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 opinions of course Bob. Today we’re going to talk about how and when to perform self massage for sciatica and we’re talking about herniated discs versus piriformis syndrome and you need to kind of know which one you have because it’s going to change what we do, two different treatment protocols, right. By the way if you are new to our channel, please take a second to subscribe to us We provide videos on how to stay healthy, fit, pain-free, and we upload every day, also go over to Facebook and like us because we give away stuff and also we like to be liked, all right Brad you did a video in the past where you’re talking about sciatica and you were describing what it is, so it’s pain, numbness, tingling Typically down the leg, typically one leg, right, past the knee down into the foot, even into the toes and you can get weakness from that you can get drop foot from it and if it’s down both legs it may be something else It could be still sciatica but less likely to be and you had come up with statistics on this Brad, and you’ve found out that normally from sciatica 3 million Cases a year are from a herniated disc, so that’s the disc that’s in your back between the bones here, and it’s bulging out or herniated out and it’s hitting one of the nerve roots I just want to show this real quickly, So I don’t know if you can see that red right there, it’s pushing against the nerve root, this nerve root actually extends way way down to the leg so Yeah if you irritate the nerve up here you’re gonna get symptoms wherever they go So if you get a new massage for that there’s one type of massage we do, but if you have a different kind of problem, which is called piriformis syndrome Which is also Known as fake sciatica So now the piriformis muscle Is a little triangle-shaped muscle, I don’t know we indicated that that well here, but it comes from the sacrum, in a little bit in the notch here and attaches right from this bone all the way down to the greater trochanter which is on the hip Now the sciatic nerve comes down right underneath it, or it could actually pierce through it even, but it comes down through that and if you spend a lot of time sitting or What I have found on some of these Brad is they actually tore the muscle and then it as it healed it tightened up Over the sciatic nerve, so this muscle can squeeze over onto the nerve Kind of pinch on it and cause pain down the leg. Right so the symptoms are very similar It’s just whether it’s up here or just a few inches below, that’s where the impingement or the lesion is, but it’s critical to know which one is which, because this treatment is way different than this treatment so we’re gonna show you three quick tests, so one of the tests Brad is very simple, So one thing you’re gonna do is you’re just gonna try to find that spot so if you go to the point of the hip and here’s the sacrum, so the muscles right in here, if you’re tender in here You know you push on here and compare one side to the other That’s one sign indicating it might be the piriformis muscle You’ll feel there’s a bony area and that’s that greater trochanter and you can feel it and then the sacrum is there and that’s how I determine, I go from there to there and right in there Yep if you rub across there and again you should see a difference from side to side, yes, so you compare one side will be very tender the other side, oh Now the other one you can do is you can go ahead and stretch the muscle and see what happens so I put my ankle a little bit beyond my knee here and then I’m gonna pull this up like this So right knee toward his left shoulder, across the body, and this is one where I have almost universally seen this in Brad, were the ones that have piriformis syndrome, they do this one, and then they do this one and they can really see a difference. I mean it’s very noticeable right away So what was the third test I wanted to do I was gonna do trunk, oh, I was gonna, this Is more to see if it is more from the the sciatic nerve itself, if it’s a herniated disc from your back, a lot of times if You bend forward like this Or if you even extend back, any movement of the back tends to make it worse, And you know of course there’s a straight leg raise one too That might be positive with piriformis, yeah that could be What about the one laying prone, where you do the internal rotation of the femur, that’s a possibility too, actually Brad I think the better one is actually doing this Bring it down like this and you bring it up like this and now you’re tightening up the muscle of the piriformis and so you bring your leg over you put this to your knee and you bring it up like this and that tightens up that muscle and that causes stress over the piriformis, so if they had piriformis, one leg would be obviously tighter than your other Using that, and one leg would bring on the pain, all right let’s start to talk about massage, yes do it Alright let’s first talk, again if it is piriformis muscle You definitely want to do some massage because it’s gonna definitely help, so what I like to do is I’d like to, if you’re gonna do this yourself, get yourself in a good position and I like to put the muscle a little bit relaxed and it’s an external rotator Brad So I’d like to put two pillows between the legs, okay and you kind of lock up the ankles together like that and now this muscle Is a little bit relaxed, now there’s not tension on it and You can start off with just your hand if you want, again you’re gonna find the spot, you’ll know cuz it’s gonna hurt, and you can rub across it like this, and you can also do circular motions You’re gonna get in deep. Bob’s just going on the surface but you are really gonna want to, you can use your knuckles Yeah You got to get through some muscle and some soft tissue before you get to that piriformis and it just needs some pressure, and that’s often why we recommend you might want to try some of these things, do you want to grab one of the tools here Brad? Well which one should we start with Bob?, We got like torture tools here don’t we I hate to use that word torture, Either one of these is fine. There’s the Theracane Or the Back Knobber They’re just shaped differently, and this one comes apart easier a little, maybe to take on a trip but this one you can really get in there and You can really start doing some Not damage, get some work done, the idea when that piriformis is tight, that muscle becomes contracted and basically knotted up and if you get pressure on it for a period of time, usually 30 seconds or so, that’ll allow that muscle to release and once that release is, you get circulation, you get the pressure off the nerve Life is much better. Exactly. It may take a few sessions, or should I say precisely? Precisely yes We’re trying to get away from the “exactly”. Never did I dream when i grew up that I’d be massaging my butt in front of people, all right, This Is weird Bob, I know all right next one Oh yeah, there’s the tennis ball you can kind of lay on that but I was going to show this one in this position and you show the tennis ball yeah? So this is the Purewave. We’ve mentioned this many many times. Just one more instance where I think this really pays for itself, because this is a hard area to massage Now I’m not even pushing that hard and it’s getting in there and it’s got the percussion so it’s It’s really sending Bob for a loop It’s funny but yeah it’s doing a good job Brad. All right so why don’t you show the tennis ball, this is a family show Bob, okay This is the way I usually like the tennis ball, you can use a lacrosse ball, it’s a little firmer I’m gonna find that bone right there in the sacrum and even a healthy piriformis is a little more tender than that, so it’s a tender spot yeah so I’m gonna get right on it right there but boy I tell you I’m putting a fair amount of weight through this arm and my legs and I’m gently working down on it and then you roll Nobody can see that ball under there and you’ll find it and then you work it forwards or backwards, right to left circles, whatever seems to work good and again you’re gonna do this for 30 seconds to a minute or so depending on how you respond The only precaution I have here with this is if the nerve is fired up a little bit and you go right over that nerve with the ball It could make things worse, I don’t want you making the pain worse, if the symptoms down your leg are getting worse while you’re doing this or as a result, it’s too aggressive. I always found the ball it’s a little harder to direct to the spot You know with these you can put, you can go around the spot first and then if there’s a tender spot that sends the pain down you can avoid it, When you’re doing that you gotta be pretty mobile and have some upper arm strength and control to get what you want Not to rain on your parade Brad I don’t want to get rained on. All right next up if you’re gonna do massage for a herniated disc, first off, quite often I think Brad and I would agree, you don’t need to do it. I mean a lot of times We recommend doing the extensions instead, yeah directional stretching But if you are, we’ve had people that are so tender when they come in that We have started a massage, like I’ve had people start by in somewhat maybe even almost an elevated position like this and then a couple pulls, pull them up, and then having someone massage them themselves, so then, we’re working the muscles not over the piriformis, although you could, it may be tight there as well, but working the muscles around that vertebra there, because they can tighten up as well from the pain and they just are natural tightness so again we recommend it more often, is this extension program which We’ve outlined in many of our other videos but if you are going to try some massage yourself, this is about massage Brad, You could try some standing massage for your sciatica and what you could do is, you could you could take your knuckles and rub right up the muscles like this on both sides, that’s what your knuckles are for, yeah I didn’t know that, well Bob So here’s my knuckles the other hand is gonna help for us and a nice thing about this, I get some extension Extension, that’s what I was gonna say Brad, you can actually even work into extension a little bit, again, don’t make the pain worse But if it actually feels okay and maybe it feels a little bit better This is a great one to do and then of course you can use the back knobber I like this one for this, not for sciatica but just for my back when it gets tight I just rub it along there Another homerun huh Bob? There you can see the difference between the two, it isn’t much, you have different handles Yeah so all these are options, it doesn’t mean that they’re all going to work equally, you go through and find which one really does the job and stick with it and then you can do this one too, you can go back and do extension while it’s doing the Work for ya Going along the pelvis there so Again to sum up here Brad real quickly, if you have the piriformis syndrome you definitely want to do the massage If you’re having sciatica from a herniated disc, not as as needed normally but you certainly can try it and it certainly won’t hurt Thanks for watching.