What is Deep Gluteal Syndrome? The deep gluteal syndrome was formerly known as piriformis syndrome. In piriformis syndrome, the piriformis muscle (a small muscle in your buttock) would press on the sciatic nerve resulting in pain, numbness, and/or tingling down your leg. The belief now is that more muscles may contribute to the symptoms including the Gemelli, obturator internus, hamstrings, and gluteal muscles. A simple test: Lie on your non-painful side and stack your legs on top of each other (knee to knee and ankle to ankle with the knees slightly bent). Put the top leg (foot) on the floor and spread your legs like a clamshell. You are trying to spread your legs and turn your knees outward. Have a friend resist the attempt for the legs to spread apart and rotate outward. If your symptoms are reproduced it is possible you have piriformis syndrome/deep gluteal syndrome. The most common symptom of deep gluteal syndrome is a type of sciatica (pain, numbness, and/or tingling down your leg). In addition, you may have pain and tenderness in some of the muscles of the buttock. You may have a hard time sitting, and the pain may worsen with prolonged sitting. We have found massage to be one of the most effective treatments for deep gluteal syndrome. We use a massage gun because it is difficult to massage these muscles with your own hands. Your hand's fatigue very rapidly. Generally, we start with a very wide target and work narrower. We would start massaging across the upper fibers of the gluteus maximus and the upper fibers of the hamstring muscles. Eventually if tolerated we would focus in on the piriformis and some of the muscles around it. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2022. For the original video go to https://www.youtube.com/watch?v=4xsd0JPNOcA&t=138s Brad: If you want to start a leg strengthening program at your home, that's your level, this is for you. It's for beginners as well as advanced. This program's going to work your hips and your knees. Pretty much everything from the hips down. Bob: Hamstrings, quads. Brad: Hamstrings, exactly. We're going to show you how to do it to protect your knees. So you don't irritate your knees while you do it, and it's easy to progress the intensity. There is one thing that's important. If you happen to have a knee or hip replacement, you need to check with your doctor first to make sure that this is okay. Bob should be, but just to be safe. Brad: If it's recent, maybe not. If it's a year or two down the road, you probably can. Better to be safe than sorry. Now, this is kind of like doing squats, but it's so much easier. It's safer and it really gives good benefits, particularly if you're interested in strengthening your legs for going up and down steps, hiking the hills, mountains, et cetera. There is one tool that people will need for this, stairs. Bob: Right. Brad: One step may be enough. Two, or at least three if you want to get to the advanced level, but how you do these is critical. You just don't go ahead and start going up and down the steps. I'm going to go up on the first step. If you have handrails, we're going to use those for balance, as well as assistance for resistance level. If you are just starting to do this, both handrails if they're there, use them. If you only have one, you could put a cane on the other side. Bob: Yeah, if you are weak or just starting out the rails are helpful. Brad: Exactly, right. Or if you're recovering from an injury, whatever it might be. So we're just going to go up, and with the same leg, go down with really good control for that eccentric strengthening. That's really important. So this is what they look like. Bob: This seems very simple, but I really like it, Brad. Brad: Right, you're going to find out how it gets harder if you would like to. Bob: Right. Brad: Now, there's one more thing I'm going to show you that you need to do to protect your knee. Okay, so if I'm starting here, watch at your knees, looking down right over your toes. It's not going to be to the right or to the left. A lot of people won't even think about it and watch my knee. Bob: It'll collapse. Brad Yeah, it collapses inwards. Bob: That will make the pain worse. Brad: It's going to be hard on the joint, hard on the ACL ligament. Watch that very closely. Bob: That alone is great training. Brad: Yeah, exactly. That's going to be good for your hiking, your walking, and even your running if you are a runner. So that's critical. Bob: Big cause of knee pain is that knee collapsing. Brad: Yep. There's one other thing to watch for, which is to watch how far you flex forward. You can flex as far as you would like to, as long as your knee doesn't hurt. If you get pain, you're going to have to go back down to the lower step and do it where it doesn't hurt. Bob: Right. Brad: Do it so it doesn't hurt. Don't irritate the knee so you get a flare-up out of this. Okay, in regard to a complete exercise workout, you're going to start out with your right leg or the left. Use good mechanics. Start with both handrails and progress to no hands as it gets easier. If you want, you can put both hands out in front of you. Work your balance! Bob: Be safe! Brad: It is not necessary to go without holding on, I would recommend most people have one hand on the rail. Okay, you do 10 of them. Make sure you do right and left, obviously. When that gets too easy, you simply go to the next step up. Now good posture, don't lean really forward like that. We want to have a good posture upright, and we're going up and down slowly. If you cannot go down slowly without good control, there should be no pain, then you're not ready for it. Bob: Again, don't allow the knee to collapse in. Bob: Right, so if it drops in, you're not ready for it unless you can control those mechanics. Very important! Make sure you do both legs. Now what I like to do, and I have patients do, if it's getting too easy and you think maybe you could go to no hands, but you're afraid of falling, simply go fingertips on the rail. That makes a big difference as far as resistance, but you're still safe. Bob: The rail is right there. Brad: Yeah. You know where that rail is if you need to grab it. It's very quick to grab. There we go, and you know, if you are really ambitious and you've got strong legs and you're hiking, like I'm going to do some hiking this winter or this fall in the mountains, I'm going to put a backpack on. Bob: Sure. Brad: Then, I'll throw some weights in it, and then I'm going to do it that way. Bob: Or just put some books in it. Brad: Yeah, put some books in it! Yeah, or what else could you put in there, Bob? Bob: Something heavy. Brad: Yeah, some food, I don't know. But it's a nice way to work out. You can work at any level you want. Bob: It's going to bulk you up. Brad: Ah, strong like bull! Ready to get up and down. Bob: There you go. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2022. For the original video go to https://www.youtube.com/watch?v=W4e251A31_8 Brad: Okay, we will give you six excellent options for improving blood flow in your feet and your legs without exercise. We’re going to explain why exercise may not be an option which is a realistic case in many cases. Mike: Can I still exercise if I want to? Brad: You bet, always exercise. Therapists, we always advocate exercises, but we’re going to get into that in a little bit. As therapists, we’re talking about circulation in the legs, and how to get the blood flowing better. As a therapist, we almost always recommend some form of exercise or repositioning of your body to get gravity to assist. However, there are three problems that can cause different populations and different people to now exercise. Number one, there are some people who absolutely refuse to exercise. If you’re a therapist, you know those people because it’s obvious. Sometimes they come out and tell you, "I am not going to exercise," and I say thanks for your honesty, and it helps me guide doing treatments that don’t include exercise. Mike: Other cases are people with severe dementia or memory loss. They do not remember to do the exercises, they don’t remember they have swelling, and sometimes they don’t know who you are. They are not going to remember. These are some options you can try as well with them. Brad: That’s right. Of course, there are certain people who may have work challenges where they’re sitting at work. It’s hard to exercise, they’re just busy people and exercise doesn’t fit into their day well, but these will and without problems. Mike: Option number one is elevating your legs for at least 30 minutes a day. You can do it laying down, or you can do it in a recliner if it goes back far enough. I have a leg wedge and you can purchase one or you could simply use some pillows. The goal is to get your feet elevated above your heart to help with that swelling and get the circulation flowing better throughout your body. Brad: Right. One thing, if you are in a recliner and the recliner oftentimes, the legs won’t go up high enough, so again add a couple of pillows onto the leg part, underneath the calves, so the pressure is spread out very nicely and it’ll work well. The second one, now this is a nice option, especially if you’re up and about or sitting at work for a long time, is compression socks. Mike has two different options here. Make sure they do not go above the knee, and they have more compression, like 15 millimeters of mercury around the ankle. Then 20 millimeters of mercury around the calf is a popular and common spec for these. So, wear those throughout the day and do not wear them to bed. Brad: If you have severe swelling or typically older people use this, my mother does, I’ve worked with a lot of patients in the geriatric community, and it’s using what we call Tubigrip. The toes are cut off and that’s because it comes in a long rolled-up tube of cloth. We cut it so the length is right at the knuckles of the toes if you will, then below the knee and you slide them on. They don’t have the compressive gradient where it’s tighter in the foot than the calf, but they work well, particularly in the population I described. If they roll down it can cause a tourniquet. It usually happens at the top near the knee, but I already put on Coban tape which does not stick to your skin, but it does stick to itself. That can prevent the rolling. Usually, you don’t need to use it, but in case you do have that problem, it works nicely. So, that’s the compression garments. Wear them throughout the day, and take them off at night. Mike: Another way to get the circulation going throughout your body and in your feet especially is just massage. You can start at the bottom of your feet and just dig in with your thumbs. Make sure to move all around, what feels good. I’m in what they call a figure four position so I can reach my feet. If you can’t reach your feet, you might have to have someone massage them for you. Brad: The nice thing about this position, Mike, is that it’s elevated so you have gravity working the fluids and getting the blood going downhill along with massage. It’s important you start on the feet, spend about a minute or so on that, and then work to the calf, working that calf belly. We’re just getting that blood moving in any areas where it’s pocketing if you will, moving in the right direction. You’re probably going to spend 3-5 minutes and what’s going to happen that’s going to limit you is your hands are going to get tired. If you do one leg at a time, if you do both legs, you’ll figure out quickly how much time you can do this before your hands fatigue, and it becomes uncomfortable. You don’t want to get problems and "itises" in your fingers and knuckles and whatnot. Mike: So, this is not a good option for severe edema, that type of massage is a little different. Brad: Particularly if you have pitting edema. If you have edema you know, where you push your thumb in and then you take it off and a dent stays in that area, that’s called pitting edema. This would not be for that situation. We’re carrying on, number four. The next option is another massage, but instead of getting sore hands and fingers, if you happen to have a massage gun, that could be a great way to get circulation moving, relax muscles, etc. Here we have a massage gun, our T2 massage gun. The head that I like to use for this is the round head. There are other heads, the bullet head, the air-filled head, not like me. Anyways, the round head I think is the best. We’ll demonstrate why now. Getting in a supine position again so gravity assists with the blood flow going down is a big advantage and it’s comfortable. This is the way I like to massage my legs, particularly lying down. Mike: This feels nice. Brad: Yeah. The massage should feel good. If it’s too aggressive, there are five settings to the massage gun, slow it down or speed it up. Mike: I’m using number one on the bottom of my feet, and this is going to be less aggressive going lateral versus directly into it. Brad: That’s the big advantage of the round head. It allows you to change the angle which then, in turn, changes the intensity of the massage. It should feel good, very relaxing. Start at the feet, and work down to the muscle belly of the calf. The blood is going with gravity and the percussion of the gun making it go down proximal to the core and into the system. How are you doing, Mike? Mike: I’m good. When you said airhead, it reminded me of the old movie “Airheads”, you’ve probably never seen it. Brad: Yeah, I’ve heard of it. So again, working the quadriceps, these are large muscles. There is a lot of blood involved in these muscles, so we need to get the fluid moving down and that’ll open the pathways for circulation from the feet and the calves. Mike: Should we go on to the next option? Brad: Absolutely. With the massage gun, your hands don’t wear out. You can spend five minutes, happily doing this and it feels good. Yet, another good option to get the blood moving in the legs and proximal, where you want it to go, is the foam roller. This does take a more able-bodied person. It’s more effort to do it. They work well, however, just a little difficult. You also want to get the foam roller that’s not so dense. You want to be able to squish it in. Some people like the black ones that are denser. That does get into the muscle and massages the muscle more aggressively. That’s your choice. Again, we’re going to start on the feet, lying supine. Mike: If want to get a little more aggressive with this, I can lift my butt off the floor, and it will take balance and coordination to do this. Also, works your hamstrings a bit. It’s just digging in down my plantar fascia area. Massaging in and just start near the toes and roll to your heels. Then I can go up to my calves easily. You can do both legs at a time or one at a time, whichever you prefer. Brad: I do both just because it’s quicker, but if you have a knot or it’s more tender, you’ll want to go one leg at a time. Mike: You can also turn your toes out and turn them in. It works different areas of the calf when you do that. That’s when I feel it the most. I like an aggressive one, mine has nodules in it. That’s just me, pick what one you prefer and what works best for you. Brad: I’m going to do the Anterior tib., the muscle which is the front part of your leg. You simply sit your legs on the roller and turn sideways. It feels great. It’s a nice massage. You’re getting that blood flow moving. Mike: Then sit back on your butt and we’ll do the same thing to the hamstrings. Brad: For the quads, you need to go prone stomach down. I go back and forth, side to side. Do one leg at a time for that so you get those lateral quadriceps. You’re probably going to spend about 15-30 seconds on each muscle group and they can get all the way into the glute muscles as well. Mike: Yeah, you can do glutes. I like to sit in figure four personally and roll around in different positions. Brad: Number six, this is probably the most desired way to get the circulation going in your legs. It is for me, at least, and that’s simply to hire a massage therapist. They’re excellent at their job. They’ll get the muscles loose, and move the blood flow in the right direction because that’s what they do and they’re experts. The big thing is, it costs money, and you must go to it. That’s why I never use them. It’s more of a treat, for me. All right, thanks! Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

When massaging the low back, your primary focus should be on the muscles closest to the spine. You will probably need another person to effectively apply the massage with a massage gun. Work your way on the lumbar paraspinal muscles up and down staying close to the spinous processes. You can use any massage head that you find comfortable. The field goal attachment is designed to be used on each side of the spine simultaneously. Always start at the lowest variable speed and work your way up. After sufficiently massaging the lumbar paraspinal muscles you may want to focus on muscles that attach to the lumbar spine through the thoracolumbar fascia. This includes the Latissimus Dorsi which has a lot of attachments to the spine and fascia. And the Gluteus Maximus. You may also want to massage the Quadratus Lumborum. The muscle originates on the pelvic crest and attaches to the border of the last rib and to the side of L1 through the L4 vertebra (transverse processes). It is difficult to get to because it is located deep below the erector spinae. Because of its location, we would not recommend using the massager on the iliopsoas. Too hard to get to the muscle. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in November of 2022. For the original video go to https://youtu.be/Q_nXIvpiUfg Bob: All right, the question we have is if you have back pain, do you have inflammation in the back? -Brad: All I'm saying, is if it hurts and it's painful when you move, you probably have inflammation. -Bob: Right? Let's talk about it. If you have constant, severe pain, that's a good chance there is some inflammation in it. So, a flare-up of pain, you know, if you went out and did something stupid. Brad: Like if you went out and cut a tree down in the backyard and moved all the wood by yourself with poor body mechanics and then it hurts for the whole night and the next day Bob: Yeah, it's just like spraining your ankle. You're going to get swelling in there. Bad: Yeah. -Bob: If you have trouble sleeping at night, you know you're lying down, you would think it should not hurt, right? But if there is actually swelling in your back, it may hurt. Finally, if it hurts all the time when you're standing or walking. Brad: That chronic pain situation. Bob: Yeah. It doesn't matter what your diagnosis is. If it’s sciatica, spinal stenosis, or Spondylolisthesis. Whatever it is, inflammation is going to make it worse. So your first step should be to try to reduce inflammation. For at least a five-day plan. Brad: Yeah. That sounds like an exceptional plan. Bob: So, one of the things you want to do is walk. Walking helps get things moving and it actually helps the swelling go down. Brad: Right. If it's so flared up, that walking makes it worse. Which I've experienced as well as some patients, then we're going to show you how to settle it down and then get to walking when you can. Bob: Right. You could try a back brace. It might feel better when you walk. We have a couple here. Brad, do you want to show yours? Brad: Yeah. You know, if you don't have one, I don't know if you really want to go out and buy one. I would try some of these other tools. Bob: Right. They are less expensive. Brad: So, these aren't that expensive actually, you know this one has the elastic. We like the kind that you can keep reasonably loose and then adjust. When you're walking, you may want to tighten it up and feel that support. It should feel like good support as soon as you tighten it up. Bob: Right. This one works the same way. This one has a Velcro closure here and then I can tighten it and really cinches up. Brad: The one Bob has on is actually more supportive than the style I have on, which I like that one. Bob: If this allows you to walk and you can't walk without it. It's a great thing to do. Brad: Yeah. Stabilize that pelvis and eventually, you take it off when you can, you don't continue to wear it forever. Bob: A little less active thing is getting into the right position and using the ice pack. Brad: So, this has been my go-to personally as well with patients that come in with severe back pain. I'll have them lie down. You can use pillows. This wedge works better for at least 90% of the people I've worked with. And you could do this on your bed or on the floor. Brad: A cold pack when it's really flared up for most people is what my go-to advice is. Get that underneath your back. And I've done this literally after I’ve been out doing yard work because I'm guilty of that. I like doing yard work and I break the rules sometimes. Literally in the middle of the day, I'll go in, lay down like this with a cold pack for 20 minutes, get up, relax, and go back out. And then I behave myself though. I won’t do things I shouldn't be doing. Bob: And you could do this throughout the day for 10 minutes. I mean, if you want you could go longer but I like to see if your pain is really flared up, do at least twice, maybe four times where you get on the ice pack and get the legs up. Brad: It really feels good, and I don't even have a flare-up right now. Bob: All right. If you're having trouble at night sleeping because of the flare-up or the pain, you might want to wear the back support or back brace at night. Because whenever you roll over it's going to hurt and that’ll help stop that. Brad: It will stabilize it. Yeah. Bob: Give it a try. We’re not worried about your back getting weak during sleep because you're not working out too much. The last thing is to avoid pain makers for now. Brad: Where do you get a pain-maker? Bob: There could be a whole list of them, Brad. Brad: Actually, I guess we've gone over that in a previous video in this series. Bob: You don't want to be riding that snowmobile when your back is flared up. You don't want to be shoveling snow. You might not want to be cutting the lawn. Brad: Yeah, on a riding lawn mower, boy, that can really tear it apart. Bob: So, until your pain calms down, then you can reintroduce the pain makers. And then at that point, use good judgment. Brad: Right. Bob: All right. Remember, get that back calmed down. Brad: That's right. Feel calm and relaxed. Bob: All right. Take care. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

Did you know that chronic respiratory diseases (CRDs) are the leading causes of disability and death in the Americas? The disease claimed 534,242 lives, or 35.8 deaths per 100,000 individuals, in 2019. Asthma, lung cancer, and COPD (chronic obstructive pulmonary disease) can sometimes cause or worsen lung problems. In rare cases, mesothelioma may also impact the lungs. But knowing the different stages of mesothelioma may help prevent the disease. If you’ve been diagnosed with a lung problem, what lifestyle adjustments can you make to help your respiratory condition? What steps should you take after getting diagnosed with a respiratory problem? This article explores the lifestyle changes you can make to protect lung health. We’ll also give you tips on what to do when diagnosed with a respiratory condition. This article aims to provide the information you need to help address your respiratory concerns so that you can get your health back and start living a healthy, fit, and pain-free life. Protect Your Respiratory Health With These Lifestyle Changes Your body has a natural immune system that protects your lungs from damage and prevents or lowers the chance of germs, dirt, and other factors from making you sick. But when you’re diagnosed with lung disease, you can no longer rely on your immune system only. You must also adjust your lifestyle to help reduce your lung disease risk and ease the burden on your immune system. Quit Smoking Cigarette smoking is at the top of the list whenever we talk about the main causes of lung cancer and COPD. Emphysema (shortness of breath) and chronic bronchitis (productive cough lasting three months or more) are also linked to smoking. Cigarette smoke can constrict your air passages and cause difficulty in breathing. Smoking also leads to chronic inflammation or lung swelling, causing chronic bronchitis. As time passes, cigarette smoke can destroy lung tissue and even cause changes that can trigger cancer. Still, it’s never too late to quit. When you stop smoking, you reduce your risk for COPD, cancer, cardiovascular diseases, and poor reproductive health outcomes. Quitting smoking also provides the following benefits: Reduced respiratory symptoms like coughing, wheezing, and sputum (saliva and mucus) production Decreased respiratory infections like pneumonia and bronchitis Improved lung function and treatment results among persons with asthma Stay Active Sedentary behavior is a risk factor for disease and premature mortality, so keep moving. Studies show that physical activity can help you avoid 6% to 10% of the major non-communicable diseases and even help you live longer! By doing moderate to high levels of regular physical activity, patients with COPD can fight the worsening of their lung function. More importantly, physical activity can help reduce the risk of smokers developing COPD. Check out this video on simple breathing exercises for COPD to learn more! Change What You Eat Food quality affects lung health. Studies have shown that malnutrition (lack of proper nutrition) can worsen obstructive respiratory diseases like asthma and COPD. One study suggested that the Mediterranean diet, consisting of high consumption of vegetables and fruits, has potential anti-inflammatory benefits and may be linked to asthma control. Studies show that high vegetable and fruit intake may help current and ex-smokers avoid the risks of COPD. Keep Informed Collaborative self-management programs can help an individual’s well-being, support self-efficacy, and improve health. These programs are designed to help an individual develop skills to manage the disease and learn more about: The nature of the disease The use of drugs and devices Symptom management Physical activity After The Diagnosis: What Can You Do? When you have a respiratory condition, visiting a doctor for regular checkups can help prevent disease, even when you think you’re feeling well. Lung diseases are no exception, especially since they can sometimes go undetected until it is serious. Depending on the diagnosis, your healthcare provider can ask you to take additional tests or exams. Your doctor can also prescribe medications and, if you’re a smoker, ask you to quit, especially if you’re diagnosed with COPD. Depending on the condition, the doctor can prescribe the following: Bronchodilators: These inhalers can help relax the airway muscles to relieve shortness of breath and coughing. Inhaled corticosteroids: These medications can help reduce airway inflammation or prevent it from getting worse. Allergy medications: These drugs can help manage asthma triggered by allergies. For more respiratory health tips when you get diagnosed with lung disease, contact the American Lung Association at 1-800-586-4872. You can also donate to help fund lung disease and cancer research, discover new treatments, and promote lung health education. References 1. Chronic respiratory disease burden https://www.paho.org/en/enlace/chronic-respiratory-disease-burden 2. COPD Causes and Risk Factors https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd 3. Protecting Your Lungs https://www.lung.org/lung-health-diseases/wellness/protecting-your-lungs 4. Benefits of Quitting https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm 5. Too Much Sitting: The Population-Health Science of Sedentary Behavior https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404815/ 6. Impact of Physical Inactivity on the World’s Major Non-Communicable Diseases https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/ 7. Lifestyle interventions in prevention and comprehensive management of COPD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118879/ 8. Diet and Asthma: Is It Time to Adapt Our Message? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707699/ 9. The effects of chronic obstructive pulmonary disease self-management interventions on improvement of quality of life in COPD patients: A meta-analysis https://pubmed.ncbi.nlm.nih.gov/27888996/

When you are experiencing arthritic pain in a joint you should not apply massage directly to that joint. Rather what you should do is apply massage and mobilization to the muscles that cross the joint. Muscles and tissues located above and below the joint should be targeted. Dr. Kelley Starrett, (author of best seller Becoming the Supple Leopard), refers to this as treating upstream and downstream. Tissues can include tendons and fascia. As an example, we just filmed a video on using a massage gun for knee pain relief. We focused on the massage of muscles above and below the knee including: 1. Suprapatellar pouch: This is the area directly above the knee. 2. Quadricep: Hit the entire four muscles and add in some flossing (movement of the muscles and nerves). 3. Hamstring: Focus on all three muscles. Can also bend and straighten the knee and add in some flossing. 4. Calf: focus on the upper calf but not behind the knee (there is a rich supply of nerves arteries and veins in that area). 5. Tensor Fascia Lata massage and iliotibial band: Cannot stretch the IT band but it could help loosen it if somewhat adhered down. 6. Hip adductors: Inside of thigh. If tight can cause the knee to bend inward knock-kneed. We would not use a massage gun directly on an arthritic neck. However, it may be beneficial to massage below the neck-the upper trapezius, the levator scapula, and the rhomboids. Use the following guidelines to choose the appropriate attachment: a. Big Round Head Attachment: Good for larger muscle groups like the glutes, quadriceps, or hamstrings. Allows you to cover more surface area. Moderate in aggressiveness. b. Small Round Head Attachment: Less aggressive to moderate. Great for tendonitis if used sideways. (Big & Small Round Head) c. Air-filled (Pneumatic) Attachment: Probably the least aggressive head. Great for use around bony surfaces and sensitive muscle groups. Good for relaxation. d. Bullet Head Attachment: Aggressive. We have found it to be helpful with treating trigger points or knots. e. Plastic Flat Head: Moderate. Good on IT band, Pectoralis Major (with ribs underneath), or Plantar Fascia (bottom of the foot). f. Steel Flat Head: (Can be heated up or cooled down prior to use). Moderate to Aggressive. g. Knobby Attachments: Generally, for larger muscles. More aggressive. h. Field Goal: Can be used along both sides of the spine. Also, some have recommended its use on the Achilles tendon. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2022. For the original video go to https://www.youtube.com/watch?v=BxBk2CYmR1M Brad: Do you experience foot pain, knee pain, hip pain, or even back pain while you’re walking? Bob: Or right after? Brad: Exactly. This is going to help you out. I have found the easiest way, in my mind, how you can learn how to walk properly without awkward exercises. This is simple, it's so simple it’s scary. We have put out several videos in the last year about walking mechanics, how to walk properly, and taking the pressure off your joints, back, and hips. We've talked about walking with Dr. Mark Cucuzzella and Rick Olderman. They both support the same idea. The concept of how to walk, the whole idea is how to walk without having a hard heel strike. Bob: Right, or locked knees. Brad: Right and I could not get this through my head for the longest time. I’d say, Bob, you can’t walk around on your tip toes! And it’s like no, I’m not doing it. I’m going to walk my normal way, but then I realized something that changed my mind because I’m a little stubborn, but finally it got through. Bob: A little stubborn? Brad: My daughter is the same way, I’m finding out. Bob: Oh my. Brad: All right let’s go on. Let’s take a closer look at the mechanics and why specifically walking, when you do a heel strike, the heel comes in contact with the floor and your knees are fully extended. That takes all the pressure, and it goes through the joints and the hip, and the back. There is no cushion there. Bob: Also, you want your glutes to work. Brad: Ah, yes. We’re talking about those gluteus maximus muscles. When they shut off, that puts further stress on the hamstring, that is a whole other issue. Now, if you come down with your foot at least flat foot or forefoot. Bob: You should not hit the heel first. Brad: Right, this way, there is a cushion. The knee automatically flexes slightly, which gives more cushion. Instead of the joints and the back taking that impact, we have a cushion. Bob: Rick calls this soft knees. Brad: Soft knees, yes, exactly. Dr. Cucuzzella, he’s a runner and he talked about running this way which can save the body. Bob: Both of us did that. Brad: Whether you’re running or walking, that’s the goal. I’m going to show you the trick on what convinced me to do this. This is what happened to me, and I realized this without even thinking about it. I’m walking on a hard tile floor without my shoes on. It happened to be where I swim. I don’t have my shoes and I realize that I automatically walk with my forefoot exactly as we mentioned. Forefoot strike first, a slight bend of the knee and it’s just natural. I know when I hit on that tile with my heel, it hurts a little bit. It’s not a big ouch, but your body knows that’s not right. So, I’m walking properly because I’m walking on a hard floor. Then I realize, my balance is better when I walk on my forefoot because my toes are in contact with the surface. Your toes have a lot of balance qualities. Bob: A lot of proprioception. Brad: You can’t balance with your heels. You can balance on your toes and forefoot nicely. That’s what they’re there for. There are a lot of benefits there. The whole idea is, to take your shoes off, take your socks off, and walk on a hard surface. Bob: You only do that a couple of minutes a day. Brad: Yeah, you’re not going to go for a mile walk. You may only need to walk 10 feet to start with and then maybe a minute or two in the morning and you’ll start to realize, your feet are for balance, they’re for proprioception and they’re for cushion, soft knees. Bob: Now, if you’re a runner and young, you might even try running on asphalt for a short period of time with bare feet. Brad: Yeah, but not on a hot summer day. Bob: Dr. Cucuzzella would mention that. Brad: Right. Now I have a concrete driveway and I do walk on that barefoot just for a little while. You start to realize, it wakes up your feet, it exercises small muscles in your feet. It can be a good thing to do. Now, I’m not saying you’re going to walk like this all the time, but you’re just training. You may realize and eventually may want to start walking like that. Do you want to talk about shoes, Bob? Bob: Sure. This shoe has no heel. It’s the same heel all along the shoe. Brad: It’s called a zero drop sole. Bob: Zero drop, right. You’re going to have more of a tendency to hit on the midfoot as opposed to this shoe which is a big heel. Brad: The heel is thicker in the back and thinner by the toes. So, my heel inherently is higher. Bob: Right, you’re going to want to hit on the heel in that. Brad: Exactly. Bob: It’s going to promote it. Brad: The thicker the heel, the more you feel like hitting your heel first without thinking about it, so that can be something to think about. If you do get zero drop shoes, don’t just throw your other ones away and start wearing the zero drop ones because it’s too much too soon. Bob: I got sore from them. Brad: A few hours a day and then progress as the day goes. That’s an option for you. Bob: Start by walking, don’t run. Brad: Once again, your balance is going to be better, it’s going to help you save your joints and hips. Bob: It’s going to wake up the glutes. Brad: Yep. It’s a wonderful thing. Start out small, barefoot. Gentle, gentle, and progress. Bob: Have happy feet. Brad: Happy feet, happy legs, happy body. Very good! It’s serious and it will help you out. Thanks! Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2022. For the original video go to https://www.youtube.com/watch?v=0VKEr_WVZuI Brad: All right. We're looking at the stability ball! Bob, you know what I always say? It's the beauty of the ball. Now the stability balls are one of the best and the cheapest tools for a complete body workout in my opinion. Bob: They are about $25, right? Brad: Somewhere in there, yep. Plus only the stability ball provides unique core strength and balance benefits that you'll get from no other device. Bob: Take it from somebody who has spondylolisthesis, that's you, Brad. Brad: Yeah. That's my back problem. I tell you, I've used this with patients for a number of years and myself personally. It's a wonderful device. All right, now make sure you get the right ball for yourself. It's important you get the right size. I think the best way to do it is if you search online exercise ball diameter sizing chart, you'll get a few charts, and it'll say your height, and then it'll give you the diameter of the ball. Bob: Yeah. I've got long legs. So I need a big ball. Brad: Yeah, I use a 65-centimeter. I think Bob probably uses a 75 cm ball. You can change your diameter slightly, there's forgiveness in this, but it's not an exact science. One thing for sure is when you sit on the ball, you should have an approximately 90-degree bend at the knees and in the hips. Bob: Right. If you are too high or too low it's not workable. Brad: And it's forgiving, again, there is quite a bit of forgiveness. Make sure you have it pumped up to a level that you feel comfortable with. You should not be sinking way into it. This one's a little bit low. I would put maybe a little more air in it, but it's okay. It's going to work fine for this video. All right. 10 exercises. The goal is 10 repetitions per exercise. You could do more if you want. If you haven't done them before, you'll probably get sore muscles tomorrow. That's okay. Join along. You can do them with me. Lie on your back. Put the ball as shown here. If you have shoes on, it actually works a little easier. The shoes will grip the ball because we're going to pick the ball up with our legs. Or if put your skin on the ball, that kind of helps to grab. So you're simply going to do what I call, "knee to chest" or "abdominal curls." Bob: And the back is protected. Bob: Yeah. Right here. That's one of the big benefits of doing this if you have a back problem. Bob: Exactly. Brad: Okay, do 10 of those. And then hands bend your head, you're not going to pull your head forward. You're just going to keep it there. Bring your right elbow to your left knee, then your left elbow to your right knee. You get those oblique and transverse abdominal muscles this way. Bob: Again, your back is protected. Brad: Yep. It's a really good way to protect the back. A little strengthening, of the abdominal muscles. Okay. The next one, number two. You're going to lie on your back with your heels on the ball, you're going to lift up, and this is great for the glutes and the core, but we really want to focus on the hamstrings as we do these I call them "Hamstring curls." Bob: Could you start with not lifting up, Brad? Brad: Yes. Good point, Bob. You know, if your hamstrings are weak or are they injured you can just push into the ball and roll it towards you. Bob: That might be enough for you. Brad: Yep. Exactly. Good point. I'm glad you brought that up. And then as you get stronger, you can lift up. Down the road, you may want to go with one leg and that really challenges you. Brad: Be careful with that. Don't jump into it right away. All right. Do 10 of those. Okay. Number three, we are going to go on the ball in the prone position and we're going to work the core, but the back side, the back core muscles. So point with your right hand, and extend up with your left leg. You can see the balance I'm challenged with, and the core exercise, Bob, what does it do for your back? Bob: It strengthens it and because the ball is there, it protects your back. Brad: It's a nice way to do core. If you have some back problems or you're recovering from a back injury to start with. All right, number four. We're going to stay in this position to make it efficient, and you simply spread your legs out wide toes on the floor. So you have a good base. You can put your hands on the ball and we're just going to do simple back extensions. And I do 10 of these. It's a good way to get all the muscles in the back and the low hips. Bob: Even though you have Spondy, you can do this right, Brad? Brad: As long as you go in a pain-free range of motion. Bob: Right, no pain, Brad: You want to maintain as much extension as you can if you have spondylolisthesis or spinal stenosis. Just be gentle. Don't push it up. Bob: Right, absolutely! No pain, absolutely none. Brad: If you've got a healthy back, if you want to put your hands folded at your chest, it's a little harder for me. I don't worry about it. I just assist on the ball as needed. Bob: Sure. Brad: All right. Number five, we're going to go down to the glute max and hip extension. Simply roll forward a little bit, hands out wide here for stability, and lift up one leg and do 10 on each leg. Bob: You can also do these with the knee bent. Brad: Yep. So if you bend the knee that takes the hamstring out of it and actually works more the glute max, Bob: Right, the all-important glute max. Brad: Yep, so, if you want to have a bent or straight knee, do what works best for you. Bob: Or both. Brad: Yeah. That's a good idea as well. All right, come on. Number six then. This is a total body workout so we've done the core, legs now, the arms, and the chest. So you simply stay where you are, except you're rolling forward. You are going to roll forward, and the beauty of the ball is you can change the intensity. If you're not very good at pushups, you may do it with the ball closer to your core. And this is easy to do pushups. If it's too easy, simply walk out a little bit and do your pushups with the ball closer to your feet. Bob: That's more of a challenge. Brad: Yeah. You can go all the way out to your toes and it'll get real aggressive. And there's also this instability that makes this a superior pushup, Versus if you do the standard GI pushup without the ball, I really like pushups using the ball. All right, next! The next one is another one for the core and upper body, and you get some LAT work in here, which is sometimes hard to get. Bob: Really hard. Brad: I kneel on a pillow because the carpet's a little hard on my knees. It's up to you. Hands on the ball, and you're going to roll out. You may walk out and stretch. The abdominal core is working well. Then come back up. Bob: This is like the roller wheel. Brad: Yep. It is. But the thing about this is it has a tendency to go back and forth, especially if you do it with your hands together. Bob: It challenges you. Brad: Yep. You're getting some core work in many directions with some balance. So, it's a great way to work the arms, core, and balance. Do 10 of those. All right. This is a real classic exercise for therapists. When you only work the hips and the core; you sit on the ball, with good posture. If you're starting out, I would suggest having someone on both sides to stabilize yourself because this ball is wobbly. Everything's working to keep you upright. Bob: Well, it's hard to do. Brad: Yep. It is. If you haven't worked on the ball, be patient with it and have something to stabilize yourself, because you're going to roll down to here, all the way up whatever you're comfortable with, and we're just doing bridging or glute sets. Bob: And it's easy to roll off. Brad: Yeah. If you don't hold on, it really energizes a lot of musculatures to keep you balanced. Because I've been doing this for years, I'm quite comfortable with it. It will not be this easy if you're just starting unless you're a natural. Not holding on is much harder. If you want to do one leg, whoa, that's too hard for me, and work that 10 repetitions. Brad: Okay. Number nine is very similar to the one we just did. However, we're going to go out and instead of doing the bridging or the glute sets, we're just going to hold it and simply straighten one leg. Then do the other leg. If you want to go from two hands to one hand for support, it's more challenging. Without support it really gets wobbly. But that's all up to you. I do not expect it. Bob: You're shaking. Brad: Yeah. Oh yeah. So do five on each leg. Build up to 10 on each leg. All right, Bob. Last, but not least, put the ball on the wall for quad-strengthening. I've had many people do this in therapy. Bob: Yep, me too. Brad: Make sure you have shoes on or something so your feet do not slip. The carpet works well with these socks. Oftentimes if you have a tiled floor or something like that have your rubber shoes on, you know, tennis shoes, running shoes, whatever it may be, so it's sticky. Feet at least one shoulder width apart and you put them out in front of you a little bit. Good posture. This is the biggest mistake people do is leaning forward with rounded shoulders, they stay slouched. So it's back and upright posture and simply go down. I oftentimes have people start with a cane or a piece of furniture to hold on to for their balance. The big thing, Bob, don't go down too far the first time so you cannot get up. Bob: That would be a big problem. Brad: This really works the quadriceps in particular. So go down as far as you feel comfortable if your knees are becoming painful when you do this, don't go that far. And so do 10 of these. I guarantee you, you'll get those muscles working well. So that's number 10, Bob. Once again, the beauty of the ball is going to work your body from top to bottom. Have a good time, and be careful. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

When you have shoulder pain, and you want to use a massage gun to help decrease it keep the following issues in mind. 1. The Pectoralis Major and Minor, and the Latissimus Dorsi can greatly affect the posture of the shoulder if they are tight. If the three muscles are tight, they can internally rotate the shoulder and/or cause the shoulder blade to be depressed. Either issue can lead to impingement at the shoulder. So, for many, the first muscles they should massage are the Pectoralis Major/Minor or Latissimus Dorsi. We would recommend massaging across the fibers. 2. Muscles that can greatly affect the shoulder blade and therefore the shoulder in a secondary fashion include the trapezius, the levator scapula, and the rhomboids. If any are tight and painful, we would apply a massage to them. 3. If you are presenting with tendonitis (bicep, or supraspinatus), cross fiber massage using the massage gun with the ball attachment. Apply the pressure of the massage head to the tendon from a sideways angle. Apply the massage across the fibers of the tendon. 4. Muscles of the rotator cuff may be sore. All four rotator cuff muscles originate within the shoulder blade (supraspinatus, infraspinatus, teres minor, and subscapularis). Because of their proximity to bone, you may need to use the air-filled head attachment. The subscapularis is unreachable due to its position under the scapula. The Teres Major may also be sore. (Rotator Cuff) 5. The deltoid muscle may also be sore and can easily be massaged. Use the following guidelines to choose the appropriate attachment: a. Small Round Head Attachment: Less aggressive to moderate. Great for tendonitis or tenosynovitis if used sideways. (Big & Small Round Head) b. Air-filled (Pneumatic) Attachment: Probably the least aggressive head. Great for use around bony surfaces and sensitive muscle groups. Good for the palm of the hand and the palm side of the fingers. c. Bullet Head Attachment: Aggressive. May be helpful with treating trigger points or knots in the forearm. d. Plastic Flat Head: Moderate. Okay for the forearm. This video is part of a series of videos on how to treat your pain with self-massage. Check the full series of videos along with the downloadable guide sheets for each video on our website here: https://www.bobandbrad.com/massage/ Bob & Brad's Massage Guns C2 Massage Gun (US), T2 Massage Gun, EM-19 Massage Gun, Q2 Mini Massage Gun (US), X6 PRO Massage Gun with Stainless Steel Head Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2022. For the original video go to https://www.youtube.com/watch?v=boU3vipxiZ4&t=346s Brad: Today we are going to show you exercises for glute medius strength, and we're going to show you how to strengthen it so that you can have hip stability which reduces back pain and improves your walking ability. Bob: And sometimes leg pain. Brad: We're going to show you how to do this without exercise equipment, only body weight, and they are great exercises. Okay, just briefly, we're going to use Sam to show you where the glute Medius muscle is and why it's so important to stabilize the pelvis, the hip joint, the back, the knee, and the hip. So, my hand represents the fibers of the glute medius muscle. It connects to the hip, the greater trochanter, which is in line with the ball of the hip. And then the fibers go up across the pelvis bone, or the ilium, just like my fingers. So, if my fingers contracted, it's going to stabilize that hip bone. This is an interesting analogy, isn't it, Bob? Bob: Oh yeah, I think it's great. Brad: It's a wonderful thing. So that's what we need to strengthen. Bob: One of the big things it does, is it stops the ball from sloshing around. That'll cause pain. Brad: Yep, and then the hip is unstable. It's going to affect the back and goes down the chain into the knee and the foot. Okay, so we're going to show you five different exercises to strengthen this muscle. Pick out the one that's good for you. Try them all, and there will probably be one that works best for you. Just do one or two, you do not have to do all five. The goal is to do 10 of them. Once you get strong enough, do two sets of 10. You could get up to three sets of 10, as tolerated. You should feel fatigued. Bob: Now, a beginner can do these in bed. Especially the first one. Brad: Yes, exactly. So just lying here, with the bottom leg bend the knee so you have a stable base, and we're going to strengthen this hip abductor. The top leg is straight. Your toe position is important. Don't let it turn out, point it straight out like that. And don't bring your leg forward, but straight in line with you. And here we go! Bob: It helps to keep that lower leg bent. Brad: Yes, because I'm a little wobbly with it straight. Again, big mistakes are toes pointed up, no good. And then out in front of you, not good. Bob: No good. Brad: Pretend there's a wall right behind your moving along the wall, you could do this against a wall, actually. Boy, I feel it already. That's some nice work. The second one. Now we're going to do the same body position, lying on the floor. You could do this on your bed but a firm surface is better. And now, instead of strengthening the top muscle, it's going to be the one closer to the floor. So you're going to bring your knee bent on the bottom, straight in line, on your elbow. Now, I'm going to lift up my body weight. Bob: You have to have a pretty good core too for this. Brad: Yes. Yep. So it's not just that muscle, it's the core, which is functional, which helps you with everything else, all the goals we mentioned earlier. Bob: It'll help your back pain. Brad: Yep. So here, you can just do it slow up. You can hold and down. Nice, slow, smooth, tighten the core muscles. And again, as I said, the goal is 10. And if you're just starting on these, you may only do five, and you'll have enough, and that's okay. Build up over a period of time. You know, do these once a day. Take at least one day off a week where you don't do them at all. Number three coming up. Okay, this is the third one. Now, these are not in order, but this is probably the most difficult, so this is when you're really getting strong. Bob: It's challenging. Brad: So, first of all, do exactly what we did before. Lift up on your elbow. Bob: Again, a good core exercise. Brad: Yep. So now I'm working the bottom hip abductor. Now we're going to double up and work the top one and do the leg lifts at the same time. Bob: A big challenge. Brad: Yep. Now, for when you get really strong, there's a way to make this even more challenging. And there'll be a few people that'll get to this level, it depends on your fitness and how long you've worked at these, but you straighten the bottom leg, and you start out like this. Now, I'm touching here, I'm cheating a little bit. If I straighten both legs, that's even harder. Okay. I'm going to touch my foot down because it helps. Brad: I'm going to tire out. Now, for those people who really want a challenge, lift up with the hip and then lift the leg up, then down. Bob: Not bad for almost 60, Brad. Brad: So, again, that's aggressive, not a lot of people will be doing that one, but there are always those people that are high achievers. Bob: Right. Brad: We're going on to the next one. The next two are in the standing position. This first one is the easiest one, but how you do it is important. Have something to hold for balance. We're going to strengthen the right hip. And all I'm going to do is pull the leg out like this. Bob: But he's leaning onto the left hip. Brad: One thing you do not want to do is lean your whole body, form is critical on this. This doesn't count. Brad: So the trunk is stable and upright with good posture. Now, look at my foot. If you point your toe out, and this is what your body will naturally want to do, that takes the glute medius out of the picture. So the toe is straight forward, and it stays that way. And again, don't bring it out in front of you. It needs to go out to the side perfectly and nice and slow, no fast ones. Bob: You'll be surprised. It's really weak on a lot of people. Brad: Yeah. All right, we've got one more in the standing position. Okay, now the last one, you will need a step and something to hold onto. This is a tricky one. A lot of people forget this one, and I think a lot of therapists may as well. But if you look at my waistline here, my feet are even. Now, one foot is off, there's nothing underneath it, and I keep my left knee locked in straight, and I drop the hip down, and then I pull it up. Straight down, and pull it up, and this is exercising the glute medius on the side that is standing on the step. Bob: The left side now. Brad: And this is where, you get some good hip and pelvis stabilization, which is going to be beneficial for your back, your hip, and your hip joint. Bob: It's good if you tend to waddle when you walk. Brad: Yep, exactly, this will help that. Now, these standing exercises are a great benefit as opposed to the lying ones, because you're putting weight through your hip joint, and it transfers over to function. Bob: It's more function. Brad: Exactly right. So I would pick at least one of those two and then one while you're lying on your side and get one of each, and that would be a good combination. Bob, I'm feeling incredible. Hips are strong, and everything's feeling good! Bob: Are you getting shorter? Brad: Strong like bull! Yeah, I am getting shorter. Either that or you're getting taller. Don't worry, it wasn't from these exercises. Bob: All right. Thanks. Brad: Take care. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull-Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.

This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2021. For the original video go to https://www.youtube.com/watch?v=N4Iia-XIsV8 Brad: We have Chris the Pharmacist with us, and we have a wonderful topic to talk about today. It’s amoxicillin, how and when we use it, plus dangers of overuse, which is out there and it’s something that it’s good to know. Chris: Oh yeah. Amoxicillin is one of the most widely prevalent drugs used in the world. In the United States in 2017, it was number 18 on the list of 27 million prescriptions filled. It’s a big number. Brad: 27 million? Chris: 27 million scripts. Brad: It’s being used out there. Chris: It’s being used. It’s an essential drug. It treats a variety of different infections. Brad: How long has it been around? Chris: Amoxicillin was isolated in 1958 but first used, in 1972. Penicillin itself we go back further. Brad: What’s penicillin have to do with amoxicillin? Chris: Amoxicillin is a penicillin. It’s a version of it. It’s a more readily available version. I think it’s crazy. There’s a Dr. Alexander Fleming in 1928, who just came back from vacation in England and he went back to his lab, and it was a mess. He started to clean things up and he noticed that on his Petri dishes all his staph infections had this mold on there, and it was penicillium notatum and around that area, there was no bacteria growth. He thought that was odd. So, he looked at it under the microscope to make sure it was clear and said wow, it was not there. At that point, he realized he probably came up with probably the single greatest medical revolution in the history of mankind, which was the discovery of penicillin. Brad: So, in 1928, there’s mold, killed bacteria and he invented penicillin. Chris: Exactly. Then it sort of died. He was a research physician, and he was brilliant. He came up with a couple of other things along the way, but 10 years later another doctor at Oxford read his paper. His name was Howard Florey. He was at the William and Dunn college of pathology and medicine, and he was a Rainmaker. This guy would go out and just make money. He found this and goes, I think we can make some money with this. He got in contact with the doctor, and they basically started to work on it. He had a big lab group in the Oxford department where he worked. There was Dr. Ernst Chain and then Dr. Norm Healey who is a biochemist. Brad: So, they came up together to make penicillin? Chris: It was a process. They started working on it and it was hard to isolate. As a matter of fact, when they got down to it, it took 2000 liters of extract to treat one human being. Can you imagine 2000 one-liter bottles? It would fill up this room. It’s huge to treat one person. Brad: So, we could get onto Amoxicillin, this all developed in the 50s and then we got penicillin? Chris: What happened is, during World War II is when this happened. They’re getting bombed out by the Germans all the time. They had a guy that had a gardening accident, and he was dying because of this horrible staph infection. They did a trial on 50 mice a little while ago. 25 that were treated with penicillin lived so let’s try it on this guy. They gave this guy penicillin and they had enough to give him for five days. They gave it to him, he was recovering and then they couldn’t get anymore because they couldn’t make it so they’re taking his urine because it was strongly metabolized by the kidney and reisolating it out of his urine, but they couldn’t make enough. That’s where Dr. Healey comes in. He’s the one in this hospital, he took every bottle, bedpan, and anything he could put in it to try and grow this penicillin isolate, but unfortunately ran out of time and sadly the poor individual passed away. So, they were like, what do we do next? So, in 1941, middle of World War II, they can’t do anything in Europe because they were getting bombed, they came to the United States and ended up in Peoria. They talked to several different manufacturers and there was this Dr. Aj Moyer that Healey met. He made suggestions. They changed the type of mold substance that you use for penicillin, and they got the extract. By 1942, it was being made by billion upon billions of units. They had it in 1942, the first American person used it and that pulled through. Then it was widely proven on the battlefields in Europe. What happened then, from World War II to World War I, the thing that was killing people in battles was an infection. It wasn’t the war wounds. They went from an 18% death rate to a 1% death rate simply because of penicillin. Dr. Fleming and his group got the Nobel prize in 1945. The interesting thing in Fleming's speech was with penicillin, we must be careful with our use because resistance could develop. Brad: So, he warned it back then. Chris: Yes. As we look at this and how we treat people with antibiotics today, we’re trying to cut down the use of any antibiotic really, because resistances are developing. Brad: Wait. We’re jumping here. We went from penicillin got invented and suddenly Amoxicillin in 1958. So, Amoxicillin is a part of penicillin, and they use it for infections very commonly, and it grew and grew and we’re still using Amoxicillin today. Chris: Correct. We use it today but it’s funny. I’ve been doing this for 25 years as a pharmacist and the doses of the amoxicillin have gone up from my first day in 1995 to where I am right now, vastly different dosing. You see higher doses to make it useful. Brad: For the same individual or same problem. Chris: Because of the resistance of amoxicillin. Brad: Let’s back up one more step. So, we have amoxicillin now, it’s working well, and we’re changing the doses, but what is it primarily used for? Infection from a nail? Infection from a cut? Chris: It’s a versatile drug. It’s going to treat things like pneumonia, UTI, staph infection, strep, and ear infections for parents or children. It’s safe during pregnancy. It works very well when used appropriately. The biggest thing for people is to make sure when your doctor gives you your prescription, you take it exactly as directed until they tell you to stop. Basically, people are inclined to want to stop taking the medication after three days and they’ll say they feel better. They’ll save it for later when something comes back and then they could be mistreating the infection because it might not be the appropriate bacteria. All your bacteria absorb the antibiotic. That’s why and we can talk about that resistance in the food supply and things like that if we want. Brad: The big thing about dosages now, your doctor gives it to you, take it all the way as prescribed until the bottle is gone and they’ll tell you that or the pharmacists will. Adults, infants, and everybody can use this. Chris: You name it. Brad: I’m assuming the dosage is going to be different from an infant to an adult. Chris: Yeah. For ear infections, they do a much higher dose of amoxicillin than what they would do for say a skin infection or a sore throat. It just depends. They always dose that by a milligram per kilogram. They base it on your body weight, particularly with kids. With adults, it is more standard and easier to dose as an adult. Brad: It seems straightforward. If you get an infection, treatable with amoxicillin, follow the directions from the doctor. Typically, it’s successful and I’ve had this myself, like the doctor mentioned in 1945, there could be some problems with over-usage. Chris: That’s one of the biggest problems that we face now as a society. You’re looking at what’s predicted right now by 2050, they think that resistance to antibiotics may overtake the cancer death rate. Brad: So, you’re saying someone has an infection, they take amoxicillin, but it’s not going to work. Chris: Then the infection is going to take over their body. Brad: Why isn’t it working? Chris: The bacteria want to live. Basically, what they do is they assimilate ways they’ve developed enzymatic systems to help to fight against it. Brad: So, it mutates, and the amoxicillin is no longer effective because of the previous history. It’s used from person to person, generation to generation. If I had amoxicillin used on me and the bacteria start to mutate, I’m going to pass that on to my child. Chris: It doesn’t work that way. It goes from bacteria to bacteria. You have your own normal flora, I have my own normal flora. Cattle and livestock have their own normal flora. Oftentimes, there are antibiotics in the food chain because they want to keep the herd healthy. Brad: So, they’re using amoxicillin in cattle? Chris: It’s not amoxicillin, but it’s penicillin specific for cattle. Brad: But it still will affect us because they inject it into the herd. Chris: Yeah, so the bacteria within those cows, it goes all the way down. It gets into the water system, you name it. Brad: You mean because it’s injected in the cow, it goes into them, we eat the meat, so it gets into us and it’s kind of the same thing as an injection into us. Chris: And they excrete things, it goes into the water and it’s in our water supplies. It’s a very widespread problem. Brad: So, dairy, not just meat. Chris: No, I’m just picking on cows, but it can be anything. It could be chickens. Brad: Pigs, chickens. So, this is where people are concerned. I better get organic to avoid taking in the antibiotics that animals are taking. Chris: Even then, organic farmers must treat their animals with antibiotics, but it’s much less. That’s something to be understood. Big commercial farmers tend to use antibiotics just prophylactically to make sure that the herd remains healthy. Brad: Before there’s an infection, they’ll use it just to make sure because they have a thousand cows and if one gets an infection, it can spread. Chris: Right, it’s a double-edged sword. It’s not an easy business. Farmers aren't just trying to indiscriminately do that. They’re livelihoods. You can’t blame them. It’s just a situation that’s arisen over the years. For a while, it seemed like an ingenious idea and now we’re just learning because these bacteria have learned how to develop enzymatic systems to help break down these antibiotics so they’re resistant to it, so it doesn’t affect them. Suddenly you give a shot of penicillin and it’s like, why am I not getting better? That’s the fear we have. Using antibiotics indiscriminately, when you don’t need it, and that’s hard because most times you go in and visit a doctor and unless they take a culture, they aren’t going to definitively know. They’ll have a good idea because they have smart people that deal with cultures and sensitivities. They talk about what the infecting organisms are in the area, and they have these infectious disease people. Brad: They just don’t say it’s an infection. Chris: No, even more so today, doctors are being much more selective about their use of infection. Let’s say you went in, and you had an ear infection, and your doctor, they’d probably give you Augmentin, but we’re not going to talk about that. But we’ll pretend they give you amoxicillin and we’re going to give you an 875-milligram dose twice a day. You have this ear that’s killing you, so you come into the pharmacy and you go, hey, I need this. Okay, Brad, we’re giving you amoxicillin, so what’s going on? And you say you have a horrible ear infection. Your doctor made the selective decision, I think Brad will be a good candidate for amoxicillin. We look at it, you’re going to take it twice a day for ten days. Sometimes it can be a five-day, seven days, or ten-day course. It depends on the nature of the infection. Sometimes ear infections can be worse because your ears and sinuses are interwoven together. You may see a prescription for seven-10 days depending on what your clinician believes what’s most appropriate for you. The biggest thing with amoxicillin, it’s tough on the stomach. I want to make sure you eat before you take a dose. Brad: So, take it after you eat. Chris: Right. Food first. Because it’s a twice-a-day dose, it’s convenient. We’re going to tell you to take it after breakfast and after supper. You might say, it’s three in the afternoon, what do I do? On day one, we’re going to tell you to get both doses in. Let’s say you’re up at 10, I’d tell you to get that second dose in. As we put more of an aggressive loading dose in there to try and get a head start on getting that nasty bacteria kind of calmed down. Then the next day, we want you to resume a uniform dosing pattern, so we keep a good concentration level of the drug in your system to aggressively manage and fight that infection. Brad: Sometimes the doctors may get pressure from the patient or the family member that it had worked in the past and the doctor might say because of the history of using it before that you don’t want to use it all the time. The doctor might say, no we’re not going to use that. Chris: Then you have a frustrated patient. That’s one of the things that doctors find this dilemma, I think on a day-to-day basis, is to what’s the most effective choice. Now we have most hospitals and clinics have what they call anti-microbial stewardship programs in place where they go through a lot of education and doctors already have a ton of hours of education, so they know when it’s appropriate and when it’s not. They generally are not going to succumb to patients calling their shots, so to speak. I’m going to go in and take some amoxicillin because it worked for my kid. It might be because there’s maybe a genetic component there but if there’s an allergy in place, maybe it’s not appropriate, or there are certain drugs that could interfere with that. There are a lot of reasons why clinicians may choose something different but for the purpose of our discussion, we’re going to say you’re not on any drugs that could interfere like a blood thinner. We’re going to pretend that you’re healthy otherwise and you have no allergies. Brad: Let’s say you have a history of using amoxicillin like me or maybe I used it a few times in my past. Would that be a reason not to continue to use it? Chris: Yes, absolutely. That’s one of the biggest things that we watch for in the pharmacy is usually the guideline that we’ve seen put in place is you don’t want to repeat the same drug within at least 30 days. I think they’re getting even more stringent about that. It kind of depends because with sinusitis that’s a tough infection to treat, to begin with. Sometimes it takes a much longer course of antibiotics even two weeks, or three weeks. Those are long courses of antibiotics. An antibiotic goes in there, indiscriminately. It kills your good bacteria and your bad bacteria, so it makes it tough. That’s why people have digestive woes when they’re taking antibiotics because their good bacteria got killed off. That’s what helps us digest our food. Brad: I’m reading a book and they’re talking about the gut, the microbiome. Chris: The biome of the gut. Brad: Yeah, which is good bacteria. Chris: Correct. Brad: Which, 20 years ago I just figured all bacteria are good until I got in the health field. Chris: That’s what happens with an infection, it’s like checks and balances like our government. Suddenly, we have billions of bacteria, all over our bodies at any given point in our body. When your immune system has an insult, something gets overgrown, and that’s when the bacteria take advantage and say "hey, I have a weakness here. This is my chance to proliferate and get big and nasty." That’s why, in the case of like an ear infection, it found a spot behind that eardrum, your eustachian tube wasn’t drained properly, it clogged up and it’s a nice warm breeding environment, and boom, it grew bad, and you had the infection necessitating the use of the antibiotic. Repeating it over and over is not a successful plan. Just because it worked last time doesn’t mean it’s the most appropriate plan. A lot of times physicians will recognize that, and they will go in a different direction and select a different, although effective antibiotic. Let’s say the second antibiotic didn’t work as effectively for whatever reason, they might have to go back to we’ll say amoxicillin in this case. So, it depends. There’s a lot of work that goes on. If it was easy, everyone would do it. It’s a challenge for sure. Brad: Well, I think we covered a lot of ground there from the history. It’s amazing how things in life and in history, accidents happen and something incredible comes of it. Amoxicillin sounds like a good drug. It sounds like you have to be careful with it and understand how to take it and when to and when not to take it, and you know what the doctors have to take into consideration. Chris: Yup. And going forward we're going to have to have these drug companies start doing more research on new antimicrobials. Otherwise, I think in a very short period of time could history wise, we could have some very big issues. Brad: Well, you said 2050, so that's 30 years. Chris: That's not that far away. Brad: I suppose. Things happened fast. So very good. I hope you learned a lot and you feel comfortable with your amoxicillin and enjoy the week. Chris: Thanks, guys. Visit us on our other social media platforms: YouTube, Website, Facebook, Instagram, Twitter, Pinterest, LinkedIn, TikTok, Wimkin Mewe, Minds, Vero, SteemIt, Peakd, Rumble, Snapchat Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts. For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun (US) Fit Glide Q2 Mini Massage Gun (US) Knee Glide Back and Neck Massager Eye Massager T2 Massage Gun Foot Massager X6 Massage Gun with Stainless Steel Head Leg Massager Holy Cowabunga Cream Uni Massage Gun D6 Pro Massage Gun Back Massager Fitness: Resistance Bands​ Pull Up System Pull Up Bands Wall Anchor​ Grip and Forearm Strengthener Hanging Handles​ Hand Grip Strengthener Kit Stress Balls Stretching: Booyah Stik Stretch Strap Wellness: Hand Warmer Bob & Brad Amazon Store and other products Bob and Brad Love Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop​ The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics. Medical Disclaimer All information, content, and material on this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced to help you make the best choice for you.