Low Back & Hip Pain? Is it Nerve, Muscle, or Joint? How to Tell.

Hello friends, I'm Bob Shrum, a physical therapist at Handy Physical Therapy, one of the most famous physical therapists on the Internet. You know Peter, of course, Bob, man. Today you wanted to talk about low

back

pain

and hip

pain

, is it a

nerve

? Is it a

joint

?

muscle

, these are important questions because how you treat your pain will depend on what exactly you discover and we have a lot of people commenting, you know exactly the same question, so we'll help our viewers and help us see if we can exactly reduce some things, how we think about things and how we think about what is happening and what exactly may be happening.

Oh, hello, new people. Oh, in case you're new to us. please take a second to subscribe to us apparently the buttons here or something if you're on your phone it might be down here it's somewhere yeah take a second and press it and we'll provide you with videos on how to stay healthy and without pain. and we go up every day thanks Bob okay move on so we're talking about

back

pain hip pain you know your leg hurts maybe going down your leg yeah so let's talk about some sources of

joint

pain, where the joints are the pain.

It could come from there are a lot of them, right, and a lot of people don't know if they're the right facet joints or the facet joints, however you want to pronounce them, what part of the world you're from, but they're in the spine and there's actually two of them. at each vertebral level from here to the neck, obviously we're talking about the ones in the lower back, so there are ten in the lower back, can we zoom in a little bit? From this, I think that yes, yes, there is a facet joint here and if you look you can see that they open up a little bit and together not much, but there is definitely movement there and there are definitely

nerve

cells or nerve endings there. that can cause and feel pain and it can wear out like a knee joint or arthritis can wear it out so it can cause you pain and the other joint is the sacral iliac joint there is the sacrum here is the ilium ilium ilium and right here This is a larger joint, right, you'll hear it known as the SI joint, right, if you see it or hear it, that's the joint they're talking about, there's not a lot of movement, yeah, very little, it's actually kind of controversial and so supposed. the hip joint we'll also touch on a little bit, of course, there are

muscle

s around all of this, cells and ligaments that hold it together and, naturally, we have these here, the spinal nerves that come out and they don't really get cut like that.

They run all the way down, those are the other ones, you know, these are the tissues and structures that can cause pain and irritation. You start to see why it is so complicated to try to diagnose or evaluate back pain and leg pain because there are so many sources where it is exactly the type so let's talk about nerve pain first, is it a pinched nerve? Well, one of the things I do is I just talk to the person. I am not going to do any tests and the information they give me gives me a lot of information. indication that, for example, if the person says I have pain here and then down here it hurts, it's kind of tingling and then down here it's actually numb and even my toes tingle and sometimes It feels like cold water running down. and these are all symptoms that are consistent with a pinched nerve, yes, and like you said, the fact that it goes all the way to the foot you're immediately thinking it's a nerve exactly and the second thing is when they have strange sensations like you said Brad, I I mean the weird ones that can even change from minute to minute or hour, you know, that tends to be more edgy, yeah, it can be bad, sure, sometimes it's on the ankle around the foot and then it moves to appear . right, and these unusual things a lot of times it's a nerve that always makes me think of more nerve and again you mentioned that if it's below the knee to the foot and ankle most of the time it's going to be a difficult nerve for other things to send pain. . that extreme right, unless you have bad circulation, you know what one situation could be, yeah, well, the other one and also with that, when that happens, we shouldn't jump to conclusions, but a lot of times it will be because of a disc or a piriformis muscle that is irritating.

The nerve is usually up in this area, it's usually not below that area, so yeah, either disc you know is pushing on the nerve and sending pain down or there's a piriformis muscle that's in your butt, yeah , and crosses the sciatic nerve there. and it can squeeze on it, sometimes the nerves cross through the muscle, yes, but it can cross that nerve and send pain to the leg quite often, you know what you can see, in those cases you can see that they have pain. down the leg but none in the back piriformis therapy good posture there are tests we can do with a piriformis test as well but that's probably in another video if you want to try our download yes actually that's doing a couple of tests that are specific for if it's a nerve, okay, the straight leg raise test, sure, and this is one of those gold standard tests that's been done for years, and you know, all the doctors and therapists and everyone Everyone else in the world knows that we can do it sitting down, I'm sure it would be that way. be the drop test, right, you can do this and then collapse.

You know, the basics: you lift your leg and bring your toe towards you and if it starts now you'll feel stretching pain, but if it starts you'll feel pain all the way up. on your right back and then if you lower your head and it gets even worse, there's a good sign that it could be a nerve problem and someone can help you do this too and you know when when I test someone, the Bible does this too. We don't just put their head down, we actually make them slump, say a word and with their head down, lift their leg and at this point, if they lift their foot like this, they feel pain up and over here, apart from just in the calf muscle is a positive right, which means there's a good chance there's a pinched nerve or a right not just from behind, so the nerve is the culprit, right?

We should just do that straight leg raise quickly, sure why don't you lay Bob down and it's called a straight leg raise because you do it with one leg straight, so you lie comfortably on the pedestal or on the floor or on the bed. at home. Now Bob is going to lie down all the way and he's going to lift this leg up and what I'm going to do is I'm going to do it on the leg that doesn't hurt at all first, make sure this one doesn't go up and I'm going to

tell

you and at this point feel a stretch there and okay, okay, keep your knees straight. you step back a little bit give it a stretch yeah be careful with that because they don't know they're uncomfortable so we know what the good leg feels like and let's say we do this leg and we get to that 400 and then if you have they pull the toe of the toe, but what is even worse, you know, and I have had people who when they lift their toe they feel it back here, right in the back, very clearly, it is a nervous problem, right, and sometimes they I say raise your finger. raise your head and I'll make it work even worse because that whole nervous system connects directly, you know, to the base of your skull, so yeah, it's one of those things where everything is connected in terms of other interests, right? okay, joint pain, so again if you think about the joints when you go like this, the joints are separating, the facet joint, when you come back like this, they get stuck, so you know one of the tests that we do here, I know when we can do is we just have the person come back and maybe to the side and push down, yeah, or back, to the side and push, and if that jams those joints and you feel any localized pain here, it's a good sign that there might be some facet joints going away right now if you did the same thing on the pain went down the leg yes not the second disc yes I said again generally looking maybe a little more punctual okay pain more localized and I often see like that with that again, this is not I'm not saying it's a Fassett, but if they lean over, let's say the pains on this side move away and open the facets on that side, it feels better, I'm sure you know that's a sign that it might I need the joints, yes, there is a lot of combination, so you have to take this with a little experience and, yes, a lot of times I just go back and push, although that could be a lot. things are still gray, he said, he starts to lean, how about that SI joint, he probably talked about that sacroiliac joint, yeah, a lot of times you know what they say, the story is if someone stepped off the sidewalk and jumped, you know , hit the ground very hard and after that felt pain? here the SI joint usually doesn't refer to Pasolini, but it can refer to the right knee and it's usually not the numbness, the tingling, it's just a pain, you know, something in the other crib.

What's very common with SI is that people have a leg length discrepancy, sure that's Maybe you can see how that would come off the pelvis, so you know, we can show you just a couple of tests for that, yeah , let's do it. One is the figure four test, very simple, you just do it like this and then you apply a little bit of pressure. there and a little bit of pressure here yeah, yeah, here and here and you push down, you're not going to be very aggressive, this is not at all gentle because you can hurt someone, yeah, and you'll feel like generally it's going to be one-sided and this is going to make things worse in the area, this is one you might not even have to press, just going in this position in this position might do it well, the lady I just saw, that's exactly it, I'm sure another really simple test is them.

Call it a dot test, you basically take your finger and point to where the pain is and you can even put a piece of tape where you point that and then you come back and a little bit later you come back again and if you point to correct the exact same thing, see again, it's a precise point, believe it or not, it's a test for YES, okay, so it's a real burn point test, yes, if it's specific, that specific pain there can refer to the leg, I think part of this is that. Muscle or not, Brad and I tend to think that the muscle is less to blame than you.

I mean a muscle strain is less likely to be an SI disc problem, but if it's a muscle, it's usually going to be more localized, yeah, okay, it's not going to refer to the leg or the foot, none of those symptoms and If you just press the muscle correctly, you will find the correct tenor, so don't you lie down? This is the best evaluation, I think. prone position so it's hard to test yourself because you can't react very well so you know Bob is relaxed and I'm going to go right down to the muscle belly not to the spine where you push you have on the outside yeah , and I'll just work down and you know, if I said joint, you might feel it there and I've worked on this thing where I push somewhere and all of a sudden like that pain or synthetic in the leg and then I know that It's not the muscle, it's a nerve, but if it's just a spot, it's tender, it may even be a little warm there, you know, that may be how often I just rubbed back and forth across the muscle, yeah, well because you tend to get more muscle and not so much. cassette a lot then and you can feel those knots in the muscle that way too and I can

tell

you, I mean, I had a pain episode recently and it was muscle, sure, I mean, I thought, oh, is that coming from a Fassett or disk and I took the theracane that I made, oh my gosh, that felt so good and it just sorted itself out right away, yeah, and then you know, in the case of muscle heat and ice, they're going to feel good, that's it exactly, it HE.

This again was totally comprehensive, but maybe it will give you an idea of ​​what to look at. Yes, back pain is not easy so you work with it and that is why we practiced this for several years and got better with it. good luck with this and take care of yourself and well again we can fix almost anything except a broken heart but we have some videos we're getting close to you oh my god we're trying can you bet we're not going to stop . you