Recurring Pinched Sciatic Nerve

Reset SI Joint Pelvis and Sciatic Nerve Belt and Ball

Welcome back to Foundation Physical Therapy'sYouTube Channel. We have quite a few patients that come in to us that have recurring sacroiliacproblems or your SI joint. SI joint is kind of down at belt level right where your spinemeets your hips and you'll feel a point off to the right or off to the left whereit's a little bit tender. So a lot of times people say it hurts kind of right here notnecessarily centralized but down and off to the right. So what you can do is a quick littlemuscle energy technique that sometimes helps is to do something we call belt and ball.Now we have a different set up in the but at home most people have a luggage strapor some sort of belt that they can cinch up

and a ball or a foam roller. What you'regoing to do is place this foam roller between your knees and take the luggage strap or thebelt and put it around your knees. So here's my belt and you want to cinch this up prettysnug. There shouldn't be a lot of motion. You should feel as you push out against thebelt, your legs don't move very much and as you squeeze to the inside they shouldn'tmove that much either you should just feel the muscles work. So I lay here and I bendthe knees a little bit then what I want to do is keep the feet together I'm going tosqueeze this roll and as I squeeze I feel my adductor muscles on the inside of my thighengaged. I'm going to hold that for a 10

second count. Then I'm going to reversethat and I'm going to push to the outside out against the belt for 10 seconds and whenI do this I feel my gluteus medius, my glutes all these external rotators of the hip kickin. and the reason this works is there's a lot of muscles in that area that will attachto the sacrum which is a part of the SI joint. So then again I would squeeze for a 10 secondcount and I would push out for a 10 second count until I've done it about 10 timesthen reassess my SI pain and see how that feels. So if you have any current SI problemsthat you're trying to fix then that's a quick little something that you can tryto basically give yourself some relief at

home.

Oral Steroids for Acute Sciatica Due to Herniated Lumbar Disk

Background Music gt;gt; The JAMA Network. Silence gt;gt; Hello, I'm Harley Goldberg,the Director of the Spine Care Program at Kaiser Permanente, Northern California. We, of course, have a lot of patients with spine problems includingherniated discs and acute radiculopathy. And over the years we have moved, as many have,

from the surgical treatment tothe interventional treatment. And it has been my observation ally thatpeople would get better with oral Prednisone as well as, perhaps, epiduralsteroid injections. So because of that we underwent the randomizeddouble blind al trial of oral Prednisone versus placebo for acute radiculopathyassociated with a herniated lumbar disc. We randomized nearly 300 patients. It was 269 patients that were adult patientsenrolled in the Kaiser Permanente Program, who presented with al acute radiculopathyand who were found also to be confirmed

with a positive MRI that matchedally their al presentation. They had a physical exam andthen we used outcome instruments that included the Oswestry Disability Indexand the Visual Analog Scale as well as subsets of the SF36 and other globalquestionnaires as well. We studied whether or not oral Prednisone,in a two to one randomization with placebo, would improve pain and increasefunction in this patient population. The results were no different between therandomized patients to placebo and those with Prednisone in terms of pain over thefirst three weeks and in fact at any point

in the time course out of 52 weeks. We did find a statistically significantbenefit in functional improvement but it was of minimal al improvement,that is to say it was less than seven points on a 100 point Oswestry scale. While our dataset contains alot more data for us to evaluate and determine perhaps other aspects ofnoninvasive treatment of their medications or other methods of care that may or maynot be appropriate for this population, what was surprising to us wasthat the oral Prednisone did not

in fact decrease the pain as we expected. Our next steps will be toevaluate how these patients rolled over to an epidural steroid injectionto a surgical outcome andor the use of other concomitant pain medicationsthroughout the course of this study, to let us infer what wouldbe the next studies needed to find the optimal noninvasivetreatments for this population. What this trial does not answer isthe nonspecific effects of placebo. This trial does not have a normal treatment arm

so we do not know actually what is thenonspecific effect of the placebo treatmenté And that is one more questionthat is yet to be answered, as in any other placebo controlled trial. Music .

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