is what threw it off.
- No, no if I go running it'll happen, though.
So I think that- - Oh, yeah.
That makes sense, though. - Yeah.
I probably shouldn't be running. (laughs)
- All right.
Remember, we can fix just about anything, Brad.
- Except, oh yeah, the broken heart.
- Yeah.
- But we're really getting close.
We've got a couple videos on that now,
and we're gonna keep going after it until we get it.
- We're gonna become the experts on it.
- Yeah. - All right, thanks a lot.
- Say no more.