How to Use a TENS Unit with Upper Back Pain. Correct Pad Placement. How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Upper Back Pain (One Sided): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for Mid-Back Pain (Both Sides): In our examples channel one has yellow pads and channel two has green pads. One pad from channel one in the upper right corner of the area of pain and one pad from channel one in lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Upper Back Treatment: Use a tennis ball in a sock on the wall or on the floor. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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.

What Is Oblique Lateral Lumbar Interbody Fusion? OLLIF is a new, highly effective surgery for spinal stenosis, scoliosis, spondylolisthesis, herniated disc and degenerative disc disease. “OLLIF” stands for “oblique lateral lumbar interbody fusion”. It is one of the most innovative back surgeries available for treating low back pain conditions. For patients considering lumbar fusion, the OLLIF offers significant advantages in the ease and speed of recovery. And unlike most other spinal fusion approaches, the OLLIF procedure can be used to effectively treat all lumbar levels of the spine. The OLLIF is one of Inspired Spine’s signature advanced minimally invasive spinal surgery procedure – a revolutionary advancement in minimally invasive spine surgery that our surgeons have perfected with years of research and practice. Inspired Spine’s OLLIF procedure is a demonstrably safer and more reliable outpatient surgery that delivers immediate and permanent pain relief. In fact, 96% of Inspired Spine OLLIF patients are walking without assistance within 24 hours after surgery and are back to performing normal daily activities in 2 to 4 weeks. OLLIF vs. Traditional Lumbar Fusion Compared to the OLLIF, traditional fusion surgeries to treat spinal conditions involve significantly more time in the operating room and a larger incision. For an open transforaminal lumbar fusion procedure (TLIF), the surgeon must cut through significant muscle tissue with a much longer incision than the OLLIF’s ½-inch incision. There is also more blood loss and bone removal. The diseased or damaged disc is accessed through Kambin’s triangle – a right triangle-shaped area over the disc, which is formed by the exiting nerve root at the top and the border of the vertebrae at the base (width). Traditional fusion surgeries are performed in a hospital operating room, take a lot longer, and typically require a hospital day of at least a few days. They can also make it much harder for patients to get back to normal life and activities with months of demanding rehab to compensate for damaged back muscles. This more invasive spine surgery technique is a high-risk inpatient procedure requiring 3 to 4 hours in the operating room, followed by a 3 to 5-day hospital stay and an 18 to 24-week recovery period. Inspired Spine’s OLLIF technique delivers commensurate to superior outcomes to those delivered by traditional approaches with a lower risk 40-minute outpatient procedure which enables most patients to be discharged the same day. The OLLIF procedure is the only truly minimally invasive alternative for lumbar fusion with clinically proven advantages in effectiveness, safety, and improved outcomes, reducing pain and recovery time while making the process simpler for both the patient and the surgeon. OLLIF Surgery Benefits for the Patient Patients with a High BMI A high body mass index (BMI) increases the risk of lower back pain, puts strain and pressure on the spine and often contributes to symptoms associated with degenerative disc disease, spondylolisthesis, spondylosis, herniation, stenosis, and scoliosis…all of which can make it more difficult to get relief. Many surgeons reject high BMI patients for traditional open back surgery because of the challenging nature of the procedure, the longer surgery times and possible tissue damage and infection complications that make it high risk, low reward. Unlike conventional treatment, the OLLIF procedure is low risk and high reward, whether your BMI is high or low. The OLLIF’s procedure duration (as displayed in the following chart) is not impacted by BMI, while TLIF and MITLIF both show considerable increases in surgery time as the BMI increases. The risk of complications increases 17% for every additional 30 minutes of surgery. Minimal Scarring As a result of our fluoroscopic minimally invasive surgery approach, you can expect less scarring, less pain from the operation and a faster recovery compared with open surgery. Often Doesn’t Require a Hospital Stay Because of its minimally invasive nature, the OLLIF is performed without an extended hospital stay and often without any overnight stay. The procedure itself can take as little as 45 minutes, compared to the hours spent on traditional spinal fusion procedures. In general, an OLLIF procedure takes about half the time or less as a comparable TLIF (transforaminal lumbar interbody fusion) surgery would. There is no need to cut through the muscles or ligaments surrounding the spine, so recovery is faster. Low Risk and Quick Recovery The OLLIF results in a very fast recovery period. Patients are frequently up and walking around within several hours and many go home the same day as surgery. In fact, the OLLIF does not need to be done in a hospital at all; it can be performed routinely in an outpatient surgery center instead. Blood loss is minimal, because of the very small incision and the risk of complications is significantly lower than that of traditional spinal fusions. But what most patients will appreciate is the speed of their recovery. Many can return to work and normal activities in a couple of weeks, as opposed to the lengthy and demanding rehabilitation process required with open fusions. Because of its short operating time, minimum rehab requirements, and high-safety profile, the OLLIF is often recommended for patients who have been denied surgery because of certain risk factors, such as age, obesity, or deformity. This is good news for elderly or frail patients with Adult Degenerative Scolosis, because several levels of the spine can be accessed from a single OLLIF incision, providing live-changing pain relief. Are You a Candidate for OLLIF? You may be a perfect candidate for the advanced minimally invasive OLLIF procedure if one or more of the following is true: You have suffered from low back and leg pain for 6 months or longer You have tried conservative treatments with no significant relief You have been recommended for lumbar fusion surgery *The information provided above has been provided by Inspired Spine

This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2021. For the original video go to https://www.youtube.com/watch?v=_pIw4JC0tKY&t=19s Bob: Today we're going to show you how to treat a recent injury to your hip, it's a three step program. We thought this is a good topic that we want to cover all the bases in treating hip pain so this is the first part. Brad: Exactly, it's like, “oh, you fell down, bumped your hip, it hurts, it's painful, what am I supposed to do?” Bob: Yeah, now first off, you have to decide whether or not you're going to see the doctor. We did do a video called "Fifteen Signs You Need to See a Doctor Immediately". We're not going to go over that now, but you can look up that video on YouTube if you do have a question. Brad: Exactly. Bob: Now, let's say you've seen the doctor or you haven't seen the doctor, or you feel like you don't need to see him. The first thing you do, step one, in the first 24 to 48 hours you're going to apply ice to the hip because there's going to be pain and swelling and we want to try to get that to be under control. Brad: So typically a cold pack about this size and you really need to get a cold pack that's flexible, malleable, when it comes out of the freezer, not one of those cold packs that is hard as a rock or, ice cubes in a bag works okay. Bob: Eh, it works okay. Brad: But these really work better and in positioning, you need to get very comfortable so that your hip is not painful before you put it on or it’s irritating it. Bob: Yeah, Brad, you're bringing up a really good point. One, you don't want to lie on it, and two, you probably want to lie on your side with a pillow between your legs. That's probably the best position to be in. Brad: I would say if a recliner reclined back feels very comfortable and it's not irritating it, that would be another option, too, where you could wrap that around there and you're going to leave it on for 15 to 20 minutes. Bob: Yes, and you can do it every three hours if need be and you could use a bag of peas. Brad also has a recipe, the old Heineck recipe for making an icepack. Brad: Yeah, I wouldn't say that because I didn't invent it, but I've used it with myself, my mother, and many, many, I'd say thousands of patients over the last 20 years. One cup of Alcohol, rubbing alcohol. Four cups of water and a gallon freezer bag, see our video, Bob & Brad on YouTube, "How to Make a Cold Pack". Bob: Why don't you go ahead and do it right now, you just take the four cups of water, you take the one cup of rubbing alcohol, you put it in the freezer bag, the one-gallon freezer bag. Brad: One-gallon freezer bag, not a storage bag. Bob: Yeah, and then you get the air out, excess air out. Brad: Yeah, zip it up, put it into a second one just because it makes it a little more protected. Bob: So a second freezer bag. Brad: Yep, get the air out of that one, zip it up, lie it, lie it or lay it? Bob: Lay it down, that would be lay it down. Brad: Lay it flat in the freezer, don't let it get crumpled up and it'll come out and it'll be like a slush and you can move it around, get it there, never put it directly on your skin. That's a big never, you want to have some cloth, usually just a pair of pants or something thin is adequate, if it's still too cold you can put another towel. Bob: Yeah, I used to sometimes take a paper towel, even. Brad: Oh sure. Bob: It works sometimes, depending on the person. Brad: Right, it depends if your skin's fragile or not. Older people typically need more insulation, another towel or two. Bob: That's step number one, so you're going to put some ice on it, step number two, you're going to limit the activities that increase pain or swelling, so if you're walking and that increases pain or swelling, you're going to maybe want to use a cane or crutches. You're going to avoid hills and stairs. When you're using a cane, you're going to use it in the opposite hand. Brad: All right, so, if this is my sore hip on my left, it's going to be in my right hand. Some people naturally would think, "Well, you put it in the same side," but you don't and then as you walk, the cane in the right hand goes in sequence with the left foot and then as you put weight through your left foot, you're putting it through your right hand and the biggest thing Bob and I both find is, don't think about the sequence, your body will do it automatically because when you walk, your opposite hand goes with the opposite leg naturally. Bob: Now, here's a walking stick by Prime Stick. My wife when she hurt her knee, she used a walking stick and she really liked it. They're lightweight, they look a little bit less clinical, wouldn't you say, Brad. Some people don't want to be seen with a cane. Brad: If you're one of those but you need a little support, a stick is the next best thing. Bob: This cane, by the way, is called the Cyclone Cane, they sent it to us and it's a nice cane. It's got a nice handle, it's made well. it's actually made to grip this way, remember Brad? Brad: Oh that's right. It is a nice handle. Bob: The same company makes this, it's called the Prime Stick, but it's just lightweight, very good grip, we thought we'd put a little plug in for them. All right, so that's number two, you're going to limit the stress on that area and you're going to do that until it starts to feel a little better. Number three, the third step, you want to start some gentle movement as soon as possible. You really don't want it just to sit there and freeze up on you. It just makes pain worse. Brad: Yep, we need to get the circulation going, keep that from turning into a stiff joint. Bob: So, the one that we really, our go-to movement, is just gentle trunk rotations or hip rotations. You're going to lie on your back, you're going to bring your legs up like this, feet are flat on the bed or floor and you're just going to gently roll back and forth like this, and this is getting movement in the hip without putting a lot of stress on it. Brad: This would be a good thing to do if you've been sleeping all night, your hip will probably stiffen up. Before you even get out of bed, do this gently to get that hip moving before you step on it and put weight on it. Bob: Now let's say for instance, I do this, and it hurts this way, but it doesn't hurt this way. We're not going to move this way then, we're just going to go to the right now and after a while, we'll check the left again and see if it's any better, if it's not, we'll still keep going to the right. Brad: Typically, you get things moving in the pain-free range, it expands and it starts to go into the painful range. Bob: Yeah, it'll go back and forth further, Brad calls these, by the way, Windshield Wipers, and you can take the wipers farther and farther as time goes on, you can actually start going all the way to the end of the windshield. All right. Brad: I just do that because people can remember that well. Bob: Right, they relate to it, it's a good visual. The last thing, that's step number three, when the pain starts going down, you want to progress to one of our strength videos on how to strengthen the hip. Which reminds me, this video is part of a series of videos on hip pain. So if you go to bobandbrad.com, go to the Programs section and find the series on Hip, you'll find a lot of videos on strengthening the hip and you'll find other videos. You can watch any video you need, you don't have to watch all of them, each video has a print out along with it, including this one. Brad: Right, so it's got a PDF, you can print it out of your printer at home and then you have a reminder of everything we went through so you don't have to go back and watch the video every time if you couldn't remember something. Bob: And this is all free. Brad: Absolutely. Bob: We don't even ask for an e-mail. Brad: That's exactly right. Bob: Check it out. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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.

How to Use a TENS Unit with Mid-Back Pain. Correct Pad Placement. How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Mid-Back Pain (One Sided): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for Mid-Back Pain (Both Sides): In our examples channel one has yellow pads and channel two has green pads. One pad from channel one in the upper right corner of the area of pain and one pad from channel one in the lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: do not place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Mid-Back Treatment: Hallelujah Stretch Over Ball. For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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 February of 2021. For the original video go to https://www.youtube.com/watch?v=mHG1YDaTgg4&t=17s Bob: Today we want to talk about the six big lies about hip pain, hip arthritis, and surgery. These are common statements that Brad and I have heard over what, 50 some years of treatment? Brad: Combined. Bob: Combined, yeah not 50 alone. But we hear these commonly occurring themes and so we're going to address that. So hip pain obviously can occur at any age, you know if you had like a sporting injury, or you have trauma. But, as we age, it can actually can show up for no reason whatsoever. I mean, all of a sudden, you know, you're 50, 60, 70 years old. All of a sudden it pops up one day. Brad: Right, right. But you know, it can go away too. Bob: Yeah, it can go away too. Brad: And so that's what we're going to address a little bit. Bob: Yeah, so we're going to talk about the typical scenarios. So someone goes in they're 50, 60, 70, they go into the doctor, because they're having hip pain. It just started on its own. First thing the doctor's going to do maybe an X-ray, MRI, CAT scan not the first thing, but depending on the doctor. Brad: Right. Bob: But eventually what they're going to show, you're going to see these results of your scans, and it's going to say, there's degeneration and osteoarthritis in your hip. It might be bone on bone, even. Brad: Right. Bob: And you're going to say,” oh my gosh now I know what's causing my pain (arthritis is causing your hip pain).” So they're going to do medications, injections and maybe even surgery. Brad: Sure. Bob: But what we have found is, and study after study has shown this, that really osteoarthritis degeneration is just part of the normal aging process. Brad: It's like getting gray hair. There are some things that may increase it. For example, maybe some muscle tightness around the joint is making it worse and if we can loosen those muscles up, the pain can decrease and actually improve things. Bob: Exactly. So it's not necessarily what you're seeing is the problem, because the studies they've done is they looked at people with no hip pain, did X-rays or MRIs on them and they found lots of these same things. Brad: Right. Bob: They found, and the other thing, Brad, I'm sure you've seen this a million times. Somebody comes in and they're going to need surgery on both knees, but they're doing it on the one that looks better to start off because that one hurts more. Brad: As far as, X-rays? Bob: Yeah, X-rays of both knees. They're both bad, but one really, really hurts and that's the one they're going to do surgery on and that one doesn't look as bad as the other one. Brad: Right, so the X-rays and the pain level, they don't always match. Bob: I bet you right now, we could do an X-ray of our hip Brad and I bet you they find stuff. Brad: Oh yeah. Bob: I know they would. Brad: All right. I want to say that, I had two episodes and I worked with you on both of them. I had severe hip pain where I had to use crutches and I thought, well maybe I better go in and get this X-rayed. And I didn't and both times within three days, the hip pain got better and actually it went back to completely normal. Bob: And it probably helps that Brad's a therapist, because he knew what you know, what to do as far as calming the pain down. And also, this by the way, is a part of a series of videos on hip pain. If you go to bobandbrad.com go to the program section look for the one on hip pain and we've got a whole series of videos and you can look through them, pick out the ones you want to watch, but they're going to tell you what to do to calm your hip down and possibly take the pain away. Brad: Sometimes it's stretches, sometimes heat or ice or strengthening and, they're all about 10 minutes long. Bob: Yeah, it might be poor daily habits. And hip inactivity too, if you're not moving your hip enough. Brad: And another big one here, I don't know if we have on the list, Bob, oftentimes you can get pain in the hip here, and we find out it's from the back, a referral pain, which, you know even doctors can get that mixed up. It can be tricky. The human body with referral pain can be tough. Bob: All right. The second lie, if you have arthritis it's going to just get progressively worse. That's not necessarily true. They've done studies and they've done scans of people a couple of years later, and sometimes it's not worse and sometimes it even gets slightly better. Brad: Right and maybe if your activity level improves and the pain goes down, that's what we're looking for even if the X-rays didn't show it got better but you can move better and you're feeling better. You know, that's what we’re looking for, that's the bread and butter. Bob: My wife doesn't like when I mentioned her, but she is an example here. I'm even going to tell her age, 56. When she was 54, her knee fired up and it got so bad she was on crutches. She thought she was going in for surgery. She couldn't even walk. I mean, and not even thinking about running. Brad: She was using a cane or a crutch. Bob: She was using two crutches first, then she went to one crutch. Brad: Sure. Bob: But we worked on it and she's back. She ran like three, four miles this morning. Brad: Really? Bob: Yup, she's been running, no pain. It's just awesome. Brad: I suppose, running away from you. Bob: Yeah, it's a motivation. Number three lie is” I wore out my hip because all my life I've been running or hiking or roofing.” I hear farmers say, “ I wore out my knees because of milking.” Brad: Right, right. Bob: And in that case, it might be actually true. Brad: Well, especially on those concrete surfaces as well. Bob: But actually it's not true as far as running or hiking because active people have better joints. Brad: Right. Bob: If you're using a joint, it's going to be actually healthier for you. You increase that synovial fluid, increase the blood flow to the area. It's the inactive people or sedentary people that start having the hip problems and arthritis that doesn't go away easily. Brad: And there's always exceptions. But as a rule. Bob: As a rule. Brad: People who move more within reason, of course and not doing excessive, extreme things, the body likes it, it adapts to it, it's healthier, all the way around. Bob: Number four. “I don't want to make it worse, so I'm going to rest it.” Now, that is okay to some extent, but people rest it too long or they like, we like the fact that if you can take some of the weight off the hip. It can actually maybe decrease the pain for a while and calm it down. Brad: So a good example is, if you have hip pain when you walk or when you stand, your body's telling you, don't stand, don't walk so what you can do alternatively is swimming, which may not be a good alternative or not very practical for a lot of people. Also, a stationary bike maybe a nice non-weight bearing motion. Bob: You're still moving the hip. Brad: Yep. Bob: You can even lie on your back and bring your knees up and rotate them back and forth. That even gets a little movement in your hip. Brad: Right, and we do have a number of these videos where we show motions you can do without stressing the hip with weight bearing. Bob: Number five lie. “My mom had arthritis so I'm pretty much destined to have it too.” And the fact is. Brad: That's a possibility. Bob: There's a possibility but. Brad: When you do that, it kind of pre-programs you. Bob: You think, I'm destined to have arthritis, no matter what I do. And the fact is almost everybody gets some arthritis at some point. Your lifestyle and exercise are more important than the heredity factor. So if you can go ahead and do the things that we're going to recommend in these upcoming videos, you can help knock the pain down or keep it down. Brad: Exactly. I'm reading a book right now about a woman who teaches Pilates and other motions, and she focuses it around, works with people specifically with pain in their joints. Bob: Oh, sure. Brad: And the whole concept of keeping moving, doing the right motions that don't irritate it. Bob: We're reading some of the same books Brad because I'm doing the same thing right now, two of them, it's always about motion. -Brad: Right, keeping things moving with proper motion that doesn't irritate it, which isn't always easy to find for some people, but you have to look for it and that's why therapists are here and that's why she's there. That's why we have our videos that help you all to find those. Bob: Yeah, because it can make a big difference in your life especially if you're having some chronic pain. Brad: Yeah, exactly. Bob: Number six, the final, big lie. “I'm going to need a hip replacement anyway so I might as well have it now.” Now first off, it may not be true that you're going to need a hip replacement. And again, we talked about the arthritis possibly could stall out and not get worse. And if you do some of the exercises and stretches and the strengthening and proper habits, you may never need one. Brad: Right. I do want to mention, you know, they may say, well I saw my orthopedic surgeon, and he says that hip needs a replacement. And that may be, however if you go to another orthopedic doctor, he might say, well I've seen a number of hips like this and had some therapy and they're able to get away without it. So a second opinion can also be very helpful. Bob: And you know, if you have a hip replacement when you're two young, obviously they wear out. Brad: Right, the replacement does. Bob: And you could end up having to have another one, you know, in 15, 20 years and so you want to delay it as much as you can, if you can. And as long as you're healthy. Brad: Because if you get one at 45 years old and say if it lasts 20 years, you're 65 and that's called a revision when they redo it. Any surgeon will tell you that it's much harder to do a revision because you’ve got the old hardware you have to remove. It’s a big challenge and they like to avoid that. Bob: When you're 45, 65 seems like a long time away but it's not. Brad: It comes around pretty quick. Bob: So yeah, again, check out the program on hip pain and each program, or each video has a PDF. Brad: PDF printout and it prints out the highlights of the exercises, so that you can review that and then you don't have to go back and look at our faces. You can actually just, you know, see if. Bob: Well if you want to come back and look at our faces. Brad: Well, yeah, you can, but you know I understand if you don't. Bob: All right, that's why podcasts are nice, you don't have to look at it us. All right, thanks. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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 March of 2021. For the original video go to https://www.youtube.com/watch?v=GlBJZfFl3YI&t=64s Bob: Today we are going to talk about the signs you should have an osteoporosis screening. So, we're going to do this for both women and men, and for women, they are at a higher risk. So you're going to find out that we're a little more stringent on them. Brad: And we'll explain it. There's a very, very good reason for it. Bob: Alright, let's get started, Brad. Brad: Let's find out about osteoporosis. So, osteoporosis it's about bone density? Bob: Bone density, but also, I found out from Sarah Meeks, one of our experts, that the structure of the bone is just as important. So like the trabeculae and how they're put together, is almost more important than if your bone is soft, or not. Brad: So, the trabeculae is that the outside of the bone? Bob: No, the inside. Brad: Oh! Bob: It's like the engineering. Brad: Oh, sure. Bob: Does that make sense to you? Brad: Yeah, the part of the bone that actually looks like a sponge, if you cut through it. Bob: Right, right! Exactly. And if that's designed to be strong, you're less likely to break bones than if you have let's say, one that's designed weak, but you have strong bones. Does that make sense? Brad: So, uh this is a genetic factor? Bob: Yeah, I think so. I don't know there's much you can do for that. Maybe Wolff's law would work with that? That means the more stress you put on the bone, the more that it reacts to it. Brad: Right, right, right. So your activity level. Bob: Right, right. Alright well, we'll have another video that we're going to show you exercises to do. So number one, all women who are over 65, you should have a screening, just out right, do it. Brad: Right. Bob: If you're post-menopausal women 60 to 65 and you have one risk. So, if you're over 60, you're post-menopausal, plus you had a fracture after age 45, you've had a hip fracture in a parent because there is a genetic factor. Brad: Oh yeah, the genetic component. Bob: If you've abuse tobacco. You smoke. Brad: Oh, so that's going to increase your risk? Bob: Right. Brad: Okay. Bob: Always does. Unfortunately, tobacco's bad for everything. If your BMI, your body mass index… Brad: So, if you're a little heavier? Bob: No! If you're lighter. Brad: Lighter? Bob: Yeah. If you're less than 22 kilograms/ Brad: That's right, because your bones adapt to that weight so they're stronger in heavier people. Bob: Can you do the calculation for me, Brad? It's less than 22 kilograms. Brad: What? In pounds? Bob: Yeah! Brad: Yeah, I can do that. (scoffs) Where's my phone? Bob: Yeah, yeah. Alright, if you've been using Prednisone for like three months... I had a patient, Brad. She was in her twenties, and she had really severe asthma and she had to be on Prednisone. We just take her for a walk, she'd break a bone. It was just, it was terrible. It actually ended up killing her. Brad: Yeah, I had a patient similar, she was in her fifties and she was on Prednisone and it’s really hard on you. It's a long story, but yeah, you don't want to get on that for too long. Bob: Well, she would die without it. You know, she couldn't breathe, so. Alright number three, if they found, if they found osteopenia when they did an x-ray on you, then you should have a screening for osteoporosis too, because that's the stage before osteoporosis. Brad: So, the x-rays will show signs of a bone weakening. Bob: Right. Thinness Brad: Yeah, thinness. Bob: Hypogonadism, that's a medical term that you'd know if you have it. Hyperparathyroidism, same thing. Here's the risk calculator, some other things that could be giving you trouble. For example, if you have heavy alcohol use, two or more drinks a day. If you're female. If you're white or Asian, you're at higher risk. Brad: Oh, really? Bob: Did you know that? Brad: No, this is statistically shown. Bob: Yes. If you're Black or Hispanic, you have lower risk. Brad: Okay. They don't know why they just know the statistics reveals this? Bob: Well, I think a lot of the Asians you see they are fine boned. Brad: Sure. Bob: Would you say that? Smaller as an overall rule of thumb. Okay, here we go, weight below 128 pounds. Brad: Oh, so we have a number? Bob: Yeah. We have a number. If you have kyphosis, if you're bent forward and your spine is rounded out. Brad: And kyphosis is the mid-section of the back. Right between the shoulder blades, and that area is rounded. And you know, this is not uncommon with older people. Bob: Yeah, if you're really sedentary, that's not good either. You want to be moving, and you just aren't doing any bone loading exercises. Brad: Right. Bob: You know where you're at least walking and trying to get some exercise. Number 8, you have a physical disability, you know, if you're in a wheelchair, you're not getting bone loading. Brad: Right, it's again, an activity level with things that are putting weight through your bones. Bob: Too much caffeine. If you're drinking more than 2.5 cups a day. Do you drink coffee; you don't do you? Brad: Yeah, I do now! I just started in the last year or so, but yeah. Bob: You're not drinking that much? Brad: Well 3 or 4 cups. No, I'm just kidding. I just, I find that just in the morning, if I drink it after that, it doesn't taste good anymore, actually. So that's good. I'm glad I don't have to fight that off. Bob: Low vitamin D, which we're in trouble for, because during the winter we just don't get much of that sun. Brad: Yeah, yeah. You tried to the thing with that one guy that goes out and freezes himself. Bob: Wim Hof. Brad: Yeah, Wim Hof. But yeah, I'm not going to do that. Bob: Okay, low calcium intake or absorption if you're not taking the calcium in very well. If you have diabetes, if you're diabetic, DM. Believe it or not, if you haven't had any children, you're at a higher risk. Brad: Oh really? Bob: They call it nulliparity. You're going to learn a new word. I think it's multiparity, if you have multiple children. Brad: Oh, really? Bob: This is kind a big indicator, if you lost over 1.5 inches of height. There's a reason for that. Since age 25, you should probably have that done. Sarah Meeks said, that the numbers are all over the place. And she said 1.5 wasn't necessarily true, but start thinking about it. That's for sure. Brad: And if you don't know, Sarah Meeks is an expert that has spent great deal of her professional life dedicated to this topic. Bob: And the last one if you do have what appears to be a spine deformity. You're rounded out. You may have already had a compression fracture. Brad: Sure. Bob: Sarah called it a silent fracture. Brad: Oh, without symptoms? Bob: She said very common. In fact, that was the most common fracture, actually is silent fractures. Brad: Interesting. Bob: Yeah, alright. So, men we have forgot about you either. So we'll talk about the men now. If you're over 70 for men you're supposed to have it done. Not 65 Like women. Brad: Okay. Bob: If you're over 50, and you've had any of the following, then you should have it a done. If you've had a non-traumatic fracture. So, it just fractured like a hip fracture or a vertebra, without a fall or obvious reason. Brad: Just got a fracture. Bob: Same thing, if they find osteopenia on an x-ray. Brad: Evidence of bone, not decay, but thinning, yes. Bob: Same thing about prednisone use. If you've taken more than five milligrams a day for three months, you're at higher risk. Brad: Now, I don't know if we cleared this up with the women. Maybe there's some men wondering, well why do men in general have less chance? It's because of going through menopause. Bob: I don't know what it all is, Brad. I think, men tend to have bigger builds maybe too, larger bones? I really don't know. I don't know the answer. We need Sarah Meeks on that one. Brad: Yeah. Bob: Same as women, hypogonadism, and hyperparathyroidism puts you at higher risk. And there's other risks that can you have. Again, if your parents had a history of a fracture. It’s interesting, isn't it? Brad: So genetics. Bob: Yep. If you've had the test in your femoral neck bone, a mineral density test, you know obviously you're a higher risk. Brad: Yeah, we're talking about the hip there. That's where our common fractures are in older people. Bob: Heavy alcohol use. Now for men, you can go up to four drinks a day. Brad: That's probably because of generally they're larger, heavier and more muscle mass possibly. Bob: BMI, or if they weigh less than 128 pounds. A slighter build. If they've had a prostate cancer, and they had an orchiectomy. Remember from anatomy what that was? Brad: Orchiectomy? No, I do not. Bob: Oh, well it's not something you want when you're a man. You're losing something vital, part of it anyway. Brad: Say no more, Bob. Bob: A loss of height also in men, 2.4 inches since age 25, is the one I read. Brad: I've lost about an inch, so far. Bob: I've lost about an inch I would say. And I had an inch to give. Brad: Yeah, you know, proportionally, you're taller. So maybe you can go a little bit more than that. You're really good I figure. Bob: Again, low calcium intake, low vitamin D intake. Again, we talked about that, the sun. Brad: So, really those, if you're not in the sun, or just getting a good diet of leafy greens, and that kind of thing. Bob: I do take a supplement, for vitamin D. Just during the winter. Brad: Okay. Bob: Again, if you're diabetic and again if you have high caffeine in takes. Greater than 2.5 cups. You know the thing is, it can be treated to some extent. You can't reverse it, but you can certainly stop it from getting worse. Brad: Sure. Bob: And, so it's better to know if you are osteoporotic, and they can put you on meds, or you can maybe become more active. Brad: More active. Your diet. Get out in the sun. It really kind of boils down to a lot of the common things. As we get older, you have to clean up your act. Bob: Yeah. Brad: You know, treat yourself well. Bob: And so finally though, let's remember Brad, we can fix just about anything. Brad: Except for... Bob: A broken heart. Brad: Right, but by the time you're this age and you have a little more experience with it. Usually, they don't need as much help. Bob: That's right. Brad: I hope, I don't know, whatever Bob: Take care. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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.

How to Use a TENS Unit with Low Back Pain. Correct Pad Placement. How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for Low Back Pain (One Sided): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for Low Back Pain (Both Sides): In our examples channel one has yellow pads and channel two has green pads. One pad from channel one is placed in the upper right corner of the area of pain and one pad from channel one is placed in the lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. Reminder: don’t place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Low Back Treatment: Prone Extensions or Gentle Trunk Rotations For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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 April of 2021. For the original video go to https://www.youtube.com/watch?v=2YDmdrYbsd4&t=516s Brad: Today the subject is, OTC or over the counter Voltaren gel. Pain reliever, versus the traditional Motrin, Advil, Aleve, or Tylenol. We're going to give you information on how to decide if Voltaren, the new over the counter pain med, is for you or not. And today we have an expert here that's going to help us out with the facts. Chris, the pharmacist. Chris: Hey guys. Brad: I'm looking at this from a therapist’s point of view. Pain management can be absolutely critical, whether therapy is successful or not. Particularly, an example is like a knee surgery. You have to get the knee moving. Chris: Oh yeah. Brad: You have break up scar tissue, and I think times like that, it's okay to have pain. So if we can decrease the pain, we can get more motion and get the therapy going on. But for the general public, if you just want to control a headache, or you want to control joint pain, arthritic pain, maybe a sprained ankle, or whatever it may be. This Voltaren gel is now over the counter, so anybody can use it, but let's get to the basics. Chris: Sure. Brad: Is it really new? Is Voltaren gel something that has been used or not? Chris: Well, yeah. Voltaren gel has been around. It's diclofenac 1%. It's a topical gel. Diclofenac is the generic name of it. Brad: Okay. Chris: It's been around, as a prescription for quite a while. I mean. Brad: For like a decade or more? Chris: Yeah, I think 2009 is when it came out. So it's been around. It's definitely had its place in the orthopedic circles. I mean, it really goes right to your arena. Brad: So when you say orthopedic, some people, you know, it's for joints. Chris: Yeah. It's widely used for osteoarthritis, but it can be used for joint pain, muscle aches, you know there's just certain joints, you can't use it on real effectively. The hip joint. The hip is just too thick. I mean, it's too deep. You can't get this to penetrate into the hip directly. So it's going to be more for your, you know, your ankles, your elbows, hands, you had a back pain, sore ribs. I mean, people have used it for a little cartilage tear. Brad: So, in the past doctors would prescribe the exact same thing? Chris: Exact same thing. There is no difference between this and the prescription. Brad: Why was it prescription, and then all of a sudden, now it's over the counter? Chris: I think really what it comes down to is safety. And so they've had decades’ worth of experience showing that it was very safe and effective product. The biggest complaint for this, for patients that have side effects, is going to be kind of a rash or some itchy skin. So that's about it. The no-no’s are if you're on blood thinners, or if you were allergic to NSAIDs or aspirin. Those would be the things that you would not use it for. And of course, patients talking to the doctors, you know. It's very important to give them all that information, so they're imbibed with that, so that they can get you the right choices. When you walk into the pharmacy and you're like, “gosh I'm just looking for some pain relief, I've got a sore knee. It's just bugging me.” Voltaren gel is actually a really good thing that people can certainly try in the arena of pain relief. So whether it's going to be ibuprofen, whether it's going to be naproxen sodium, or acetaminophen. Brad: I always get this confused. So naproxen sodium is the same as Aleve? Chris: Yeah. Aleve. Yeah, we are talking ibuprofen would be Motrin or Advil. Aleve is going to be neproxin sodium, or acetaminophen is Tylenol. Brad: Okay. Chris: And then Voltaren is diclofenac. Brad: Ok. Yep. So, it's whether, it's the manufacturer or the generic term. Chris: Correct. Brad: But it's the same active ingredient? Chris: Yeah. Exact same thing. That's the business end. Brad: Sure. So for diclofenac, is there other manufacturers that have it? Chris: Well, GSK owns the patent that was on diclofenac gel. They actually, havea 3% prescription one also for a different process, or problem. So, but yeah, that's been around for years, and you know, it's effective good stuff. We've been using as a generic medication. So it's a lot more cost effective alternative for patients. And now, this is just really affordable stuff over the counter. So it's just nice because now it gives access to many. So you don't necessarily need to see a doctor. So if you have, you know, weekend wear kind of stuff. You were out in the yard, and you were raking, and you hurt your back, or you pulled something, or did something to your shoulder. You were playing catch with your kid and just did something to your rotator cuff, or labrum, or something silly, that maybe is minor. You know, maybe it doesn't need a doctor, or physical therapist yet. Now let's try and use something like this, you know, 3-4 times a day and see if it helps to relieve it and provide the pain relief that the patient needs. Brad: So I'm thinking in my head trying to separate all these different avenues out for pain relief, because, in my case I do best with ibuprofen. Chris: Sure. Yeah. Brad: Okay. I've tried Tylenol, doesn't seem to work, and everyone’s bodies have their own preferences. Chris: Correct. Brad: So if you know that I'm thinking, well, what about this? Now my understanding is, say I have a sore knee. If I take my ibuprofen, it goes throughout my whole system and it gets to that knee. Chris: Yep Brad: So if I take this, if I'm thinking right, and I put it directly on my skin, does that medication go through the skin to the point of the irritation? Chris: It depends on the depth, but I mean that's why the hip joint is not the best place to put it. Brad: Sure. Chris: But let's say, we're talking to knee and ankle, you know people use it for arthritic hands all the time. And so, you know, it's important to get the correct product. So basically below the waist, we use 4 grams as the measuring tool. There's a measuring guide that's actually included within the box. Well, basically upper joint is going to be 2 inches, lower joint is going to be 4 inches. And so basically, it's just like squirting out toothpaste. So you just put it on the spreading blade, let's just pretend that I've got a sprained wrist. So we're going to put 2 grams on the wrist, and then you're just going to rub it in really well. Just wash your hands down. You don't really want to wash off the spot, but maybe wash the other hand with soap and water, just so it doesn't irritate the skin. I mean, there's no point to it. The biggest complaint can be a little bit of skin irritation, but it's going to penetrate through the dermis, into the joint. It's not going to get all the way, deep into the joint, but it's going to help to where those pain receptors are, and hopefully help to kind of control some of the inflammation, that's creating some of the pain. Brad: Sure. Chris: So, then you'll apply every 6 hours, or 4 times a day max, 3-4 times a day. For lot of people it's going to be hard to go on a 24-hour schedule because we sleep somewhere in there, or we get busy, but 3-4 times a day, 4 to 6 hours apart, is a reasonable usage pattern for this particular product. Brad: So upper body? So like Chris says, it's just so nice, because you can just squirt it out on there about that size. So you get an accurate dosage. Chris: Exactly. And that's important. Brad: You don't have to get a measuring cup. Chris: No, you are not guessing. No. You'll get an idea, and then you just basically, let's say your elbow, you just kind of rub it in. Do that 4 times a day, and hopefully we're going to help to control the pain and inflammation, so you're more functional. Brad: Have you heard a lot of people allergic, or break out from this or is that pretty weird? Chris: No. I mean the biggest common side effect is a little bit of itchy, irritated skin. If you have an allergy to NSAIDs, which would be your ibuprofen, your Aleve, those types of things. Aspirin. You would want to avoid using the product because there's a higher chance, you know this is diclofenac, it is an NSAID. So it's, it's certainly something that is within that family, that umbrella. So you could see an allergic reaction. We don't want to tip the balance in the wrong direction. Brad: Sure. Chris: So if you know you're allergic to an NSAID, you should avoid it. And that's when we go to Tylenol. Brad: Sure. And the other hand, if you have problems taking some of the other oral meds, because it upsets your stomach. Chris: Yeah. And that's one of the advantages but while we're on it we'll just keep talking about it. So, when you take a traditional anti-inflammatory, so ibuprofen, naproxen sodium, aspirin, those products are going to have an increased risk of causing some stomach ulceration or some kidney damage. So, NSAIDS do have a risk. They can raise blood pressure, that can be damaging to the heart and kidneys. So there's a lot of things, that even though they do very good things for us and for many of us, we have to use it appropriately, under the doctor's guidance or at least make sure, you talk in your pharmacy about safe use, length of use, those types of things, because we don't want to create a new problem, in a different area of the body. Brad: Right. Chris: One of the distinct issues, that drives the bus with NSAIDs is stomach ulceration or irritated gut. So when you use something topical, like Voltaren gel or diclofenac gel, what that's going to do is you're not going to get, that whole amount of systemic absorption. So when we take the tablet, like you said it kind of goes all over. This acts right in the area. And so you're going to get some, that goes into the bloodstream. So you can see some prostaglandin inhibition. So there is still the remote, and I do mean remote possibility, that even though this is a topical gel, that it could cause stomach ulcerations, which is why we don't stack in on said NSAIDs. So if you're already taking a regimen of, let's just say, 600 milligrams of ibuprofen, 4 times a day. You're not going to use this, on top of that. Brad: I see. Chris: Because there is a synergistic or additive effect, that when we're talking about swinging things to the negative. So kidneys, stomach, heart. So we need to be careful with all of those things. Brad: All right. So if you've got arthritis and I'm thinking of my mother right now, she's got a knee that bothers her, on and off, it's an arthritic problem. She's not a good candidate for surgery, so to manage the pain, she could put this on that knee. Say there's no skin irritation. She could put that dosage on there. Chris: Yep, that should be a 4 inch. So yeah. And then, it's really neat for your mom. I mean, you know, one of the easiest ways, you know, a lot of times it's like, are you really looking at your clock? Has it been six hours? I'll tell people just go breakfast, lunch, dinner, bed. Those are intervals that are somewhat, just through our lives, we've kind of naturally spaced those apart. Brad: Right. So let's say you put it on there to. Do you notice the effect? Is it typically within an hour? Or is it kind of take a day? Chris: Yeah, it's going to take a day or 2 with some consistent use. I mean, you might get some pain relief right out of the gates, but it needs to be kind of an additive effect, because there's a lot of things going on with inflammation, that's causing pain. Brad: Sure. Chris: And so we have to calm down all those chemotaxis, and healing factors, to give the relief to the patient. So it does require repeated dosing, to get adequate drug response. Brad: So a typical scenario, my mom's got knee pain. She uses this for a couple of days. The knee pains getting better, or maybe it's back to normal again. Then you can stop? Chris: Yeah. Usually we're not going to want people to use this longer than 7 days, without at least discussing with their doctor. Just because there could be something more potentially wrong with that knee. Let's say she tore some cartilage, or you know, and there's a litany of things that you're going to see in there. So we want to make sure, that we're not overlooking something. So, 7 days is kind of the max, unless your doctor says, “Oh yeah, you can use, as long as you need to kind of thing,” but make sure your doctor's involved. I mean, that's, the quarterback of the team. I mean, you're very important with your own healthcare, but your doctor should be involved or at least ask a pharmacist or one of the other healthcare professionals. Brad: To make sure there's no red flags. Chris: Exactly. Brad: If you're on other medications. Chris: Yeah, blood thinners would be the big no-no. Brad: Okay. So any other side effects or things to be? Chris: No, it's actually some pretty slick innocuous stuff. I mean, not much bad with that, simply because it acts locally, so you don't get as much into the system. Brad: Yeah. Chris: So it doesn't create all the systemic onset side effects. It's pretty impressive stuff. There's a lot of orthopedic surgeons and doctors out there, that routinely prescribe it still, even though it is over the counter because sometimes your co-payment might be a little bit cheaper. Brad: Sure. Chris: But I mean, you can get a tube of that for about 9 bucks, over the counter. It's affordable stuff Brad: And that'll last you the 7 days? Chris: Oh yeah, easily. I mean the, depending upon the size of the tube. They actually make a larger tube too, so it's a little bit more economical, I just grabbed a small one. Brad: It depends on what size area you're covering. Chris: Exactly. And how frequently, hopefully it's just going to be kind of a short-term thing anyways, but it's available to you if you need it. Brad: Yeah. Well, that's great. I think it's a great alternative, especially when you don't have to take pills, if you've got digestive irritants. Chris: Yeah. Just remember guys, it takes about 5 minutes for this to absorb. So let's say you're treating a shoulder, while you rub it in, give it about 5 minutes to dry, otherwise you’ll put it on your shirt, your shirt kind of stick to it. Brad: Oh, I see. Chris: I'll get a little slimy, so. Just, that'd be just one of the other negative things. That's not really an overt side effect, but it's definitely a cause and effect kind of scenario. You want to keep your clothing looking nice. Brad Yes, exactly. All right. That answered a lot of information for me. I'm thinking this is going to be a go to. I'm going to at least try it with my mother's knee. Chris: Yeah. Give it a go. Brad: See how she responds. Chris: I bet she'd appreciate it. Brad: All right. Very good. Take care and enjoy your pain-free way of life. All right. Chris: Thanks guys. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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 March of 2021 . For the original video go to https://www.youtube.com/watch?v=ntWElqA4LFU&t=276s Bob: Today we're going to talk about common "pain makers" causing pain in your neck and arm and how to get rid of them. So our goal is you want to, of course, decrease the amount of neck and arm pain you're having. So to do that, we're going to show you exercises and all sorts of other things, positioning but it's also important for you to decrease the things that are causing the pain in your life. Brad: And you might say, well, it hurts all the time everything irritates it, but we're going to talk about how you can find a few things out. Because we've heard those comments many times from patients, and after a little discussion, we find out, “Oh well, they say it really hurts when I do this.” And then we go into that area and it becomes very much clearer than. Bob: It becomes clear as you stop doing some of these things, you start finding out that things are causing my pain. Like, let's say you, you sit in a chair with your head bent down, you know? And after a while, you fall asleep in a chair, and your neck falls down and your head falls down and that causes increased pain. And that pain goes on for a couple of hours because of that. Brad: Sure. Bob: And, you stop doing that all of a sudden, you maybe have two, three hours of pain free moving. So, you know, it could be pain in your neck or even referred pain down your arm. If you perform a task and it increases your pain, it's a pain maker in our book. If you move a certain way and it increases pain, it's a pain maker. If you're lying in bed and that causes pain, it's a pain maker. Brad: It may be something as simple as just posture you're not aware of. And it's, you have poor posture you have no idea, until someone takes a picture of you, and you look at it from a certain angle. Bob: Or like the bed example, you think, well, I'm lying in bed. Why am I having pain? And then, maybe you're lying with too many pillows Brad: Sure Bob: You know so, the other problem with the pain is that the more pain you have often the more sensitive your nerves get. So now rather than taking a large event to cause your pain, it only takes a small trigger. You know what I mean? Brad: Right. Bob: The nerves become so much more sensitive that the what used to cause a lot of pain hardly takes anything now to set it off. Brad: And you can think of that. You know it's going to be painful when you move this direction or when you're going to do this activity, so even before you get to it because you're starting to feel anxiety and that can all trigger into the whole pain cycle. Bob: Right. So the cycle is hitting the wrong way. It's getting worse and worse. Now you can also hit it the right way by taking the pain makers out of your life you can see that you can control the pain. Brad: That's a big deal. When you find out you can control it. You know, that's, that's huge. Bob: Yeah. It doesn't have to control you. So, what Brad and I thought was that we’d go over some things that you probably should do right now. And Brad, and I 'll go back and forth. And now, number one I would not look down continuously, right now when you're having neck pain while reading, knitting or performing desk duties. You want to try to get things. That's how we often talk about setting up your office or home computer, making sure the screen's high enough so that you don't have to look down. Brad: In our society, these are challenges that Yeah, they are challenges. Bob: Yep, they are challenges. Brad: And number two, we're looking at continuously looking at a phone or a laptop. You know phones are, you know pretty much phones are the new TV. Bob: Yes, it is. Brad: You know? So we're down looking at the phone, putting stress on the neck. And it's one of those things. When you do it immediately, it doesn't cause pain, but over 20 minutes, it gets it that fired up mode, and then you don't really realize that, that was the problem. Bob: You don't even realize it that it's sneaking up on you. So bring that phone up by your face. This is what you need to do. So I just a generalize one is putting the neck in what we call putting the head in the forward head posture. So you know, that neck is geeking forward. This is such a common position that we see with sitting and working and, and even lying down sometimes. Brad: Yeah, the pillow issue again. Bob: All right, Brad, what else we got? Brad: Ooh sleeping on your stomach or your head is turned to one direction as far as it can go. And that's fine. But if you lie there for any period of time, that's end-range on the joints, which is a common therapist term that we use. We know we don't like to put our joints at end range for prolonged periods, that irritates them. So, no more sleeping on the stomach. Bob: Yeah. If you do it, do it for a very brief time. Brad: Hopefully if you do, when people that do sleep on their stomach that don't have any pain, they've probably got pretty normal motion. They probably turn their head right to left frequently, without even knowing that. Bob: Sure. All right. Like we alluded to a number of times as sleeping on your back with the wrong number of pillows. Generally, when you sleep on your back, and we'll go into this in another video, you want to have a thinner pillow so it doesn't move your head and neck forward. Brad: And the same thing with sleeping on your side you've got a different posture you need to accommodate so that your neck is not stressed. And we'll cover that probably in the same video. Bob: The other one, number seven don't sit in a slumped rounded position. What does this have to do with neck? Well, if you're like mid back is rounded out, there's no way you can have the neck in good posture. It just, it just follows suit. So you got to have the entire spine in good posture or your necks going to be in a bad position. Brad: And this is one of those things where it comes into play with our next thing, watching TV, you know it's all that slumped posture, sitting in your car or sitting anywhere. And you know, Bob, we both know that particularly with younger kids, you ask them to sit up tall and straight with good posture and a lot of times they'll say “it just feels so weird and it’s not even comfortable.” Bob: I know they say, “who sits like this.” They don't realize how bad they look the other way and how good they actually look sitting up straight. But the other thing with that, Brad from that same point is that you don't want to have your computer screen off to the one side either or TV off to one side. If you're constantly looking, let's say to the right, you're going to develop pain on that right side of the neck possibly. So you want to have the things right in front of you, even if it's slightly off, it's not a good thing. Brad: This is one of those things that, the older you get the more you realize it. Bob: Yeah, it becomes very evident with you as you get older because these things crop up and you’ll know. Brad: Particularly over the age of 50. I just had a physical and the doctor said “Once you get over 50 things kind of start changing.” It's like, wow, that, that was my experience. Bob: Well, Brad jokes, something new crops up pretty much every day, Brad: Nothing major, but you know things that you used to be able to do. Bob: Next, cycling with your head down posture, Brad you're a big biker. I do some biking. Rad: Yeah. And it depends on the type of bike you have. If you've got a bike that is more normal it keeps you upright. you're going to have less stress on your neck. Bob: You’re just not going to go very fast. Brad: I have the bike that you lean forward and go in the arrow bars, and it's not that comfortable. I've got to sit up every now and then stretch my neck because it's a little uncomfortable. Bob: Yeah. And you know what I do? My bike is upright but I often like take my arms behind my back and stretch it. Brad: You can let go of the handlebars? Bob: I can let go of the handlebars. But I started thinking maybe I shouldn't do that anymore because if I go down, I'll go down. So, all right. Number 10, Brad, you’ve got number 10, right? Bob: Oh yeah. Driving with incorrect posture, same concepts that we aren't talking about. The thing in a car is you can adjust your lumbar support, hopefully. If your lumbar support is good it makes it much easier to have good posture in your neck. So make sure you're got that adjusted properly. Bob: This next recommendation is with a caveat because if you can run without pain, I absolutely recommend that you run. But if it's increasing your pain one might be that you have bad posture while you're running and then it's actually the shock absorption is making it worse. But generally, running is good for you as far as increasing the oxygen to the area, and the healing power but you have to have good posture while you're doing it. We have a neighbor lady, I want to put my knee between her and back, pull her shoulders back Brad: Go out there and do it and see what happens. She’ll probably thank you for it. There are a small percentage of people that actually run, I think overall, but yeah. It's something good to point out. Oh, here we go. Next one sporting activities. Bob: Don't do them if they increase your pain. Brad: Or change how you're doing them. Maybe it is a postural thing or something of that nature. Bob: We’re not saying that you can't go back to it, but we want to calm things down. We want to calm the pain down. So let's say you're having pain while you're playing tennis. Cause you're turning your head a lot, wait until we get the pain knocked down again. Then you can gradually go back into town Brad: Boy, that sport just with the abrupt changes in directions, that can cause pain. Bob: I think the big one now is pickle ball. Brad: Oh yeah. That is becoming very popular. Do they eat pickles? Bob: I don't know. I haven't got into it. So, lifting weights am I'm going to tell you it’s fine to lift weights, as long as it doesn't increase your pain but if it increases your pain, you can't do it. It’s that simple. Brad: Well, body mechanics is so critical at lifting weights and there's a lot of people that lift that aren't aware of their poor biomechanics. So make sure you get some proper instructions. Bob: Yeah. You want to bring up pretty much you, one of your spine nice and upright and completely erect when you’re lifting. Brad: And that's why a lot of gyms have mirrors. So you can actually see what's going on with your posture. Bob: Not just to look at yourself and see how big you're getting or toned you're getting. So number 14, Brad that's you. Brad: Oh, working in a cramped or awkward space. That's very typical with a lot of computer work stations. You put everything into one area so you can work. Especially now with COVID people are trying to convert things into their house. Bob: What about a car mechanic or a painter? You know, they're really in confined spaces a lot. Brad: Yeah. It depends. I mean, when I was working on equipment for service calls where I'd be almost upside down and trying to reach under something. You need three elbows just to get your arm around. If you're a mechanic, you know exactly what I'm talking about. Bob: Unfortunately, with that, if it’s your livelihood, there's nothing you can do right now. We'll try to show you some things to do in between. Brad: The elevating work bench can be a really handy tool for something of that nature. Bob: If you tilt your head out of habit in the same directions, a lot of you don't know you even do this. I do this when I'm doing notes, I'm always tilting my head to the left. So as an exercise, actually I have to tilt my head to the right, the opposite direction. We'll go into that later. But you want to try to avoid those, you know especially if it's a daily habit you're doing hour upon hour, day upon day, years upon years. Brad: Yeah. Bob: All of a sudden it will start giving you pain. Brad: So shoppers tilt? Bob: Well, is that referring to the same as the shopping cart and a shopper's tilt is when you just carry something on just one side. Brad: Oh. So if you've got a big purse or something of that nature or backpack. Bob: Or if you bought something and you're carrying it all in one hand you're supposed to have spread out the load. Brad: So you should buy two of them? Bob: That's right. Lol Brad: Carry one in each arm. Bob: That’s what you can tell your spouse. I was supposed to buy two of these Bob and Brad said. So, keep the weight evenly distributed. Number 17, it's kind of a repeat there but what they're talking about is if you're carrying a heavy suitcase at the airport. You, want to get a rolling one. Brad: I don’t even think they make them the other way anymore Bob: I know my, my niece just was having trouble with this. She, she flies a lot, was flying a lot. And she was getting like thoracic outlet syndrome. I don't know why she didn't have a roller. What I think it was, you know there's times you have to lift it up to go upstairs or something. You know what I mean? And she was always using one arm and she has a purse over her neck. Brad: Did you straighten her out? Bob: I straighten her out. Brad: Oh good. Bob: So anyway, again, decrease the pain. So you decrease the sensitivity of the nerves. We're going to show you some exercises to help you also along with this but the pain does not have to be permanent. You know, we're going to help you get rid of it. By the way this is a part of a series of videos on neck pain. So you go to https://www.bobandbrad.com/ go to the program section and look for neck pain. And you'll see a whole series of videos. Brad: Go to the one that fits you. Don't worry. They're not all just talking like this. We're actually going to show you some exercises that we've had great success with patients and you can work with them yourself. And there's a PDF printout to show you the exercises. Once you turn the video off so that you can refer to it, a little review of the video, it's a great thing. There's no email or anything. It's all free and rate ready for you. Bob: Like this one week, for example we got a list of the 17 things you should do right now. Brad: Oh so they can read it all. Yeah. They'll probably print it and not watch the video. Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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. 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Additional information on the Intracept procedure video with Bob and Dr. Ekstrom

How to Use a TENS Unit with Inner Thigh Pain. Correct Pad Placement. How to Use the TENS Unit: If you are using an iReliev TENS unit we provide step-by-step video instruction on how to use the following types: iReliev 1313 iReliev 5050 iReliev 8080 Just go to the program section at bobandbrad.com and click on the TENS series. Under the series look for the videos with the 1313, 5050, or 8080 TENS units. If you are using a TENS unit from another manufacturer you will need to follow the instructions provided with the product. Where to Place the Pads: There is NOT a specific right way to position or place the pads. The best approach is to place the pads wherever they relieve pain the most. Experiment and see what will work best for you. General Guidelines for a Smaller Area of Inner Thigh Pain (Hip Arthritis, Hip Adductor Strain): Use one channel and two pads. Place one pad (either one) directly on the pain. Place the other pad either directly above the other pad (at least a pad’s width apart) or directly below the pad (at least a pad’s width apart). Use one channel and two pads. Place one pad directly above the pain and one pad directly below the pain or place one pad on each side of the pain. General Guidelines for a Larger Area of Inner Thigh Pain: In our examples channel one has yellow pads and channel two has green pads. Option one: one pad from channel one placed above the area of pain and one pad placed below the area. One pad from channel two placed in front of the area of pain and another pad from channel two placed behind the area of pain. This arrangement forms a cross pattern. Option two: one pad from channel one in the upper right corner of the area of pain and one pad from channel one in the lower left corner of the area of pain. One pad from channel two in the upper left corner of the pain and one pad in the lower right corner of the pain. This arrangement forms an X pattern. See Photo for Example General Guidelines for Pain Referred from Another Area: An example of this would be inner thigh pain that is coming (referred) from the back. Using channel one, place the two pads along the nerve pathway. Reminder: Don’t place pads over open wounds or areas with excessive hair. Clean the area with soap and water prior to placement of the pads. Buttock Treatment: Adductor Massage with Cordless Massager. *Update Bob & Brad have come out with their own line of massage guns: https://amzn.to/36pMekg For more information on the TENS programs visit: https://www.bobandbrad.com/tens-program If interested in purchasing the TENS/EMS unit by iReliev visit: https://ireliev.com/bobandbrad/?uid=15&oid=1&affid=10 DISCLAIMER We insist that you see a physician before starting this video series. Furthermore, this video series is not designed to replace the treatment of a professional: physician, osteopath, physical therapist, orthopedic surgeon, or chiropractor. It may however serve as an adjunct. Do not go against the advice of your health care professional. When under the care of a professional make certain that they approve of all that you try. This information is not intended as a substitute for medical treatment. Any information given about back-related conditions, treatments, and products is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this publication. Before starting an exercise program, consult a physician. Medical Disclaimer All information, content, and material of 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 May of 2021. For the original video go to https://www.youtube.com/watch?v=4F6MP0l50uU Bob: Today, we're going to talk about how to finally stop your back pain. We're going to have you answer 10 questions. All right, let's get started, Brad. Brad: All right. Bob: So, these questions were developed by Stuart McGill. He is probably the world's foremost expert on back pain. Brad: That's right. Bob: It's in his book. It's an excellent book. These questions are from his book called "The Back Mechanic." I think it's the best book out there right now. Brad: Sure. Bob: So, the most important thing you need to do when you're trying to get rid of back pain is you got to stop the cause. Brad: Stop the irritating component, right. Bob: A lot of people think like, “oh, I hurt my back. It's going to stay hurt.” That's not true. You've got something that's irritating you during the day, and if you stop those irritating things, the pain will calm down eventually. The nerves will calm down. Everything will calm down. Brad: And you might think, I had a lot of patients say, "What irritates it," and the first response is everything. Bob: Everything, exactly. Brad: And then I talked to them some more, and finally we can figure out where the primary causes are, or maybe two different causes. Bob: Yeah, we start off this process by basically doing the questions, but we're going to do another video that's going to show you some tests you can do on your own, to try to help narrow down what is the cause. Brad: Right. Bob: So you want to watch both of these videos, or all of our videos, you want to watch. So number one question, does the pain change in intensity? I like to see that it does, like there'll be times where maybe you have no pain or a little pain. Brad: Right. Bob: And then times where you have severe pain. That usually means you can control it then. Brad: Sure. Bob: I mean, if you can have times where there's no pain, well we're going to increase those. Brad: Right, try and associate that with your activity then or just prior to that. Bob: Yeah try to make note. It's not the worst thing to even have a log book. Brad: Yes. Bob: Okay, When you roll in bed, do you feel any catches? This is a really good sign of instability in the spine, and I'm going to explain that one Brad. Brad: Right because that might not be clear. Bob: So let's say you have a disc problem at one level. You have all of these vertebrae that stack up to make your back. If you are unstable at just one level, when you move, all of the movement's going to occur at that one level instead of all spread out among the other levels. Brad: Sure. Bob: It's hard to explain this without showing it, and we don't have a good model to show it. But, you just have to take our word for it. It's usually the sign of a disc problem, and it's a sign of instability in the back, and so what you're going to want to do is you're going to, when you try to get out of bed, you actually tighten your abdomen. Brad: Right. Bob: Like a corset. Brad: Yep, like you're putting on a back belt, you just tighten up those core muscles and really try and keep your whole trunk, we call it log rolling. Bob: Right. Brad: So it's everything stabilized together by using those abdominal and back, or you know, core muscles we'll call it. Bob: What a difference it makes. I've seen it with patients, like they were very skeptical. They thought it's not going to make any difference, and they're like, "Wow, I got out of bed without pain." Brad: Sure. Bob: And that's the first step, then. You start realizing hey, maybe I can control this pain. Maybe I do have control over it. Brad: That's a big step, feeling confident that you can deal with this. Bob: Right, exactly. So this is probably the most obvious question. What makes your pain worse? I mean, you start writing down. Generally, we find is that people are going to maybe have worse pain with bending forward. Which is a really common way, or maybe it's bending up straight and backward. Brad: Yes, sir. You're not even bending forward. Sometimes it's bending over a bench while you're doing something perhaps at work or in the kitchen, and you don't even realize that you're bending forward, and a little bit can make a big difference. Bob: Why don't you show twisting too, Brad? It might be with twisting, just turning. Brad: Yeah, so when you turn, especially the low back pain, ooo. And just a little bit. Bob: And maybe it might be in one direction. Might be mostly to the right, and when you go to the left, you're fine. And of course, we have to throw in things like load and fatigue. Brad: So lifting, pushing, pulling heavier objects. Bob: Or some things you might be fine with until you've done it for a long time. You might be fine sitting for 10 minutes, but at 15 minutes, it starts to hurt. You don't go to 15 minutes then. You have to stop at 10 minutes, and do something else in between. So there's ways around this. We brought this one in, too. Any history of osteoporosis, osteopenia? The reason we ask that is it's very common with osteoporosis or osteopenia, by the way. In some ways, they're not that much different. People think osteopenia, they're fine. You could be a higher risk for fracture with an osteopenia. Brad: So we're talking about bone density loss. Your bones are becoming weaker. Typically, with older people, it's common. Bob: So the problem is there's about 300,000 patients who go to the doctor each year, because of a fracture. Brad: In their spine? Bob: In their spine, yeah. Brad: Compression fracture, whatever. Those are common. Bob: Yeah, the bones squeeze together. But they estimate another 600,000 don't go to the doctor and don't even know that they have a compression fracture. It's called the silent fracture, and it's very, very common. So if you have osteoporosis, you probably want to have that checked out. A bone density test and also probably you might, if you're having pain, you should have an x-ray. Brad: Of your spine. Bob: Yep, of your spine. Brad: Yeah, it's not a major fracture. It's something that has to be read oftentimes by a radiologist. The MD may not be able to see it. You have to get an expert, which is very common. They almost always do it. Bob: They always do it anyway. Number five, Any trauma involved? If there was trauma involved like you're in a motor vehicle accident or if you fell, you should be seeing your medical provider just to make sure that no fractures occurred. Or nothing untoward happened. All right. Is your pain worse thing in the morning? If it is, this could be your sleeping posture. Brad: Sure. Bob: And quite often, that's what we point to. If you're sleeping in a good position and you're moving a little bit, you really shouldn't have increased pain at night, you know what I mean? Unless you irritate it during the day. Brad: Right, right. Well, yeah, and we have videos on how to readjust your body or use some supports to help eliminate that. Bob: Exactly, you might be putting pressure on that back all night long if you have, for example, if you have kind of a large buttock, and you sleep on your back. Actually, the back is going into flexion all night long. Brad: Or side lying. Bob: Or side lying, if you have a little bit wider hips, you could have your back sagging all night. Bob: Or wide shoulders. Bob: Right, right. Absolutely. All right, Does your pain worsen throughout the day? This usually indicates that you're putting your back into some poor positions. Or maybe too much load. I mean, maybe you're fine at a lighter load, but as soon as you start putting some stresses on the back, it can't handle it. Brad: So if you have to move boxes throughout the day, and the lighter ones are, you're doing fine, and that's kind of a common sense one, I think. But just when you say load, I just wanted to clarify that. Bob: Well, I think Brad, what we're trying to hammer home here is that something is causing your pain, and look for it, and if you can't find it, you aren't looking hard enough. I mean, really. Brad: Right. It's one of those things as a therapist, we're trained and we have this experience. A lot of times, it's just sitting, you feel fine, but that sitting long-term sitting with poor posture kind of sneaks up on you, and it feels fine until you get up, and then it's like, oh, what was that, what did I do? And it was actually the seated posture that you're completely unaware of. Bob: Or it might be you're seated in a perfectly fine position, but you sit too long. I mean, there's lengths of time, too, so you should get up and walk. Brad: Which can be a problem depending on your job. Bob: Well usually, you can walk to the bathroom anyway. All right, Is your back pain more concentrated in the middle back? This is for people, a lot of people Brad, they've developed poor positioning and movement patterns where they actually tend to, instead of bending at their hips and keeping their back straight, they bend at the mid back. They call it a hinging right where the ribs meet the low back. Brad: Right. Below the shoulder blades, but above the low back, just right in the middle there kind of. Bob: But they get into this movement pattern of going like this, and that's almost always causing the mid back pain. Brad: And that's one of those things you're certainly almost certainly not aware of. It's a habit that's been going on for years and developed, and so that is one of, like a lot of these things, you're just not aware of what you're doing. Bob: Yeah, I think back to a couple of patients I had who had mid back pain, and they had to lean over a fence to do something, and I'm like I knew right away what they were doing. They were doing that. They were bending at the mid back and hinging, and you want all the movement to occur at the hips, not the mid back. Brad: Right. Bob: All right. Does your pain also radiate into your buttocks and feet? If it goes all the way down into your feet, it's more likely a disc problem. Brad: If it's past the knee, disc, if it's to the knee, then it could be SI. It's still a back thing, but then it's a little bit more challenging to fix it. Bob: You're getting a pinched nerve somewhere. It could be piriformis, too, but somehow, you're getting that nerve pinched. You're definitely going to want to see the doctor in this case. Does your pain increase with fast walking, or does it decrease? Usually if it decreases with fast walking, it's often a disc problem because a disc problem will increase when you're walking slow. It just puts a little more load on the spine. Brad: Stuart McGill, he talks about that as well. Bob: But then, what case? Does it increase, Brad, when you're walking? That would be spinal stenosis, and that's such a common thing that they call it shopping cart syndrome, like you lean on a shopping cart, and it feels better, and if you have spinal stenosis, you may be only walk a hundred yards, and you have to sit down and give yourself relief. Brad: And then when you sit, it feels good. Typically, right away, and that's more with the older population, 60 and over. It's not an uncommon diagnosis to have, but it's certainly nothing to get too excited about. There's some exercises that can help you out. Bob: And you know, you deal with it, too. You manage it like Brad bandages his spondy. You figure things out, and Brad runs and bikes and swims. Brad: Right, I just got to be careful. Bob: And irritates people, so he does all those things. Brad: I don't bike too far, Bob. It's still uncomfortable getting off the bike. Bob: You don't let it bite too far. Brad: You learn your limitations. Bob: Yup, and that's the whole summary of this video, is let's find out what's bothering you. Let's calm it down. Let's not let it irritate you, and it can flare up to the point where you can't do anything. Brad: So you need to either modify the irritant, maybe use a back support, change your body mechanics, or if you can avoid doing that activity which can be challenging. Bob: You may have to avoid it for a while, but then we can eventually get you back into it, maybe with modifications. Brad: Sure, yeah. Bob: All right, remember, Brad and I can fix it about anything. Brad: Except for. Bob: A broken heart. Brad: Right. Bob: And I think I've been working on it harder than Brad to be honest with you. Brad: Well, that's true. I kind of, you know. Bob: I hate to be catty about it. Brad: What's a guy going to do about it? Sometimes you have to take a break from the old heart thing. Bob: All right, thanks. For more information on Dr. Stuart McGill visit: https://www.bobandbrad.com/experts/stuart-mcgill Visit us on our other social media platforms: YouTube:https://www.youtube.com/user/physicaltherapyvideo Website: https://bobandbrad.com/ Facebook: https://www.facebook.com/BobandBrad/ Instagram: https://www.instagram.com/officialbobandbrad/ Twitter: https://twitter.com/ptfamous Pinterest: https://www.pinterest.com/mostfamousPTs LinkedIn: https://www.linkedin.com/company/bob-and-brad TikTok: https://www.tiktok.com/@bobandbrad Wimkin: https://wimkin.com/BobandBrad Mewe: https://mewe.com/i/bobandbrad Minds: https://www.minds.com/bobandbrad/ Vero: vero.co/bobandbrad SteemIt: https://steemit.com/@bobandbrad Peakd: https://peakd.com/@bobandbrad For this week’s Giveaway visit: https://bobandbrad.com/giveaways Bob and Brad’s Products Pain Management: C2 Massage Gun US: https://amzn.to/36pMekg Now available in EU: https://amzn.to/3eiruwV Now available in Canada: http://amzla.com/t4qn7uniltfb Q2 Mini Massage Gun US: https://amzn.to/3oSMBu9 Now available in UK: http://amzla.com/qe4bmn3puczb Now available in EU: https://www.amazon.de/Massagepistole-Muskelentlastung-Handmassageger%C3%83%C2%A4t-Muskelkater-Entspannen/dp/B08M8YSFC7/ref=mp_s_a_1_2?dchild=1&keywords=bob+and+brad&qid=1620323625&sr=8-2 Handheld Massager: https://amzn.to/2TxZBqU X6 Massage Gun with Stainless Steel Head: https://amzn.to/38zRLEv T2 Massage Gun: https://amzn.to/3GfflX1 Foot Massager: https://amzn.to/3pH2R2n Knee Glide: https://store.bobandbrad.com Fit Glide: https://store.bobandbrad.com​ Fitness: Resistance Bands: https://amzn.to/36uqnbr​ Pull Up Bands: https://amzn.to/3qmI4Rv​ Resistance Bands for Legs and Butt: https://amzn.to/2G5mXkp​ Hanging Handles: https://amzn.to/2RXLVFF​ Grip and Forearm Strengthener: https://store.bobandbrad.com​ Wall Anchor: https://store.bobandbrad.com​ Exercise Ball: https://amzn.to/3cdMMMu​ Pull-Up System: https://www.optp.com/Pull-Up-system-by-Bob-and-Brad Stretching: Booyah Stik: https://store.bobandbrad.com​ Stretch Strap: https://amzn.to/3muStbi Wellness: Bob and Brad Blood Pressure Monitor: https://amzn.to/3hm721f Bob & Brad Amazon Store: https://amzn.to/2RTSLLh Check out other products Bob and Brad Love: https://www.amazon.com/shop/physicaltherapyvideo?listId=3581Z1XUVFAFY Check out our shirts, mugs, bags and more in our Bob and Brad merchandise shop here: https://shop.spreadshirt.com/bob-brad​ Check out The Bob & Brad Crew on YouTube by clicking here: https://www.youtube.com/c/thebobbradcrew Medical Disclaimer All information, content, and material of 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.