Do You Have FAKE Sciatica? Herniated Disc vs Piriformis. How to Tell

♪ Bob and Brad, the two most famous physical therapists ♪ ♪ on the Internet ♪ Hello friends, I am physical therapist Bob Schrupp and physical therapist Brad Heineck. Together we are the most famous physical therapists on the Internet, in our opinion of course, Bob. Today we are going to talk about Brad, do you

have

false

sciatica

? You know,

piriformis

versus

herniated

disc

, is that

fake

news? Getting political here Yeah, actually if you

have

what's called

piriformis

syndrome, it's also called pseudo

sciatica

, which means false sciatica, okay, then there are other things that can cause leg pain as well. I think a lot of people have leg pain. and they immediately think I have sciatica exactly, but there are a lot of other things that can cause it, so we're going to show you some tests to try to help you determine what he has and that's what the rest of this video is about. but if you're new to our channel, it's very important that if you want to subscribe, we have a button here or sometimes it's up here.

But press that button to subscribe, because we will provide you with videos on how to stay healthy. fit, pain-free, and we climb every day. Exactly, the most common cause of sciatica, of course, is a

herniated

disc

, herniated or bulging disc, and you once made a video, where you cited a statistic that there were usually 3 million. Cases per year in the United States of sciatica or herniated disc. And a small percentage was piriformis, 200,000 piriformis, so let's start with the most likely cause, which would be true sciatica. So with that, the first thing you want to do is The gold standard is to lift your leg straight, Brad, so if I'm lying down And you could almost even do this with yourself If you lift your foot and bring it this way and start to hurt, reducing the pain.

This is the side that has the pain, sure, but why not? You show him how you would do it with someone, in the clinic I will put this, I will ask him to lower this leg and you will have the person relaxed. But normally I put a pillow under his head, but for Bob I don't go. To worry about that I ask the person to just relax and I will make him rise until he feels a little bit of stretching pain and when he gets to that point I will do dorsiflexion or I will bring the toe this way and if the person says oh it hurts and they say well the pain is just here.

It feels like a muscle stretch. That would be negative, but if you do this and they feel pain or symptoms. Numbness, tingling in whatever is beyond me, particularly in the lower back of the gluteal area, that would be positive for a straight leg raise. Yes, and The positive thing is that it is not good that you have a problem, since it is probably a herniated disc or are there not things that are pressing there? Yes, nervous people get irritated in one way or another. Let's slide the table down, Brad, and show a position test. You're going to have to move that wall.

Now, let's move the wall. This is the proof of the collapse. , Lonnie over here Okay, so with this one It's something similar actually Brad and your depression Right, which is putting a little bit of tension on the spinal cord and then you lift your foot like this Let me come over and I bring the toe towards you at the right so that it is almost like a straight leg, lift. You could do that yourself and then while you're doing this, even lower your head like that, right? One thing you have to think about is we're back in that position, Bob, if you think about the mirror they actually make, the nerve will come here, go around the ankle all the way to the spinal cord and then the spinal cord goes up. to the neck, so when you lower your head it pulls on the nervous system a little bit, so that it tenses everything up.

And if there's a problem when you put everything in that top position, you have symptoms. You're going to do it again. You may feel a stretch here. What is common? But when you try to recreate that pain that goes down your leg when you pull a nerve, it's a very different feeling than exactly pulling a muscle, you know, Brad? Do you want to show that you just stand on your tiptoes and stand up? safe heels, this is one of those tests that all the doctors do, and they will say it's easy to do if I get up, can you walk on your heels?

There's a good reason for them to check your L5 nerve root, your dorsiflexors, and then they say stand on your toes, and if you can do this, that's just a good sign that you're nervous, a good sign of your money. You're looking for it, You may not be able to do it because it is weak or you may not be able to do it because it is painful. A positive side would be like this: You can't lift one side and then it falls down or something like that. So let's say everyone is fine or if they are fine. not well.

You may want to check and see if it is your piriformis that is involved, the piriformis is a muscle. Here's Napoleon Bone-aside Napoleon has his back to us, and there's a little muscle that goes from the sacrum or as people call it, coccyx, right above the tailbone and it attaches to your hip, the greater trochanter, so this Blue represents muscle and sometimes this muscle becomes tight or even torn. Sometimes the sciatic nerve is right under that muscle and can tighten on it and can send pain down the leg. So here is the sciatic nerve that comes from the lower back.

It's actually a bundle of nerves and it goes all the way down to your toes, so this little muscle can cause problems all the way down, like a lower back problem, and this nerve can also go through the muscle. Brad For Some people, some people have what we call an abnormality, so what I've seen in a lot of people who had this is a lot of people sit for a living and they're sitting right on that muscle where they irritated it, I had a couple from accountants who had it, this is where a lot of people say don't use your wallet in your back pocket.

Very good point, people like me. I have that big fat wallet that goes in there. Yes, because he never spends. So okay, the first thing you want to do is get that muscle really tender, so you can feel it down here. And you know, especially, that the muscle is more sensitive on one side than the other, that could be a sign. You know your hip is right here, and you just follow it in, so it should be somewhere in this range. Here I always do what you move your leg like this. And you'll feel that boney thing move.

Back and forth is your greater trochanter. And you just go in there and go deep there, and you'll feel one side to the other, right, and there's a difference. That's a sign that it could be piriformis. Another is that you can just do regular stretching. You stretch the muscle, so if I lie down I'm going to stretch this one. I'm going to bring my knee closer and raise my hip like this. And I'm stretching it, you can see. This is one. What therapists told me when I was in school: look at your clothes. If the clothing is stretching, the muscle underneath will likely stretch so I'll take it to the opposite shoulder.

Now, what's the

tell

tale sign here? I, Brad, what I often see with people is that you compare the two and they say yes. Maybe that's a little tight and you go like this side and say Oh, that other side is tight, or it's really painful. Cute, it's like I don't want to throw it away much more, right? The other thing is you can make the muscle work once and see if it hurts, so one way to make it work would be to do a clamshell, I mean, because it's an external rotator, Brad. , so the shell, you can't see it from that side of the video, but hey, let's try this one So I'll go like this.

Big clam shell opening and closing now if you give it a little resistance Brad Yeah, and Push it and then try it, that really makes it work. It's also a bit of a hip abductor, Brad, so even if you do this with a little bit of resistance and that hurts, that puts the piriformis under tension and if you're at home doing this. The good way is to simply do both sides and you will see the good leg compare to the other side if there is a noticeable difference. It will show up if you have that piriformis, again always compare one side to the other, so it's something like that.

Is the piriformis test painful? You stretch it, it hurts, and if you put it under stress it hurts, great now. Let's go to the third possibility which could be spinal stenosis pain, now in this case you are receiving pressure right on your spine. cord itself And these are really

tell

tale signs. I have a patient coming in today who has it, I can tell you over the phone. And I ask you: did they tell you that he has spinal stenosis? Yes, they mentioned that and as I realized one thing is that they both have pain that goes down both legs and usually to the knees.

I don't usually see it much beyond that, but it runs along their back and down both legs. It feels better when sitting, much worse when walking. Typically their walking is disrupted to the point where they can only walk so far and what they call shopping cart syndrome. This isn't a shopping cart, but it's the same concept if you're holding on to something and they're walking and they're just leaning forward or going like that a little bit, it makes a big difference in how it feels, like you know they can walk a long distance. older with this, a little movement, a little rest. the shopping cart or your walker Unlike a normal upright position, people who have spinal stenosis often cannot stand upright.

They cannot stand completely upright. So that would possibly be spinal stenosis. Again, at the end of the video, I'm going to show you how to treat sciatica, piriformis spinal stenosis, and even the next one, which is a hip problem. Your hip may also send pain down your leg. Sure, eventually I'll have a video playlist. So you can click on it to go to those videos to learn more. So for your hip problem, one thing you'll find is that, generally, if it's coming from your hip. Your hip often lacks range of motion on that side, so one thing you can do is cross your legs to do a .

You know, going lower than the other, one stays very high. Can you go this way? Can you go much further than the other? the other, bend one more than the other, knee to chest Yes, and if they don't, that could mean you have some pretty severe arthritis that sends pain down your leg. The last thing Brad does, sometimes people are surprised that just Regular Back Pain can sometimes send the pain up the leg, not very far, just up to the knee. But run-of-the-mill arthritis can send pain down your leg. From the SI joint, you have SI pain that can refer to the knee.

As Bob said, typically to the knee, if it goes down to the foot or toes, it's almost a sure sign that that nerve is being affected, so I hope that some of those tests help you narrow it down, obviously you're going to see your doctor and you get it, but I mean you can come with a little bit of knowledge, right? You might have some questions to come back to, so watch the videos at the end here. They'll help you treat these things, so we're getting really good at this sciatica by helping people with a lot of comments, but we're still working on this one, Bob.

This is simply a broken heart. We can fix almost anything except a broken heart, but we're doing it. Well, let's break it down. No no no I don't want to save it for another video. I have another idea. Very well thank you.