- Hi, I'm Bob Schrupp, physical therapist. - Brad Heineck, physical therapist. - And together we are the most famous physical therapists on the internet. - In our opinion of course, Bob. - Is your calf pain a blood clot? - My cat?
- Calf. - Oh, calf.
- Calf. Yeah. - Okay. No, I mean, I don't know. - This is actually a very
serious subject, Brad. - Right. - I mean, if you get a
blood clot in your calf and I'm gonna talk about this right away. - Sure. - If that clot can break off or a piece of it can break up, travel up into your lungs
- Hm mm. - and actually block off a part, an artery in the lung to the point where it kills
off that part of the lung and you're gonna become short of breath and you can kill you.
- Sure. - There's 600,000 cases a year and of those 60,000 people die. So- - And the tech, the technical term is deep
vein thrombosis, right? - Right. Because it's a deep vein and thrombosis means clot. To give you an example, Brad, I don't, if you remember David Bloom. He was a reporter for
NBC during the Iraq war. - Hm mm. - And he got it from, he was 39 years old, healthy, but he was traveling around in tanks with the troops.
- Right. - And he was immobile for
a long period of time. And that's probably one of
the number one causes of it. Is immobility.
- Right. - And he actually developed a clot, went up to his lung, killed him. - Right. - So, I mean, this is
a serious subject, so- - And so, we're gonna go through a test that physical therapists
use on a regular basis. - Very simple test and kind of some of the things we look for and-
- Sure. - it's called the Homan's
test or Homan's sign. - Hm mm.
- Right. And I've probably assessed at least a half dozen Brad. - Hm mm. - And that I was right on and I've been wrong too and I know you've been wrong.
- Right. - It's better to be wrong
and send somebody in - Right. - than to, you know, not send them in and- - Right, so in other words,
you perform the test, which takes about a half a minute. - Right. - If the tests are
positive, you send them in and then they get the test
through an ultrasound. - Right, like a Doppler ultrasound. - Right, and that confirms it. - I think they could do an MRI too, but ultrasound is so much cheaper and they always do an ultrasound. - Right.
- So. - And if it's positive, they take, you know, they'll take care of that. We're good at that. If it's negative- - Ah, coumadin and warfarin, they'll put you on something like that. - Right.
- Exactly. - If it's negative,
they come back and yeah, that's good news. - So, alright. Homan's test. Very simple. First thing what I do, you know, it generally happens in the calf. - Hm mm. - I know a thrombosis can
happen up in the thigh too. - Right. - I've never seen one. I know it happens.
- Right. - I just never have seen one, so. It always seems to happen
in the calf for me. You're gonna notice first
off that it is swollen, especially on one side
compared to the other. - Right.
- You know. And you're gonna have swelling
after surgery quite often. So that alone is not a sign.
- Right. - So, I also notice usually
there's some redness, they, the person themselves
may feel some burning pain. - Hm mm. - You know, there's
gonna be sometimes pain, discomfort there, but this is burning pain quite often. - Right. - So swelling, redness, some pain and, you know, probably
roll down the larrup, so. Alright, you're gonna
have the leg straight. Now they can do this
in bed too very easily. - Sure. - And basically what we
call is Dorsiflex the ankle. We bring the toes up towards you, up towards the head. - Toes, towards the nose - Towards the nose. There we go. And sometimes that alone
will bring on the pain. - Right. Hm mm. - And if not you squeeze here
- Hm mm. - and it's not usually very subtle. Right, Brad? - Right, go ahead and do that. - Yeah, I go like that-
- OW! And then, you know,
- Yeah. Person'll issue, eyes will
open, they'll jump up. - That's what really alerts me to it. If they go. And the other thing I'll often do is I'll squeeze on the
other side too, Brad. - Sure. - And then they go, "OW," just as bad. - Yeah. Then I'm like, "They're
just a very sensitive person or their calf is really sensitive." - Right. - But that's a simple
test, the Homan's test. And you know, if there's some reason why you could have a clot, you know, then you're more likely to
go have this checked out. - Sure. - So should we talk about
some of the risk factors? - Well, I guess in my experience,
I'll do the same test. I'll look for the swelling,
but there's swelling for other reasons.
- Right. - I'll squeeze here. It might be painful. I'll dorsiflex if that's painful. But I found that, you
know, it's a judgment call. - It is a judgment call. - Is it just a, "ouch?" Or if it's a, "OW!" - Every time I've seen one, Brad, what I do is I bring a nurse in then too. - Right. - Every time I go, "This
is what I'm seeing. What do you think?" And quite often they'll,
you know, "I concur." - Right.
- So. - And if it's in a gray
area, I'll send them in. - Yep. You send them in. Especially, you know, a lot
of the people we're seeing are after surgery, which is of course one
of the risk factors. - Sure. - Let's kinda go down the list, Brad. Again, prolonged bedrest. But the other one is
that a lot of people do is sitting in a car or sitting in a plane for a long period of time.
- Right. - So what should they be doing just to prevent this? - They could be doing some ankle pumps. - Yeah. Can you see this at all? - [Camera Person] Hm mm. - Yep. Working those ankles
- Yeah. - all the way up and down. Not just little wiggly's,
- Yeah. - but good, meaningful ankle pumps. - I do these on the
airplane all the time, Brad. - Sure. - I'm tappin' away or pumpin' away. The other thing, which
actually I didn't know, is dehydration makes you more at risk. - Sure. Hm mm. - You wanna make sure
you keep your fluids up while you're on the plane. If you have inherited, you might have inherited
a blood clotting disorder. You know, if your parents have had it. - Sure. - If you or any of your parents had a DVT, a deep vein thrombosis, you're more likely to have one too. - Yeah.
- So. - There's nothing you can do about that. - Yeah, there's nothing can do about that, but what you do want
to do is be self-aware that you may be more likely to get one. - Right. - Another one, Brad?
- Smoking. - Smoking. Yep, that's always one.
- Right. - Obesity. Heart failure. Keep going. - I can't read your writing. (both laughing) - Brad can't read my writing. - Well there's a whole list there. - Inflammatory bowel disease. Age, if you're over 60. we already said the fly me family history. Pregnancy. Did we say pregnancy? - .No - Same thing happens with
pregnancy, doesn't it? - Right. - If you're on birth control pill or hormone replacement therapy. I think that's the vast
majority of it, Brad. - And treatment, like we said, usually it's not the therapist's job to treat.
- Right. Oftentimes if they have one
we're not gonna walk 'em. - Right. - You know, they're gonna stay off of it, cuz we don't want to irritate it. - Right. - They gonna put 'em on warfarin some kind of oral medication.
- Or coumadin. Yeah, yeah. Something like that. That's of course in your family doctor's or your doctor's- - Right. Any idea what that is, it's gonna dissolve the clot and it's gonna break it up.
- Right. Exactly. - That usually takes a period of time. - Yep, it does.
- Hm mm. - So, that's it. There's not much more to it Brad. Do the Homan's test and again don't be playing with your life here. If it looks like it's bad, go in and have it checked out. - Right. And on the lighter side, we can fix just about
anything outside your leg except for? - Oh, a broken heart. - Broken heart, yeah. - Aah, you see- - But we're working on that. Continue to do home,
home study work on that. We talk to our spouses about it. We're gonna get good PhDs on it. - No, we won't. No, we won't. - We won't? - Night.
- Well, we may.
