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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
Exercises are a great way for someone that's sitting long periods all day long and they're kind of limiting space, limiting blood flow, and not getting enough mobility in that nerve. Exercise are a great way to intervene with that. Welcome to the doctor Joj Thomas podcast. Hey, everybody. Welcome to the doctor JJ Thomas podcast.
Dr. JJ Thomas:I'm JJ Thomas. Glad to have you here today. Those of you that have been with me a while, you know that sometimes we'll give information on better evaluation strategies, assessment, reassessment, sometimes we'll talk about different, tools and techniques. But one of my favorite loves is exercise prescription. And so today's episode is to help clinicians who have that patient with that neural tension that's just chronic, not highly irritable, not strong radicular, not highly inflamed, but just that old chronic kind of neural tension symptom that, you know, they're the patient, that it's the mom that gets the symptoms after driving their kids around to all the practices all the time.
Dr. JJ Thomas:It's the dad that gets the symptom after sitting a long time driving in the car on his way to work, you know, after an hour. Maybe it's the desk worker that gets it when they've been sitting too long. A lot of times it's that sitting long periods is the driver, but it's this, like, vague, achy kind of referred pain, radicular pain. But again, you've done a slump test on them and it's positive, but it's not highly irritable. They likely don't have numbness.
Dr. JJ Thomas:They hopefully don't have weakness in that myotomal pattern. So it's that very safe patient that, you know, nerves, all the nerves need space, blood flow, and mobility. Right? And so exercises are a great way for someone that's sitting long periods all day long, and they're kind of limiting space, limiting blood flow, and not getting enough mobility in that nerves. Exercises are a great way to intervene with that.
Dr. JJ Thomas:But if you're anything like me, I get a little bored with the slump test, with this not the slump test, with the slump exercise. Right? It has its place, and I use it a lot. But if we really want to give patients space, mobility, and blood flow, the best thing we can give them is a little versatility in the exercises that we're using to mobilize the sciatic nerve, or the lower extremity nerves. So, today, I'm gonna give you over a handful of exercises that you can add to your toolbox or repertoire for your patients, that have that chronic lingering neural tension.
Dr. JJ Thomas:Let's go. So we're gonna start in basically a lower regression and work our way up to higher levels. The first one is gonna be more of a, it's gonna start with a very static type, exercise. This one, what you'll have them do, it'll look like it looks like the start of that old, like, we used to call this, like, the Cosmo, the Cosmopolitan, or the Hollywood, or whatever. So it kind of looks like that.
Dr. JJ Thomas:You'll have them sitting on the ground, they'll put one knee over the other, so like this. Right? And then, I'm gonna go here now, and then you can start them by pushing up and having them rotate away. You're gonna get a little bit of neural tension there just like that. Right?
Dr. JJ Thomas:Always add breath if you can. So here, like that. You can have them do the twist just like this. You can have the add that internal rotation of the femur to add a little bit more neural tension on the sciatic nerve path. The other thing you can do is have them floss in that position.
Dr. JJ Thomas:So here, chest up, floss, then maybe rotate. Unfloss, back. Chest up, floss, then maybe rotate, then come back. And then the last progression in this position would be if they're able to grab here, and then straighten the leg, and then rotate. So that's another.
Dr. JJ Thomas:So you could even go external rotation, internal rotation, floss. External rotation, internal rotation, floss. We're talking of the leg here. So that's option number 1. That's a basically, it's loaded, but it's loaded in a seated position.
Dr. JJ Thomas:And again, remember, this is a chronic, not highly inflamed, not highly irritable patient, who really needs mobility and space and blood flow to that to that along that nerve path. Whereas somebody who has a highly irritated nerve root or nerve anywhere along the path is not gonna be able to tolerate probably even this. And they're someone that you would do the traditional flossing or glides with. The next one is gonna be advancement of that in the sense that it's loaded. So from a standing position Now, this was seated loaded, the other one.
Dr. JJ Thomas:Right? This is standing loaded. So what we can do is take them into, we use airplanes, I think. You know, we call them airplanes. Essentially, you're gonna be bent over like this, and you can keep the back foot on the ground, and slight bend here, but a hip hinge, so that they're getting that glute access a little bit.
Dr. JJ Thomas:And then from here, just twist, and then twist the other way. So we're getting back mobility, we're getting thoracic and lumbar mobility, and when we get to this top range here, we're getting neural tension. Right? Like that. Now, we can progress that right away to like, we call this, this is like a warrior 1 position in yoga.
Dr. JJ Thomas:Right? We can progress that now from the standing airplane position to, like, a twisted warrior, like that, and then we can even from there, we can straighten the leg. This mat's a little hard to balance. Hold on. I'll set that over.
Dr. JJ Thomas:So we can progress them to this loaded, like, warrior 1 position, and twist them here, so we're getting that lateral access of the hip, and then they can straighten the leg from here. So now, in straightening the leg, we're creating more neural tension again in a loaded position. So just helping you think out of the box a little bit about ways we can access that nerve and give it mobility, space, and blood flow. Another one of my loaded my favorites, which is a loaded challenge, this one is it's it's called Sexy Bear. So those of you that follow me on Instagram or even on YouTube, or any of these other podcast channels, you know that we love our primal locomotions, our GMB Fitness.
Dr. JJ Thomas:Most of them originated from GMB Fitness methods that I learned from. This is sexy bear. I don't show it all the time, but it's a great one for, accessing that sciatic nerve neural tension. And so I'm gonna talk you through it. So we start in the basic bear, Right here.
Dr. JJ Thomas:And then basic bear would be like this. Right? This is great for neural tension as well. But if we wanna get it even more, we can now bring the leg across, and then bring the other leg across, and then bring the other leg across, and bring the other leg across. So now we're getting if you essentially look at my pattern here, I'm in that neural tension position, but I'm doing it in a in a way that's dynamic, it's loaded, it's variable, it's activating my core at the same time.
Dr. JJ Thomas:It's incredible, because we're not just mobilizing the nerve, we're mobilizing the nerve in a way that our brain and our body can access. It's functional for it, it's dynamic, and it just feels good. So I'll show that one one more time because it is a favorite. So you start in that basic bear position, and then instead of just walking opposite arm and leg, when you go, you're gonna bring this one across, and then bring the other one across, and then bring the other one across, and then across, like that. If you don't make the sound, you're not doing it right.
Dr. JJ Thomas:No, I'm just kidding. You may not make the sound if you're on a if you're on a hardwood. So that's that one. I love all of those. Those are good, kinda early phase for somebody who, you know, for the mom, the drive the mom that's driving the car and maybe doesn't always get isn't an aggressive exerciser, I'll say, like, doesn't always get to the gym or whatever, because they're pretty low.
Dr. JJ Thomas:They're they're low in terms of difficulty. But they're great in terms of versatility, variability, and and the multiple, gains that you get out of it. These next 4 that I'm gonna give you are ones that are for a little higher level, more of an athletic type. This might be the runner or the bike the bicyclist that they have that chronic irritating neural tension because they're doing a lot of this flex posture. Maybe they're on the bike a lot, maybe they're a rower, and they're on the erg a lot.
Dr. JJ Thomas:And so they have neural tension, but they have an ability to meet higher demands on the body. So you can be a little bit more intense, more aggressive with the exercise prescription. Remember, when we're prescribing these exercises, it doesn't just need to meet the needs of the patient's presentation, but it needs to meet that individual patient's need for their ego, I'll say, or need for their ability to envision themselves getting better faster. And so these next 4 are gonna be ones that you're gonna give your athlete. So let's talk about them.
Dr. JJ Thomas:So the first one in this, sequence of this next sequence of 4 exercises is from a yoga position. And in that position, essentially, you're gonna stand with your legs in a slightly wider than normal stride length. The back leg is gonna be out like 30 to 40 degrees angled externally. The front leg will be straight. And then what you're going to do is, slight bend in the front knee.
Dr. JJ Thomas:You're going to aim to have your hand of your of their front leg, the opposite hand of your front leg down on the floor, or if you can't reach the floor, or if your patient can't reach the floor, then you can grab a block or a step, and then you're gonna drive down through that hand, and then twist up like that. And if you look at this from the side, what you'll see, I can show you without the block, what you'll see is that I'm now putting my hip in that neural tension position again. So, I'm getting that nice loaded neural tension position, and remember, we need space, blood flow, and mobility, so you can always choose to mobilize in any of these positions. Like, if I'm gonna go here, I can mobilize by bending and straightening the knee, or I can mobilize by twisting the spine, like that. So a loaded progression of the, essentially, the slump position in a standing forward bend.
Dr. JJ Thomas:That's one of my favorites. Another great progression is if you from there, you do this again, this is for the athlete, You can do a single leg stance variation. Again, let's say I wanna mobilize the right side. Single leg stance, bring the leg up to, like, essentially 90 degrees, hold your balance on one side, pull this leg into slight adduction, maybe you'll get some internal rotation, and then from there, you can try to twist away to the opposite wall. The added piece to that is that once you get there, if you wanna floss the leg in that position, you can.
Dr. JJ Thomas:So you're here, you're here, grab the leg, pull it across. This mat makes my balance like standing on a foam pad. So I'm here, and then you can straighten and floss. Hopefully, you guys can still hear me. So I'll show you in this position, so that you can still hear me as I look.
Dr. JJ Thomas:So here, single leg on the left, bring this up to essentially 90 degrees, bring this into adduction, get my balance, start to twist and rotate, and then, when I'm comfortable, I can floss the leg. And essentially, I'd love to work towards getting my eyes all the way back there as I floss. So it's an advancement, but it's something that an athlete can identify with, like, Alright baby, let's go. I feel like I'm working now, and I should be because I'm an athlete. So, it's a great variation for your athletes with that chronic neural tension.
Dr. JJ Thomas:My next favorite is it's another GMB fitness special. It is, it's Twisty Bear. And you guys have seen this before, but this Twisty Bear variation has a leg thread that gives a great neural tension component. So this one takes a lot to learn. I'm gonna I'm gonna demonstrate it multiple times, so you can try it along with me if you're up for it.
Dr. JJ Thomas:If you have the space in your, where you are. So twisty bear, you start in that regular a frame like this. Most bears' opposite arm and legs slide together, right, like that. What we do with twisty bear is we'll go right arm, left leg comes up to about 90 degrees, twists perpendicular to my body, then, on a strong base with shoulders stacked, I allow my hips to drop. It gives me a good flank stretch, it gives me good spinal side bend.
Dr. JJ Thomas:Now I'm gonna drive through my base arm. From there, this is where the neural tension piece comes in. I'm gonna touch my knee to my elbow, straighten the leg, and then, this is the neural tension piece, I could just do this in neural tension, but if I really want, I can push and slide that leg up before I progress to the next pattern, which is here now. I come down, I push up, knee comes to elbow, straighten the leg, I can lift it if I want, then I'm going to push through my base arm and my base leg, and I'm going to drag that into a neural into neural tension essentially, before I progress to the next level. Here, touch, straighten, here's the neural tension piece.
Dr. JJ Thomas:Boom. It is so good because not only am I dynamically mobilizing that nerve, I am stabilizing in single arm, I'm stabilizing scapulars, I'm stabilizing core, I'm stabilizing my hip, I'm mobilizing all of those things at the same time too. I mean, this exercise is one of the exercise one of the reasons I fell in love with the GMV fitness, animal locomotion patterns. Is that you get so many things at once. How many of you had, like, you know, you have a patient, and you're like, okay, I need you to do this hip stretch, and I need you to do this shoulder stretch, and I need you to do this abdominal exercise, and I need you to do this nerve glide, and that's 4 exercises.
Dr. JJ Thomas:Nope. I'm like, I want you to do this one exercise, you're gonna get all those things. I usually tell them set a timer for a minute, so you're not thinking about repetitions, I just want you to think about the form. And, they work on the form, and they work on the patterns, and it's it's beautiful. So let's go through it again, just so you can kinda see it again, and maybe process it differently the second time around.
Dr. JJ Thomas:So we're gonna start in that a frame, right here. I'm gonna side left arm, right leg comes up perpendicular. I'm gonna drop the hip, I get that nice oblique and plank stretch. I'm gonna drive down through the base arm. From there, I'm gonna touch my top elbow to my bottom knee, straighten the leg, and then this is where it gets tricky, You have to make room to slide that leg through straight, so the way I'm gonna do that is drive strong through the base arm and leg, kick it up, progress forward.
Dr. JJ Thomas:Excuse me while my back is to you. Up, knee to elbow, straighten, push and drive as it slides and reaches, and then same thing on the other side. Here, here, there. And that's it, I'll do one more. Kinda fun, right?
Dr. JJ Thomas:But that's not all. I have one more. That is one of my favorites. If the athlete can get it, and they're able to do it, you get a lot for your you get a lot of value with that one exercise. So try that one.
Dr. JJ Thomas:But the last I'd say, the last exercise I put on here, it's it's maybe not as difficult as the twisty bear in terms of, learning it, but in terms of challenge for the patient, it's pretty challenging, so this would be, I'd say, one of the last progressions I would give to somebody. Essentially, it's the standing forward bend, but instead of starting here and rotating, and then flossing, you're gonna start them in that if they can reach either their ankle or their, or their foot, they're gonna start here, and they're gonna straighten it up. It's actually difficult to talk and do this and not fall over, but they're gonna grab the ankle, straighten it, and then chest up, and then rotate. So that's something we do, you know, if you've done yoga, something I learned in yoga, and now I use it I remember doing it and thinking, oh my god, this is a great neural tension stretch. So just there again, you can go here, grab the foot, straighten up, and then twist.
Dr. JJ Thomas:If they can't do that, and they can't balance that I'll show from this angle here, here, straight I'm losing my balance, hold on. It's funny, like, floor variation. I might have to do it on this. I'm gonna do it on this because it's more sturdy. I know this sounds weird.
Dr. JJ Thomas:So here, and then here. So it's a good thing to talk about with your patients, like, I do talk about floor variation with my patients. If they're new at this, I tell them, please do this on the hardwood or the tile first. Don't try this on, like, carpet or, especially not like a not especially not a foam pad. Like, the wrestling mat is much more challenging than the hardwood on this.
Dr. JJ Thomas:So consider that. But if they can't do that, but you still want them heavily loaded and in that stretch position, you can put them against a wall, or, like, up on a table. So this isn't high enough, but essentially hopefully, you guys can see this. Like, I'm just gonna do it against this wall. So essentially, you can still put their I'm so sorry for having my back to you.
Dr. JJ Thomas:You can put their foot up on the wall, straighten the knee, and then twist. So now they're not working the balance component as much, right? Essentially we're in that same position, but they don't have to balance as much. So if you find that they're limited by the balance component, first of all, that that We should note that there's something we can work on there, and we should work on it. But if we still want them loaded and in that very intense stretched neural tension position, loaded and standing, then you can make a modification and do it against the wall.
Dr. JJ Thomas:So that's it. That was my that was my nuggets for today. Thank you for spending your time with me. I hope I hope it was valuable to you. I really enjoyed the time with you, and I appreciate all the comments you guys have made, in the past.
Dr. JJ Thomas:Please continue to comment. If you have any questions or comments, leave them in the comments below. And, I look forward to hearing from you more. Make sure you subscribe so that I so you don't miss anything, and, we can continue to develop this work together. Take care.