♪ Bob and Brad ♪ ♪ The two most famous
physical therapists ♪ ♪ On the internet ♪ - Hi, folks, I'm Bob
Schrupp, physical therapist. - We're going? I'm Brad Heineck, physical therapist. - Together we are the most
famous physical therapists on the internet. - In our own opinion, of course, Bob. - Time to wake up Brad. - I know you wanted to stay
in bed this morning, buddy. - Good thing I got the lines memorized. - Today, we're gonna talk
about chronic piriformis and hip pain. And fix it yourself. We're gonna show you three steps to do so. - That's right, Bob, one, two, three. - All right, if you're new to our channel, please take a second to subscribe to us. We provide videos how to stay healthy. Fit, pain-free and we upload every day. Also go to bobandbrad.com and you're gonna wanna go
to the giveaway section. That's right. - [Bob] Because this
week we are giving away a SleepOvation mattress. - [Brad] Look at this baby. - [Bob] Yeah. - [Brad] They come much bigger than this. This is a sample and it's a cutaway view so you can see how they're made. - Yeah, you don't be able to see that at home
unless you rip it apart. You can go to Facebook and the contest will be pinned at the top of the page. Go to Twitter, Instagram or TikTok if you want a 60-second
version of our program. We actually have another channel, too, where we have 60-second clips. - [Brad] Oh, good, that's all they can, some people can't take any more than that. - [Bob] That's right. - But with the pillow. This is what they look like on the end, if you cut this apart,
this would look like and they've got actual
springs inside the pillow, but you cannot feel them, it's here, but they're in there. - And they give a good support. - They do. - [Bob] I think it's a
great side sleeping pillow, if you're a side sleeper. - They give you a lot of, that airflow is in there. - [Bob] And this mattress is by far the most comfortable
mattress I've been on. I haven't tried them all, - But I'm very happy with mine. Anyways, we gotta get
on with our piriformis and hip problem. All right. Now Bob, we need to talk about this. As therapists, we know if the doctor gives us orders, says piriformis hip pain, the first thing, not the first, but one of the first things
we're gonna think about is we need to rule out is
it part of the low back? - Right. Is it the back causing the pain. - Right. - And not the piriformis. - So, for this, for a
little brief explanation, we need to refer to Sam. Sam, I am. He is our skeleton model and he's been very good to us in the last few years. I need my stool, as well. - Oh, you made the muscle in black. - Yeah, I did because he's got white bones and it's just a little easier to see. Liz, can you see the location of the piriformis muscle? I don't have exactly the connection. It's actually underneath the sacrum, but for this discussion
it's not that important. From here, down to the
hip greater trochanter is where that muscle goes. - [Bob] A little bump. - That's right. And then, you know, the hip is here, so if you got pain from the piriformis or the hip, they're located
right next to each other. So you gotta determine which it is. But also the back. Now the low back,
oftentimes you'll feel pain in the low back, but it's not uncommon for the pain to refer distally or down into the buttock, into the hip and down into the leg. Which, by the way, Bob and I, we know that the piriformis muscle can also refer pain down the leg as it pinches the sciatic nerve. So, you really need to kind of rule out at least low back and
there's one way I think, and Bob, you may have some other input. - Sure. - But the two options that are, you know, the layperson can do
without too much problems. - Yeah, the sciatic
nerve travels underneath the piriformis or through it, so if the piriformis
muscle is tightened down for some reason or contracted down. - Sure. - It puts pressure on that nerve and sends pain down your leg and you think I have sciatica. - Right. - And it's really not, it's false sciatica we call it. - Either way, you still have the pain- - You still down the leg. - Just from a different source. But just something to rule out the back. If you're standing and you have your pain in your hip and you go like this and you extend, you keep your legs and everything still,
but you just stabilize your back here and think
of all motion going from above there in this direction, if that changes that pain, particularly significantly,
there's a good chance you got some low back involvement, but just wait, before you go any farther, let's assess even- - You want me to do it? - Yeah, go ahead. I want you to lay down, probably on the floor would be best. You could do it on the bed, but the floor is better. - Lie down. - Lie down, yes. And I want you to think that your waist is glued to the floor and so everything, the hip
is all completely motionless. - Yeah, so the piriformis is not kicking in whatsoever. - No, hip motion. Everything down here and then you're going to do a press up. Now if you have pain doing this, particularly in the leg, in the hip or down the leg, it's very, very certain that you probably have a low back problem referring down. You could have a low back problem and piriformis, but if you can do this and it doesn't bother you at all, you can do this, no real change, then it probably is from the hip and/or the piriformis. - Yeah, and the thing is,
these are things that, it's pretty, you know, difficult sometimes for a therapist even to assess, but as a rule of thumb, if this recreates the pain, you know there's a good chance that it's the back. - Right, exactly. So, let's say you did
your extension exercise that we just demonstrated. Didn't change anything. We've got the hip and
piriformis to work with. Now the second step is this
is how we're gonna do this. Won't you move Bob, I'm gonna do... Knees like this and
we're gonna simply bring the knee up and over to the opposite knee and this stretches the piriformis. - [Bob] Yeah, this is
the one that's painful, the right side. - You do this and feel
it pull tight there. Make sure you do the other one, because if that piriformis is tight, I've had many patients say oh, boy, I feel it right in here and then the other leg that doesn't hurt. - [Bob] Yes, almost,
Brad, almost universally it seems like I found it to be that true. - Exactly. - So it's another sign
that it is piriformis. - And then you can also just do the knee straight up. And that might give you some indication of the actual hip joint itself and it will take out some of
the piriformis involvement. You know, this hip might go up to here and this one, oh, this is no problem here. So then you may have some
hip tightness, as well. And that's the thing, you know, it may not be just one or the other, you kind of, you know- - You could have pain. - Your piriformis could
be tight as a result of a painful hip. - Sure, sure. Or vice versa, your hip got tight because your piriformis hurts. - Right. - You don't want to move your hip. - Yeah, what comes first
the chicken or the egg. - Right. - Well, we shouldn't discuss that because we've got other work to do. Anyways, do the figure four. So ankle goes above the
kneecap on the thigh and then check range of motion this way. Now this is not gonna check, this is more of the hip joint. Not so much the piriformis, but there's some
involvement that way, too. If you find that this
one only goes to here or you even have a hard time
getting your foot up to there and this one drops like this. - [Bob] I don't know
if you remember, Brad, the piriformis actually
is an external rotator and sometimes it's an internal rotator when it gets up there farther. - Yeah, it gets kind of complicated. - It get complicated, so you probably are actually stretching the piriformis if you get up like this. - Right. - And then push it down. - I knew he was gonna get it. - Yeah, he knew I was gonna say something. - I wanted to keep it simple. - Right, and that's the case. You don't even need to, so should they be doing those stretches? - Well, yeah, if they're right, then you are gonna do the stretch, but before we go any farther. - And those stretches are
good for you no matter what, even if you don't have piriformis. - Even if, yeah, and I do them myself. - Right. - But if you got the painful hip and you want to get that
piriformis muscle stretched, as well as the hip muscles, this is what we're gonna show you. This is step number three, the treatment part. - Sure. - One thing you can do is
before you do the stretches, we're gonna do this on the floor. What you can do, a little foam rolling. Now I like the foam roller. There are some things I like about it and some things I don't like about it is one, you know, you can work it and as long as you can do this, some people may have shoulder problems. If you're a little older,
you have some injuries, you may not be able to control the weight, but we have another option. - [Bob] Brad's not putting
full stress on that. - No. - [Bob] He's able to
take his arms and so... - I've got about 50%
of my weight on there. - [Bob] Sure. - And if it's sore, you need to. - [Bob] And he's kind of
rolled towards that side where he could roll off it a little more and take even more stress off of it. - Like now I'm on the sacrum mostly. - [Bob] Yeah. - But you're gonna work that and you'll get a feel for it. When you get over that
tender tight muscle, that piriformis, you're gonna have to be, tread lightly on it and then work into it. You'll do this for a minute or two and longer after it starts to loosen up. - [Bob] I wouldn't do
this one, Brad, though, if it increases your pain. Do you know what I mean? - Right. - [Bob] Starts sending pain down your leg. - Yes, particular the leg symptoms. - If you feel a little soreness right a you roll over, that's fine, but don't increase that leg pain down, you know, down the leg. That means it's too tender. You're gonna have to
maybe use the next step. - Right. - And massage around it. - Exactly. Which, and these massage
guns are getting so popular. Now, I've got orange tape on it just so you can see
this on my black pants, but I use the round ball. - Sure. - You may want to- - They've got five attachments. You're probably gonna use either the airhead, that's just a little softer to get started, the round ball
is a little more aggressive, but then they have some other heads that are really aggressive. - [Bob] Yeah, this would
be really aggressive. - The little pointer. - [Bob] And that's the one I
use on my calf right now, so. - Sure. But to start out with, go with this and you'll get a feel for what you need. So I'll demonstrate, and I have a patient right now, he's gotta have a hip replacement, probably in about nine months. He's trying to hold it off.
- Sure. - And he's using the massage gun as part of his treatment. Chris. - Oh, sure. - So I'm gonna get this thing going. You can see this- - [Bob] You're gonna have black on black so it's good that you
got the orange on there. - Yeah. So this is a reciprocating gun and you need to have a
gun that reciprocates- - [Bob] Not just vibrates. - It's gotta get into that muscle. You got large muscle mass here. - [Bob] And also, you don't
wanna go cheap on these things. Like the ones they're like 20 or 25 bucks or something, they're junk. - Right. On the other hand, they sell them for 4 or $500 and they're probably good guns, but you can get a real
nice one for around $100, or 120, 30. - [Bob] I have found on
the piriformis muscle, this is what treats it for me. I mean, I've had the best luck by doing massage on it. - Sure. - [Bob] And you can use
your hand to do it, massage, but you're gonna wear out very fast. So, anybody I've had,
including family members, if they had piriformis problem, I sent them a massage gun. - Sure. And, you know, and the hip like with my patient who's getting
a hip replacement, I don't know if we can roll Sam over. - [Bob] Sure. - Then we can see, we want to get those muscles
around that hip capsule, as loose as possible so
that when you have surgery, things are loose and you're gonna have a better surgical results. So I'm going over that
piriformis right here. You don't wanna go- - [Bob] Go on a bone. - That's just gonna hurt
like, you know, the dickens. And here and over on the top. - [Bob] There's a sit bone, too, you don't wanna hit that. - Yep. You're gonna go into the muscle and you can even get into the front a little bit here. You know, touch on that leg. - [Bob] You don't wanna be in the femoral crease
where the lymph nodes are. - Right, right. Okay. So, you can work with that. - The big thing is, too, you can work around. If it's a real tender spot, work around it and then eventually go into the tender spot. - Exactly and you'll feel the tender spot, especially that piriformis. There's a trigger point
down there typically. You know, the patient, you can always, they'll let you know it. - You'll see from the look in their eyes. - And I'll just review the stretches. So, you know, you can do that, work the massage, work the roller first or the massage gun and then do your stretches and I like to start with
the knee to the chest first. It's not quite as aggressive and you go pressure on,
pressure off, 10 times and then you may go to the figure four and again, if you wanna hold it for 15 to 30 seconds. - A great stretch to do. Everybody should be
doing this stretch, Brad. - Especially when you get older. - Yeah, especially when you get older. You get 50 plus, you should
be doing this stretch. - Exactly. - And we're eating our own recipes here because I stretched it this morning. - Sure. And then you do the clamshell like this. You can grab, I do this actually. I use the belt and then
I put my elbows here and I stretch here just
to get that abduction with the flexion. Get that loosened up and
when you regain motion, the pain almost certainly
is gonna come down. - Yes. They correlate. Like if you have tightness,
the pain goes up. As the hip becomes more loose, it gets worked out. - That's right. All right.
- Guaranteed. - Good luck with that hip. Be careful and we can
fix just about anything. - [Together] Except for. - A broken heart. - That's right. - But Valentine's Day is coming up. - Oh, that's right. - So we're gonna start fixing hearts. - We could score a double bonus on this. I even got my wife a gift yesterday. And I wrote a card out and I stuffed it in there and I got some stuff, but don't tell her. I've got it hidden in the house. - All right. Yeah. Good job. - I'm gonna have a good weekend. - Yeah.
