Everything about Piriformis Syndrome Physiotherapy Treatment

Piriformis Syndrome

 • Overview

Sciatica-type symptoms can be produced by compression of the sciatic nerve as it passes through the piriformis muscles (as it does in approxi mately 15% of the population). The patient presents with sciatica but no history of back pain. This is a history that can be found in patients with a back problem that is producing sciatic-type leg symptoms. In those cases if treatment fails it is worth attempting stretching of the piriformis muscle if it appears to be tight 

 • Subjective Findings

Onset This is gradual with no known cause and occure most commonly

 • Duration 

The patient will have suffered symptoms for at least several weeks, if not maths. This is partly due to the insidious nanare of on and also partly due to the fact that this condition is normally confl with a back problem It is often therefore treated incorrectly, and thus unsuccessfully, for sex time before being correctly identified 

 • Frequency 

This will in all likelihood, be the first time that the patiene has experienced the particular symptoms, although there may have been a few previous episodes over a period of 1 to 2 years, with increasing spread of symptoms into the leg. It is important to check the patient's hack pain history very carefully, as it may provide useful ches that will help to differentiate between this condition and other conditions that might produce server cool imitation in the sciatic distribution

 • Area of Symptoms Symptoms 

are fell in the buttock and in the area of sciatic herve distribution in the leg the back of the thigh), as well as the posterior or lateral aspect of the lower leg 

 • Type of Symptoms 

Pain is the main presenting symptom, although the patient can also have paraesihesis or numbness in the ing. There should be to back pain en if there is pain or discomfort in the buttock .

Miscellaneous Coughing and straining should not produce the symptoms.

 • Active Movements 

There is usually no limitation of movement however, the patient may get some discomfort in the buttock at end-rane of internal rotation of the hip. Active straight leg raising may produce the patient's typical leg symptom.

 • Passive Movements 

Pain  is experienced at end range of al rotation of the hip and muscle spasm may be found to resist this movement at the end of range Passive straight leg raising may produce buttock and leg pain, which is resisted in the supine lying position with the patient's knees flexed initially, so that the hip is flexed. Then, while the hip is kap feed extend the knee slowly 

 • Resisted Movements 

Good strength levels should be present on all movements of the hip and knee, however, pain may be produced on isometric resisted external rotation of the hip.

 • Palpation 

Some ill-defined discomfort may be produced on deep pal pation of the buttock, but this must be compared carefully with the other de as the depth of palpation required may produce pain in the normal subject. The parient must be able to make a definite differentiation be tween the levels of discomfort in the two buttocka for the finding to be considered positive.

 • Special test

 • Piriformis stretch test

Finally, two maneuvers which put a stretch on the piriformis muscle can also be used to test for piriformis pain.

Having a partner rotate your hip and leg inwards while you lie on your back with your knees straight can produce pain, as can lying on your unaffected side and rotating the painful side across your body with your knee bent.

 • Physiotherapy Treatment

Any activity that is known to produce the patient's typical symptoms should be avoided for a few days and ice should be applied to the buttock, preferably in several doses approximately 1 hour apart  and repeated three or four times during the day. 

Modalities such as interferential therapy and transcutaneous electrical nerve stimulation can help to decrease localized discomfort in the back. 

The patient can then be progressed onto heat applied to the area of the buttock in order to promote muscle relaxation.

Gentle stretches can be started for the hamstring and gluteal muscles.

Specific piriformis muscle stretches can be performed, the simplest of which is carried out in long sitting with the affected leg crossed over the thigh of the unaffected leg. The patient then applies pressure on the outer aspect of the knee to take the knee towards the chest (ie, into flexion and medial rotation).

 A program of general lower extremity stretches should also be provided for the patient, a tightness in the piriformis muscle is usually associated with a general lack of flexibility in the trunk and extremities.

The patient can be further progressed to light to moderate resisted exercises for all movements of the hip, which should then be followed by appropriate stretches for each muscle group. 

Proprioceptive neuromuscular facilitation techniques in the patterns of hip lateral rotation combined with other hip movements can be used, followed by the application of contract relax techniques to gain further stretch of the muscle. 

Patients can be taught to apply contract-relax techniques for themselves at home by first applying a flexion and medial rotation stretch to the affected hip, then main training a low-intensity isometric contraction of the lateral rotators, which in turn is followed by further stectch into medial rotation

In progress

As their symptoms ease the patient can be placed on a gym program for general lower extremity exercises. The patient must continue with the stretching  exercises, particularly during and after the exercise program, as the affected musculaines will then be warm, and hence more pliable Ap plying gentle, painless, and prolonged stretches to the muscles as they cool down after exercise can often produce good long-term effects. The patient must be advised to come with the stretching routine (specifically the carty piriformis munces) a regular inervals for an indefinite pe nod, even after the signs and symptoms have cleared