Best Positioning Tips for Sciatica (Herniated Disc) + Cold vs. Hot??


the two most famous physical on the



hi folks I'm Bob Shrum physical

therapist and I'm Brad Heinrich physical

therapy that we have the most famous

physical therapist on the Internet in

our opinion of course Brad today you

want to talk about best positioning for

sciatica also kind of as a bonus hot

pack cold pack while you're in those

positions sorry this is a lot of things

that we get a lot of comments from from

our viewers as well as in the clinic you

know what should I use hot pack or cold

pack and then what position or how can

they get that amazing how critical this

is because if you kind of put yourself

in these positions that help the back

heel mm-hmm it that alone can help

really start tamping down the pain

exactly I really think the position

you're in while you're using the hot

pack or the cold pack is more important

than then the hot pack or cold pack

itself exactly so we're gonna combine

agreement Brad right once okay by the

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all right Brad what do you use the hot

pack or the cold pack I am in the

opinion that you use what makes your

body feel the best however there is a

rule of thumb that pretty much everyone

agrees on throughout the medical

community if it's a very acute injury

just happens it's very tender almost

always use the cold pack first 72 hours

28 to 72 hours they almost always

because you think about it there's

probably some damage and there may be

some swelling exactly back I mean

there's swelling you may not see it and

and so the ice can help you know keep it

down and keep it and then after they say

48 72 hours go to a hot pack I

personally don't agree with that and I

think it may be true but I personally

use cold packs a lot more in the clinic

than I do hot packs I'll go a little

deeper and they they seem to you know

last a bit along right they work better

for spasms i severe back spasm and there

are some people just do not tolerate

cold and he

what works good and whatever works good

for you use it and go with what works

best for you I just want to give you a

couple benefits of hot packs number one

they almost always feel good right so

you put it on and it feels boy I've got

one right here in a matter of fact I'm

gonna put it right on my leg there it

feels real nice my hands are getting

warm now the other thing is they do

increase blood flow the Veysel dilation

opens up those vessels and blood flow

more circulation which is a good thing

okay and the low cost it's not a big

expense to have a hot pack you know you

can buy all the kind you put in the

microwave you can buy an electric one

one of the dangers of hot packs

particularly if you have electric plug

in heater you might turn it up on the

warm side put it on your back and then

fall asleep yeah and after six hours

later you can literally burn your skin

now it's typically not like a match burn

but the skin get red hot you can get

blisters with it and particularly people

Gerry out you know in the older

population their skins more frail so you

always need to go watch odd walk

overheating you know the thing about hot

packs - which is a little deceiving when

you lay on it they're the Bloods not

flowing as well so you can have you know

you might be able put a hot pack on you

and you're sitting up and get away with

it and won't burn you but as soon as you

lay on it there's that much more

possibility of burning because the

Bloods not taking the heat away exactly

good to see cold packs one thing that

nice about cold packs there's no

negative effects unless with the

exception of put it directly on your

skin you could get frostbite

superficially that's really the only

thing you really have to be aware of

with cold packs always put especially if

you went right on the bone like right on

the patella where there's not much skin

layer there you know and you can you

could burn yourself and you could also

freeze yourself exactly with cold think

of it this way inflammation things are

swollen up okay and now if you think of

a blue and it's swollen it's this size

if you put a balloon in an oven that's

not too warm it's going to expand even

more if you put it in refrigerator the

balloon will decrease in size this is

may not be what's happening this is how

I tell my patients for an analogy

the hot pack on something that's

inflamed you got your cells and

everything's full of fluid and packed

full in the you know it's just painful

and you put some warmth on there and

anything span even more fans more like

that whoo and making everything more

tight more painful so that's why you

know that's the analogy with the cold

pack now well as far as are we gonna go

into positioning Brad let's do that well

sometimes some people do heat and cold

contrast right yeah that's a good point

and this is something I personally have

not done I've been trained in it I just

have good luck without it but I know

particularly in athletics they probably

use this more than other places where

you'll put you if you got that sprained

ankle you put it in that warm water

maybe a warm jacuzzi they have in the

fitness center right take it out and put

it into a bucket of ice water and we

have a video on contrast right I don't

want to get into the details Annette we

don't have enough time but it is an

option and it's out there so okay well

let's take the positions right yeah the

most important thing I could mention for

let's go to back pain because it's so

from you know so common let me start

from Brad sure okay now if you can lay

prone on your stomach and your back

feels better that's a really good sign

this is what you need to do this is

going to be for sciatica now Brad Monica

let's see you lay on your stomach you're

having leg pain but when you lay in your

stomach the leg pain and there are other

symptoms actually improves this would be

a good position and if you if you want

the hot pack we're gonna put that on

there how's that feel bow feels great

good but now I can make a slight

suggestion Brad please I mean if it

doesn't feel that good laying this way

you might just try shift your hip this

way or maybe you're shifting your hip

the other two are x-ray quite often if

the pains down this side if you shift

away from it it often feels better you

make yourself into it your body kind of

into a banana you know if you're looking

from the top down the pain is in his

right leg you're gonna move your hips

slightly to the left so my feet are to

the right my shoulders are to the right

but my back is to the left and you'll

know if it's the right position to be in


clearly gonna feel better in the leg

right very clearly okay yeah we're

looking for that position that's taking

the pain out of the way

that's that Bob and actually that

contrast isn't that bad cold pack on him

there yeah okay I think she does work

now someone might you know I used to be

a really nice treat my back with back

pain years ago on my stomach was very

successful and now that I've developed a

different diagnosis I always have to lay

on my back so should we try that for the

table you want me just to flip flip over

Bob you're probably gonna get a pillow

again when you're doing cold packs and

hot packs being completely comfortable

and relaxed is critical it's very

important to the whole treatment process

are you gonna fall asleep by thinking

about it all right oftentimes a couple

pillows under your knees I'm just gonna

put one there Bob for him just cuz it's

easier for the video that does that feel

a little bit better Bob a little bit I

cares more all right all right we'll

give you another big baby I'm just

kidding actually you do whatever take

this feels a lot better okay that makes

a big difference now I do this often

times I keep walking in front of you Bob

I hope the people aren't worried yeah

I'll get a cold pack underneath their

back in this position and initially kind

of leaning but after about a minute you

get used to it and some people like it

right away I say boy does that feel good

15 to 20 minutes on a cold pack now in

the clinic I will always use the leg reg

which we've done some videos on and

almost always people are there this is

this is really nice this is deluxe I

just used on with a patient last week

she went out and bought one for home

yeah that day I I don't doubt it bread I

mean this is it's hard to understand why

this is so much better than pillows

right because we also have people

sometimes just lay on the floor and put

their feet up on the couch yeah you know

or something right which is good tool

sure and certainly but I mean this

really I don't know what it is but it

just really feels good and it has to

have this angle here and it needs to be


hence foam the density is just critical

we can't talk more about how nice these

are you can get him for about twenty to

thirty dollars online actually I think

it's the support all the way along that

yeah good I sure think you might be

right pal okay now so you don't have all

this one other position that a lot of

people have at home and I've used this

often times is we don't have one here

but a recliner and on the recliner it's

very important I'll just try to work

through this is you're gonna recline

back and you have to have support in the

low back all right so you're not in that

rounded out position if you've got a

really soft cushy recliner it's not

gonna work in this sometimes like a roll

pillow York felt really good on those

that's what I do

yeah a throw pillow or whatever it takes

to fill that gap so you can feel good

support and you'll know what's right

because it's gonna feel like oh that

feels like a really good support and

then take your cold pack and put it

there woah I know a lot of people Brad

and we've had this discussion before

there a back pain that they um honestly

cannot sleep in their bed and they have

to sleep in the recliner I don't like it

I'd rather have them sleep in their bed

right but they can't I mean I know it

and and so as what I try to do is have

them compromise by by putting a throw

pillow behind them in in their back and

but there must be you know I it gaps the

back a little bit I think gives them

enough that they they're not getting

that pressure on the dryer so and some

people when they turn to the side that's

worse and nice thing about a recliner is

you cannot turn to your side

so eliminates that side position if

that's the irritant and this feels

really good Bob now the other thing

about when you do this you get yourself

a nice book to read you watch TV or you

just take a little nap and you know the

thing about a cold pack that's really

nice is they just warm up after a while

and it's not like a hot pack where you

know I couldn't keep sitting right it's

just there and and then just and again

make sure that this is helping take pain

out of the leg that's every position we

want to see if we can take pain out of

the leg exactly oh boy alright remember

Brad we can fix just about everything

except for that broken heart and


we can fix a Attica we're coming a long

ways on sciatica bass Wow thanks for