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

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

hi folks I'm Bob Shrum physical therapist at Handy physical therapy every of the most famous physical therapist on the internet you know Peter of course Bob man today you wanted to talk about low back pain and hip pain is it nerve is it joint is it muscle these are important questions because how you treat your pain he's gonna be depending on upon what you find out exactly and we have a lot of people are commenting you know the exact same question so we're gonna help our viewers and we're gonna help ourselves see if we can narrow it down exactly some things that how we think about things and how we think about what what's going on and what may be going on right exactly oh hi some new people out there Oh in case you are new to us please take a second to subscribe to us apparently the buttons over here or something if you're on your phone it might be down here it's somewhere yeah please take a second and hit it and we will provide you videos on a stay healthy fit pain free and we upload every day thank you Bob all right okay moving on so we're talking about back pain hip pain you know you get pain going on leg maybe down the leg yeah so let's talk about a few sources joint pain where the joints the pain could be coming from there's a lot of them right and this is one that a lot of people aren't aware of is facet joints right or facet joints however you want to pronounce it what part of the world you're from but they're in the spine and they're actually two of them at each vertebral level from here all the way up to the neck obviously we're talking about the ones in the low back so there's ten in the low back can we get a little close-up of this I think yeah yeah so right here is a facet joint here's a facet joint and if you look you can see they open up a little bit and together not a lot but there's definitely motion there and there's definitely nerve cells or nerve endings there that can produce and sense pain and it can wear out just like a knee joint or arthritis can wear it out so that can give you a pain right and the other joint is the sacral iliac joint there's the sacrum here's ilium ilium ilium and right in here this is a bigger joint right this is you'll hear known as the SI joint right if you see that or hear it that's the joint they're talking about not a lot of motion there yeah very little as kind of controversial actually and of course the hip joint we'll get into that a little bit too of course there's muscles around all this here cells and ligaments right that hold it together and naturally we got these right here the spinal nerves that come out and these actually not cut off like this they run all the way down right those are the other you know these are the tissues and structures that can cause pain and irritation you start to see why it's so complicated in trying to diagnose or assess back pain and leg pain because there's so many sources where it kind exactly so let's talk about nerve pain first is it a pinched nerve well one of the things I do is I just talked to the person I'm not going to do any tests at all and the information they give me gives me a lot of indication that for example if the person says I got pain here and then down in here it hurts it's kind of tingly and then down here it's actually numb and down into my toes it tingles and and sometimes it feels like water cold water running down there and these are all symptoms that are consistent with a pinched nerve yeah and like you said the fact that it goes all way down to the foot right away you're pretty much thinking that's nerve exactly and the second thing is when they get strange sensations like you said Brad I mean the weird ones that might even change from minute to minute or an hour you know it that tends to be more nerve yeah it can be bad too sure sometimes it's down on the ankle around the foot and then it moves to appear right and this unusual things often times it's a nerve that always makes me you think more nerve and again you mentioned if it's below the knee down into the foot and ankle most of the time it's going to be a nerve difficult for other things to send pain that far right unless you got some real bad circulation you know which could be a situation yeah well the other and also with that when that happens we shouldn't jump to conclusions but oftentimes that's going to be from a disc or a piriformis muscle that's irritating the nerve usually up in this area that's usually it's not down below that area so yeah that either disk you know is pushing on the nerve and sending pain down or there's a piriformis muscle which is in your butt yep and it crosses over there the sciatic nerve and it can tighten down over it sometimes the nerves crosses in through in through the muscle right yeah but it can cross over that nerve and send pain down the leg quite often you know what you might see in that instances you might see that they have pain going down the leg but none in the back therapy piriformis good posture there's tests we that we can do with a piriformis test too but that is probably in another video if you want to try our download yeah actually that's do a couple tests that are specific to if it is a nerve okay the straight leg raise test sure and this is one of those a gold standard right exactly been going on for years and you know every doctor a therapist and everyone else in the world know we can do it sitting sure that would be the slump test right right you can do this and then slump down you know basic you bring your leg up and bring your toe towards you and if it starts now you're gonna feel stretching pain but if it starts feeling pain all the way up into your back right and then if you bring your head down and it gets even worse there's a good sign that that might be a nerve issue and or someone can help you do this too and you know when when I test someone I Bible do this too we don't just bring the head down but we actually have them slump run a word and the head down bring the leg up and at this point if they pull the foot up like this and they feel pain up and through here other than just in the calf muscle that's a positive right which means it's a good chance that there is a pinched nerve or a right not only from the back then the nerve is a culprit right I just should we go through that straight leg raise quickly sure why don't you lay down Bob and it's called the straight leg raise because you do with a straight leg so lain comfortably on the plinth or on the floor or on the bed at home now Bob is gonna lay completely flat and gonna bring this leg up and what I'll do is I'll do it on the leg that doesn't hurt at all first sure this one doesn't go up and I'll say and at this point you feel a stretch there and right okay keep the knees straight throws you back down a little bit give it a stretch yeah be careful of that because they don't know them uncomfortable so we know what the good leg feels like and let's say we do this leg and we get to those 400 and then if you have them pull their toe but even worse you know and I've had people when they pull a toe up they feel it back here right in the back very clear it's a nerve problem right and sometimes I'll have like I'll say lift your head up your head up and I'll make it work worse yet because that whole nervous system connects right up you know to the base of your skull so yeah it's one of those things everything's connected as for other interests right okay joint pain so again if you think about the joints when you go like this the joints are spreading apart the facet joint when you go back like this they're jamming together so that's why you know one of the tests that we do here I know when we can do is just we have the person to go back and maybe to the side and push down through yeah or back this way and to the side and push through and if that jams those joints together and they feel some localized pain here that's a good sign that there might be some facet joints go right now if you did that same thing in the pain went down the leg yes not the second disc yeah I said again generally looking for maybe a little more pinpoint okay more localized pain and I often see like with that again this doesn't say that it's a Fassett but if they kind of lean let's say the pains on this side they kind of lean away from it and they're opening the facets on that side it feels better sure you know that that's a sign that I might need the joints to yeah there's a lot of combination so you have to kind of take this with a little experience and and just yeah a lot of times I just go right on the back even and push and if it although that could be a lot of things still gray said starts leaning how about that SI joint probably talked about that sacroiliac joint yeah often times you know what they say the history is if someone walked off a curb and they jump you know hit the ground really hard and after that they felt pain in here SI joint typically does not refer Pasolini but it can refer to the knee right and it's typically not the numbness tingling it's just a pain you know anything on the other cot very common thing with with SI is that people have leg length discrepancy sure it's may could you see how that would throw off the pelvis right so you know we can show you just a couple tests for that right yep let's do it one is the figure four test very simple you just go like this and then you put a little pressure there and a little pressure here yeah yep here and here and you push down you're not gonna be very aggressive this is not all gentle because you can hurt someone yep and you're gonna feel it's gonna be generally one sided and this is going to make it worse in the area this is one that you may not even have to press just going in this position in this position might bring it on right the lady I just had see that's exactly I'm sure another real simple test brad is they call it the point test basically you take your finger and you point to where the pain is and you might even put a piece of tape where you point that and then you come back and then a little bit later you come back again and if you point to right the exact same see out again it's pin point believe or not that's a test for SI okay so it's a real burn point test yeah si is specific that specific pain back in there can refer down the leg I think the part of it is it muscle or not right Brad and I tend to think that muscle is less often a culprit than you are I want to say that a muscle strain is less likely of the problem is usually a disc SI problem but if it is a muscle it's usually going to be more localized yes okay it's not gonna refer down the leg or down to the foot none of those symptoms and if you simply push on the muscle right you'll find tenor right so aren't you lay down this is best assess I think in prone position so it's hard to assess yourself because you can't react very well so you know bob is relaxed and I'm gonna go right down on the muscle belly not down on the spine where you push you have on the outside yep and I'll just work down and you know if it's if I said joint you might feel it there and I've worked this where I push somewhere and all of a sudden just like that pain or synthetical down the leg and then I know it's not the muscle it's a nerve but if it's just one spot it's tender might even be a little warm there you know that may how often he was just rub back and forth across the muscle yeah like that cuz there tends to get more of the muscle and not so much the cassette then and you can feel those knots in the muscle that way too and I can tell you I mean I I had an episode of pain recently and it was it was muscle sure I mean I was like oh is that coming from a Fassett or disc and I took the theracane I've done oh my god that felt so good and it just took care of it right away yeah and then you know in the case of the muscle heat and ice are gonna feel good right that's all exactly I know this again this was a totally comprehensive but maybe it gives you somewhat of an idea what to look at yeah a back pain is not easy so you work with it and that's why we practice this over a number of years and get better with it so good luck with it and take care and well again we can fix just about anything except for a broken heart but we got some videos we're getting closer to you gosh darn we're trying do you bet I don't we're not stopping you

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  1. Thank you guys! I think my back pain is muscular then because it only remains in my lower back because I picked up something heavy too quick and got some paint the next day. It hasn’t moved from my lower back to my legs etc.

  2. I am finding that memory foam beds are causing issues for me. Haven't tried a different style of bed yet, but hope to soon. Maybe a pocket coil. I feel as though sinking into a bed until it is compact enough to hold you is an improper and unhealthy method of support

  3. ???I have been suffering with back and neck pain for years I just tried the toe exercise so much pain cannot bear it using patch and pills ??????

  4. What if you have a pulled muscle and a bulging disc and some pain and tingling in the legs. How can you help the pain.

    Don, From Indiana… Have a Great Day.

  6. I have the area (full width) between my waist and top of buttock get a very strained feeling at times, especially when standing from a seat – so I avoid my couch. Recently I reached to the right and down to my foot – and got a severe shot of pain in middle of right buttock and also the area below the waist mentioned. 2 weeks severe pain when lying, standing, sitting, then resolved. Happened again. Now on and off. When I walk around I feel better. Then I started getting legs that sometimes felt weak or heavy or giddy when in middle of or after mild exercise liking walk or bike. Docs disagree. A neurosurgeon says inflammation of tendons below waist. Pain doc says bilateral SI joints. and wanted to give me big shots in both hips. I said no to shots and take Advil and watched your video. PT just giving core strengthening and not testing for SI like you do. Any thoughts?

  7. when injured or feels something painful
    others: goes to the hospital
    me: search for the famous pt in the internet

  8. Can you guys show some videos on how to do tapping… and about his indications and contradictions..

  9. I use to get sharp pain down my leg at random times while having back pain. I don’t get the sharp pains in my leg anymore but my lower back still hurts

  10. Very insightful and encouraging since I just recently got pain in my lower back from picking up a nightstand. I’m going to the doctor but feel better that I don’t have nerve pain to my leg. Thanks for the clarity !

  11. if it is a nerve issue would you recommend a chiropractor to align things to fix the pinched nerve?

  12. Can you get surgery for disc or nerve issues? I can’t stand the pain anymore I even stopped working out ?

  13. Thanks for the video. looks like my chronic pain that is getting worse and worse is muscles but i dont know what can be done about it. what are the remedies for muscles issues. I can feel many knocks in the lower back muscles. its killing me for the past few years

  14. Wow. This is a super annoying video. Way too much chatter. Now my head hurts – Maybe quit talking over each other that might help

  15. Hello, I’m having pain on my left lower back and hip. I was just wondering is there any tip you guy could give me or do a video for it. Thanks and keep up the good works!

  16. Thanks, I think I strained a muscle as there is no numbness or tingling or even referring pain into the leg. Very localised and very sharp pain when I sit up. Sound like muscle? Thanks

  17. I have arthritis in the si joint it’s agony my back spasms and if I sit or lie down getting up is agony and my knees hurt I also suffer nerve pain thankyou for your YouTube channel you give more insight than any medical persons I see I live in Scotland ??????? sometimes I think we are a bit behind medically

  18. omg… i just did the straight leg test and the already nagging pain shot sharply up the back of my neck, i literally cannot move right now. :'(

  19. how n
    many injuried people are not compensated because of your videos? personal injuries from accidents…

  20. Guys
    Why the fuck i almost have all the symptoms
    When the pain started i was getting pain and tingling down my leg then it stopped and continued to just back pain but when it do the slouch test i shoots up in my back like fire
    I also get pain doing the facet joint assessment only on the right side
    My lower back is hot and putting cold things does help alot
    It's ok if I'm laying or sleeping but how the fuck i dare stand or walk for a while
    It's been 6 months I'm bored of this constant pain i used to be bodybuilder not a cripple i can't even wear underwear because the tightness to my lower back fires it

  21. When you push down on the lower back and the pain is deep does that mean that it’s muscular or something else?

  22. I’m 24 and after I had my daughter last year in 2018 I started having pain that would radiate from my back to my hip and it hurts can u tell me what it may be it’s only when I stand in one spot or when I am bent over for just a min or 2

  23. I have detouring in the L4 and L5. I don’t know what to do. When doing the laundry, after washing, drying then folding, I am in so much pain I wNt to cry….what can I do, or is it not as serious as I think it is.

  24. Can you do a video for people who drive all day? Suggest stretches we can do after our shifts, sleep position? My right hip and left shoulder/neck feels like there in a vice.

  25. My MRI report says 1) Degenerative changes in lumbar spine. 2) Annular and left para-central disc protrusion at L4-5 level causing compression thecal sac,encroaching on bilateral neural foramina and indenting on left exiting nerve root. 3) Postero-central and left para-central disc herniation at D7-8 level; causing significant compression of thecal sac and left para-central thecal recess. Please suggest some exercise.

  26. I know this videos old and this is a long shot. But ive been in pain for 6 months and needed help. The straight leg raise test causes extreme pain in right testicle area. Ive established that its 100% referred pain. And i know i have a l5-s1 disc bulge on the same right side. but numerous docters and pt says theyve never heard of this. Have you?

  27. I’m researching all of this nearly every day I’ve had enough ive had lower back pain for over 4 years now all I get from the doctors is it’s muscular, I’m only 33 and fell 90. It’s got to the stage I’m finding it hard to walk on a day to day basis and believe there is more to it than the docs say. ?

  28. I just leaned back to do the joint test, leaned to one side, then the other, felt a big crack and the pain improved. Cheers!

  29. Umm, did it occur to anyone that physio therapists aren't supposed to diagnose conditions, but rather help with treatment after a orthopedist has diagnosed? Come on Youtube, stop giving me Bob and Brad for everything I search!

  30. I hope it so much it is just a muscle pain cause i feel pain only in a specific area of the lower back on the left side.

  31. Thank you so much for sharing your professional knowledge!! Lots of details very educational! Love it?

  32. Just had my hip replacent is normal that my hips longer, i feel like i have a whole other disability my good left leg need needs a 4.1/2 cm raise on my shoe

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