Is It A Back, Sciatica, SI Joint, Hip, Or Piriformis Problem That’s Causing Your Pain? Watch & Learn

ready yeah hey everyone dr charlie johnson physical therapist here in today's video i want to share a personal case study of a woman named melanie she's right here say hi no hi uh who came to me with sort of some hip back leg stuff i had seen hip specialist back specialist a bunch of different people uh and is still unsure about what's going on but uh is set up for spine surgery actually i think coming up and we're trying to prevent her from having us so i want to walk you through sort of how we're going to bring some clarity to that to determine is this a back problem a hip problem sciatica what is it and i want to walk you through sort of what i'm thinking there so before i do that just so everyone uh watching knows i help people get back to normal without pills injections or surgery so we definitely want to prevent her from having that and for anybody out there who's looking for natural relief call 484-552-3767 so here we go um so melanie is it cool if we talk a little bit about your story here yeah yeah awesome so um yeah tell me a little bit about sort of what's been going on like how long you've been dealing with this and then i'll just pull some other stuff out of you if it's cool like ask some questions and then we'll draw it up for everyone here and then i'll bring her through sort of a brief exam and walk through uh you know my mindset of what i'm thinking cool what concerns you what brings you in what's going on um yeah so started about six months ago um i don't really know how it started or what happened but um like wasn't something specific but i had some like back pain on the left side um and it would kind of wrap around the front like into my groin a little bit um but like down the front of my leg into my shin and like around my ankle um and so yeah i mean i went to a back doctor i went to a hip doctor they kind of each pointed to each other and so i've got this surgery scheduled i really don't want to have it and i'm just trying to figure out what's going on okay um and then did you have injections did they do an injection i think you said well in your hip one to your back yeah and didn't didn't really work okay so just to get this um right a lot of times people seem that this issue a lot of times where they go to the back doctor and the back doctor sees things as a back problem right and the hip doctor often sees things as a hip problem or they just point fingers at one another so you've had a lot of times they'll do injections to try to determine if like what area is the problem they try to use it as sort of a diagnostic thing where you know the idea is hey if we give an injection to the hip and you get relief from that then it must be a hip problem right or if we give an injection to the back and you get relief of things it must be a back problem but i you know and that doesn't work all that well uh it's a good thought but it just doesn't in this case you haven't had relief from either so then it's like what do we do so melanie's looking for some answers so i'm gonna bring some clarity to this um you know off screen i know about her story so i'm going to share a little bit here again if it's okay with you and we'll just spell it out we'll go into an examination so you can see sort of what we do and how we would work through that process and maybe how somebody watching us at home could do the same so here we go so um this is a picture of the kind of like i don't know pelvis area and down as if somebody's looking from the back uh and then from the front so this is the left side of looking from the back uh this is the right side and so on and so forth they're labeled in orange so it's her left hip you said right left hip back area um and by the way like there's a saying in medicine right that if you listen to what the person's saying often tell you the answer so you feel as though it's like what's going on do you feel um i mean my hunch is it's my hip okay your hunch is that it's coming from your hip all right so um on the left side actually this is screwed up it should be a little different here we'll do this try again all right so from the back right she's got some like lower back discomfort it started as a little bit of that then it kind of went down towards the hip area and then it wraps around the front a little bit in the groin and i think you said it goes down towards the knee and down the leg and you even mentioned like feeling some shin pain like a band around um the you know ankle area so uh you know what what's going on well the question is right is this a hip problem and this is sort of where we start with everybody we start with what i call a deck of cards this idea is when somebody comes to see me the first thing i'm working through is like what could this be so i'm sort of shuffling through them saying this could be a back problem and this could be a hip problem and this could be sciatica and these are the things right that we have to sort of work through so we've got hip we've got back then we've got a nerve or in this case like sciatica problem right where is it bothering her in these areas that i highlighted uh when does it bother you most so i think you said right when you were like sitting for a while and then going from sitting to a standing position to be super like stiff and achy or yeah and after walking for a while okay also when i sleep walking and then sleeping not cold at the main priority anybody i work with is that we have to improve sleep because we know that people who don't sleep uh they just have more pain they're generally have higher like cortisol levels they're a little bit more stressed out and that keeps the pain cycle going she's not exactly sure this is sort of a piece of the puzzle she's not exactly sure what uh started and we tried to dig in there but we can't um figure that out so what i'm going to do is right now i guess i'll walk you through a little bit my thought process and then we'll go to the examination obviously you know we have to ask is his hip back or nerve it started off with some back issues so it could be a back problem um now she's got some groin stuff which points me more towards a little bit of like a hip thing and here's the thing i know that the hip uh can cause some groin discomfort but you can also get what we call like referred pain so it's this idea of if you've ever had somebody push on something maybe a knot or something like that an area in your body and you feel like some of the pain travels somewhere even though you're pushing up here you might feel it radiate uh we know that the hip can actually cause some symptoms down the leg uh into the knee and in fact we have cases where people have had knee replacements uh thinking it was a knee problem it was actually the hip uh because the same nerve controls both the hip and the knee and then we also have uh symptoms that can radiate all the way to the shin uh and uh over top of the foot so what you'll see a lot of times is that in this case melanie was sharing with me that she she went to the hip specialist and the hip specialist i you know was moving her through a couple different things and talking to her and when she mentioned that it was all the way down into her shin and into sort of her ankle she felt like she had a tight band over top of her ankle the hip physician after especially on top of the uh the injection not working the hip specialist automatically sort of you know threw it out and said it can't be the hip because the hip doesn't send signals down here it's got to be sciatica or a back prop which can often refer there so then the back specialist as soon as they heard this did the injection didn't respond so they were kind of scratching their head but they thought hey it's probably something up here because they did an image and they showed they showed some ugly stuff right some arthritis things like that and here's the thing it shows up in like in 80 percent of people over the age of 50. even younger folks arthritis starts as young as like 25 and it's actually just a completely normal part of just being alive and being human and using our bodies so uh this was sort of a finding that popped up and they were kind of blaming this for everything now here's the interesting thing when i asked her when she went to see the specialists what type of examination they did meaning they took images and they did the injection but did they bring you through many movements or yeah yeah so this is a common uh experience for people they come to me because they're frustrated and confused in that they go and they see these specialists and they don't spend that much time with them they don't get to really listen to the whole story and then they don't even go through a movement exam and a lot of these problems melanie is explaining that you know when she sits for a while when she does a certain movement walking for a while and when she's in a certain position she gets the symptoms but none of these things were evaluated during the examination with the specialists they're simply going off symptoms and then the results of their images which we know are not all that great so you know so we've got hip we've got back that could potentially definitely cause all this and then we have to decide hey we know the sciatic nerve can cause symptoms all the way down the leg but she's telling me she does not have any form of numbness or tingling um you know any excessive weakness in the leg anything else funky going on there that would make me think this is a nerve problem so there's just preliminary thoughts there but what we're going to do is we're going to systematically go through a quick couple motions of the back go through a few motions with the hip and then go through a very good self-test to determine if the nerve is the cause of a problem and then we're going to wrap it up so you can see just sort of my thought process there so here we go we're going to go through an examination with melanie through an examination now and the first thing we're going to look at is standing just because that's where she is um and we're going to look first at the back because that's sort of the most upstream if you will and then we can sort of look at the hip look at the nerve and look at everything downstream so we're going to start with just seeing how her back moves and seeing if that changes her symptoms so through the examination we're really trying to determine what specific movement brings on her discomfort so we're trying to establish a movement and a pain relationship there um so we're going to first look at the back and then go through hip and nerve problems so here we go so first thing i just want to see how the back is moving can you go ahead and touch your toes for me please as far as you can yep anything with that are you okay a little bit of a pinch here all right now is it okay if we do a few more meaning like in your experience if you do one thing and then you stop doing that one thing after you feel something does it seem to go away pretty quickly or does it linger no it does it goes away okay cool so i feel confident moving forward with more motions and i like to assess the effect of multiple motions so repeated motions because sometimes you do one thing and it could just be a fluke so i want to see number one what happens as i do more motions and what is the trend of doing more motion so a lot of people are sort of led to believe like hey when i do this motion it hurts and that's not good but oftentimes if you don't explore repeated motions people will stop at one or two but the more they do the better it feels and that's pretty cool and sort of um enlightening for a lot of people so if you can go ahead and touch the toes for me just for the sake of you know the video just a few times and let's see what happens with it so you've got some stuff going on here for anybody watching and you get a little bit down the leg i think you said earlier okay all right and keep going just a couple more okay one more all right so tell everyone what happens when you do that yeah it's getting worse it's starting to go down this way okay done all right so um here's what we're going to do now think sort of like a mechanic here i'm letting you inside my brain um this could be right because her back is sensitive to being rounded you could say and maybe the back special would say hey that's a back problem but we can actually tease out by just changing one variable thinking through this really systematically and saying hey could we actually is this a problem with her not liking that motion of her back or is it because when she does that motion she pinches in her hip right so we need to figure that out so i'm going to remove the hip as a potential component here so what i'm going to have you do is i'm just going to have you relax this hip and sort of slack in it so this way it's not as pinchy when you bend down and go ahead and touch the toes now all right so what happens there much better yeah okay much better so notice that if she brings the hip forward i'm gonna put it there now touch your toes all right what happens yeah it's worse okay so when we just change the hip component we bring it more forward right it closes down on the hip quicker and it causes an issue sort of groin and down to the knee and is that exactly sort of what you feel like those symptoms so it causes what you you know came in with yeah all right but then when we slacken it and then she goes to touch it sort of opens up the hip area so we can see now that yeah i mean when she moves her back it looks like the back could be the problem but when we just change how our hip is positioned we can also change the symptoms so that tells me right off the bat this seems more like a hip issue all right so um now just stand here for me um and go ahead and bend backwards for me as far as you can hands on the hips go go go go go go go very good motion any problem no okay go ahead again anything there um a little bit starting in here okay got it and what does it feel like is it just like a pool or yeah but like a pinch a bit of a pinch okay so now again we could ask ourselves is this because of the back notice the back motion looks really good or is this because she's getting like a stretch on a hip that's stiff and doesn't like to move so we could literally just have her sort of go up like this so this one kind of slack in this right and now go ahead and bend backwards and back up any pain or problems there no that's better yeah so again when she changes the hip position her back looks great as far as motion um any type of like pain across lower back or no no all right great so um yeah we can change the hip and we can change the fact she either has symptoms or doesn't have symptoms again an indication that providing the back moves so well that this is looking more like a hip fit put the heel down for me and step it back um just like this and actually face away face like the uh my diplomas or whatever this yep and relax that foot i'm just gonna have you bend left and right all right so go ahead and just put your hand on your hip bend to the right as far as you can for me go go go good and go the other way as far as you can good any major issues there um no okay yeah so motion looks really good i know uh people watching might not know what good back motion looks like but i'm telling you she's really great motion either way and that didn't cause any issues so now go ahead and take a seat right there for me so now she came in with some left sided you know her issue is on the left side so i'm going to look at the right side because i want to be able to compare here and in this sort of position i can isolate out the hip so she's just sitting here right do you have any discomfort just sitting here great so she feels okay i'm going to wiggle the right hip around and i'm also going to look at how the nerve is moving so my brain i'm looking at the hip and i'm looking at how well her nerve is on this side and i'm going to compare this to this side and walk through all right so i'm going to move this hip around this is quote unquote her good hip so you see she's got x amount of motion here x amount of motion there that feels okay for you cool no problem and go ahead and pull the toes up for me straighten this leg so this looks at sort of the ability for the tissue or the hamstrings and the nerve in the back of the leg especially because we pulled the toe up uh to stretch on that side uh so she has you know an angry nerves they don't like to be stretched so she has good healthy kind of nerve motion through that leg and her hip wiggles really well so now we're going to look at this side um so we're just going to move it side to side and look at the same stuff so we're going to compare all right i'm going to go slow okay what what happens there it starts to go in here okay all right got it so less motion right here versus there-ish right you should get some onset of her kind of groin and then kind of down into a thigh and knee area i'm going to go this way good same thing and actually if i try to push on this it just feels like it doesn't go all that well so it's stiff and it causes the same symptoms that she came in with now the question is okay it seems again because that's the only variable i change it seems as though this is looking like a hip issue now i want to know though because as she alluded to when she went to see the spine doctor you know they said hey well you're having shin stuff and ankle stuff that's got to be sciatica and then the hip doctor as soon as the hip doctor heard that she had anything below the knee they thought this is a back problem because while it's not super common yeah it's not very common the hip refers down there but it can i've seen many cases of causing the shin and ankle pain like she's describing so a simple test one of the best tests we have to determine if somebody has sciatica is to stretch the nerve and if somebody um stretches the nerve and they have symptoms well then there's a pretty strong indication that the nerve is irritated notice though uh generally people also have complaints of numbness and tingling and she does not so already i'm not thinking that but let's just go ahead and move it anyway so go ahead and just straighten this leg for me awesome any pain or problems great so the nerve looks like it moves really well and actually symmetrical to the side it's looking like a problem within the hip joint so go ahead and if you can um i think we're good there lay on the back for me so again i'm going to look at her right side and just bring her through some motions you let me do all the work all right so i'm just going to look again try to isolate her hip this is again her good side or right side so good hip motion there we did this and seated so that's good that's good and i'm going to kind of bring her hip up and cross over and rotate the hip in a little bit and this is a really good test to determine if there's something you know irritated within the hip joint because it kind of pinches some of the structures in there and again is a really good test to determine that as well as sort of pushing down in the hip and i don't expect to find anything here it's just i want to have a comparison side to side so i know what her normal is all right so pretty good hip motion here just to make sure i wasn't making anything up i will also stretch the nerve in this case most people have sciatica will have limitations here and in her case she just feels a stretch but any issues there great and then last little thing i'm just going to look at it on this side so i can get a sense of how she's moving there's a test that can determine um pretty well if there's a problem within the hip joint it's called called a log roll so literally somebody could just take your leg and roll it in and out you'll see that it doesn't move that well and it can bother people if there's a problem within the hip joint so now i know what that moves like i'm going to go to this hip we're going to see what's going on here i got all the motion or i got all the uh you know the weight of the leg all right tell me if i have to stop i'm going to slow all right so what are you feeling there yeah so it's starting to come down in here so okay so kind of growing down a little bit in the front of the thigh yeah right so she's getting some kind of again her symptoms when i get to about this level now notice this is interesting right just think about the story so she's been having trouble when she's been sitting so if she's sitting in a car and her hip has to go any higher than this because she's sitting in a bucket seat and it has to move up higher net or she's just sitting in a chair that brings her hip just or her knee just higher than the point of the hip she's sitting on an annoying annoyed hip like in a position that the hip doesn't like right even on the table does that make so that would make sense that if you're sitting in that position for a while then you're going to let it down man it's going to be really annoyed and stiff there so that's one motion there again looking like the hip we already know that this is a little annoyed and stiff i don't even need to go into that pinchy test position because she already has it and then i'm going to let this down and i got the weight of the leg and i'm saying that because it's important in that when i look at this motion you okay with that yeah so if it was a true sciatica problem somewhere between here and here would shoot numbness and tingling down her leg and or she would just say stop don't do that it's really uncomfortable i don't want you to do that alright so i wouldn't be able to go any further sometimes what happens is if you see a specialist for the problem they're quickly going through an examination if you're lucky enough to have one this thorough um is that if you if they don't instruct you know in this case melanie to not help at all what happens is melanie's going to kind of lift the leg herself so go ahead as i'm doing it and yeah sorry that'll cause um that'll cause problems uh within the hip and it'll stop her from lifting the leg anymore and it'll make the specialist think that it's a true um you know positive testing that oh yeah but she can't go any further because her sciatic nerve is a problem when actually it's because she's firing the hip muscles which are irritated and cause uh pain all right um last thing here so i'm just gently gonna roll this let me know if there's any problem yeah all right so where do you feel again when you come in yeah all right same type of location or okay yeah so again just moving the hip and only the hip as a variable i should get some symptoms there all right now go ahead and show me just curious here um show me the position that you're sleeping do you sleep you prefer to sleep in on your back side what works best for your side sleeper okay is that just because you like to do it like habit or i it's just the way i like to sleep okay got it so show people like how you would normally sleep right side the left side usually on my right okay got it so go ahead yeah just for camera yeah good so right size so so that's how you would fall asleep right yeah all right guys so everybody just take a look at this and picture in your brain take a snapshot and then go on her back thanks so just like we talked about with sitting when she brings her hip up to here ow and that's basically the position you need for sitting so she doesn't even have the motion she needs to sit because something in the hip joint is irritating now if you just notice the way she side sleeps well what did she do she crossed this leg over brought it up and over and i mean how does this feel yeah uncomfortable so that is reproducing or she's basically putting herself into a um a hip test that annoys people with problems within the hip joint she's sleeping like that or attempting to sleep like that for hours because when she's stacked her legs are just naturally falling across so we've got to change number one the way that she's sleeping as far as treatment i'm getting a little ahead of myself but we have to make sure that when she's sitting her knees are below the level of the hips so that her hip stays sort of open like this it's not here we can do that by having her sit on a wedge or something like that and when she's sleeping we've got to make sure you know either she doesn't sleep on her back or on her side or she puts a large enough pillow or something like that so her legs don't fall across so just trying to figure out strategies to reduce symptoms so again first you get a lot of sleep and then she can sit and move better um all right awesome and then last thing go ahead and lay on the um on the belly for me got it all right now just to be sure here if this is an issue in the back generally we're going to find if we push on certain levels in the back it can cause some um of her symptoms to occur and she'll have some discomfort there so i'm going to try to i'll go over here so we can see so i'm going to start sort of mid back up here you let me know if there's any problems okay i'm going to start gentle so i'm just going sort of one by one down her lower back joints and bones if you will okay yeah doing okay yeah doing okay yeah now i'm gonna sort of one by one here you okay yeah you okay if there's any issues good so i can't go any lower otherwise i'm going to go into other structures but that's going through her toe her whole lower back using different sort of pressures right to try to provoke any type of issues and sometimes what you'll get is you'll get sick symptoms that go down the leg or in this case might cause her shin pain or her ankle pain or whatever if somebody truly has a back problem she doesn't have any issue there with the lower back and no pain throughout it so last little thing it's going to wiggle sort of her legs here so this is now the right side because she's on her belly this is her good side let me see probably hard to see from the camera there but she has pretty good motion and isn't um you know sensitive to any of those things i'm going to go slow here all right so that's all we can go yeah it's all we can go and what do you get when i do that it even comes back into my butt some but around my thigh and down my knee okay got it all right so go ahead and sit on up for me okay thanks all right so in closing a lot of people come to me frustrated because uh they're in her case scheduled for a lower back surgery uh and had multiple fail injections things like that been passed from provider to provider uh but at the end of the day they've never really had a good uh examination would you say it's the most thorough examination you've had yeah no one's done that yeah and that's even debris for the uh for the point of just uh the video we've sort of shortened that down and just kind of gone through it for you all but the point is that we need to take your story right and then we need to systematically just change one or two threa one or two things within in the examination using a super kind of smart systematic process to work through it to determine is this a back is this a nerve uh is this a hip problem or other problem right so hopefully that makes sense and in her case it's going to a problem in or about the hip not to be a lot of things in her case the hip is very stiff so again could be a bunch of things but something within the hip joint there the diagnosis doesn't exactly matter but we can start treating by number one putting out the fire so teaching her specific ways to sleep differently sit differently so she's not in that pinch position maybe like she is now notice she likes to kind of cross her legs here so that will kink the hip in and notice when i went through my test that kind of bothers her so she just habitually is doing things uh that are sort of potentially flaring things up or nicking the scab and we need to have that conversation first so once we do that right we can do less of that which makes her feel worse and we can teach her more of that which makes her feel better which are going to be specific movements just to gently regain motion and try to sort of calm things down and get you moving better how does that sound cool cool so that's sort of a sample examination uh and just like some basic treatment recommendations there but really just uh thoughtfully working through is it's a back hip um and or nerve problem um so for anybody out there watching who found this helpful like comment or share and or call three seven six 484-552-3760 uh if there's any issues there or um you know you're trying to figure out hey is this a is this a back is this a hip is this a nerve problem um and for anybody who's sort of been tossed between uh physicians and is still looking for natural relief so thanks everyone for watching

Channel: Dr. Charlie Johnson, PT

Views: 502,762

Keywords: Piriformis Syndrome, Sciatica, piriformis test, piriformis stretch, sciatica pain, sciatica test, sciatica stretches, si joint, si joint test, sacroiliac joint pain, herniated disc, Hip bursitis, hip labral tear, hip arthritis, glute pain, buttock pain, piriformis issues, physical therapy, si joint dysfunction, lower back pain causes, low back pain causes, si joint pain symptoms

Id: KeT3v1OHhi8

Length: 27min 36sec (1656 seconds)

Published: Sun Jul 19 2020