The Chiropractic Examination For Piriformis Syndrome (Piriformis Syndrome)

Piriformis Syndrome

The chiropractic approach to diagnosing Piriformis Syndrome includes a full evaluation of your spine and pelvis and the related musculature. A functional, orthopaedic and neurological examination is also performed for Piriformis Syndrome.

• Dysfunction in the sacroiliac joints is one contributory factor, which can lead to neuromuscular dysfunction causing weakness in the other muscles in the area.
• Several activities are said to aggravate the pain in a Piriformis Syndrome such as walking, sitting, climbing stairs, performing squats and running, but they are so general and therefore unreliable for diagnostic purposes.
• A possible sign of a tight piriformis muscle is having one foot pointing outwards more than the other when you lie relaxed on your back.
• Direct palpation (touch) of the muscle reveals a taut and tender muscle, often with trigger points present causing referred pain locally or down the leg.
• Either resisted external rotation or passive internal rotation of the hip may increase the pain.
• Resisted muscle testing can be used to see if a tendinitis is present. But since the piriformis works in conjunction with several other muscles in the buttock area such as the Quadratus femoris, Obturator internus, Superior- and Inferior gemellus, it is difficult to be specific.
• If there are neurological signs and symptoms present several tests are performed to rule out a disc injury. Some of these tests are modified to find out if the sciatic nerve is being affected and irritated by the taut piriformis muscle, such as Bonnet’s test.

The diagnosis is quite straight forward and there is no need for imaging such as x-ray, CT- or MRI in most cases. The diagnosis is made from the clinical tests.

When neurological symptoms are present the chiropractor will do a full neurological examination in order to identify the cause of the symptoms. Disc herniations are the most common cause, but sometimes, although rarely, more sinister causes have to be excluded. In those cases a MRI scan is requested.

Once a specific and accurate diagnosis has been made the treatment can start.

Piriformis Syndrome

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Treatment and Prevention of Piriformis Syndrome (Piriformis Syndrome)

Piriformis Syndrome

Treatment of Piriformis Syndrome

The RICER regimen should be implemented for at least the first 48 to 72 hours after injury.

After diagnosis, treatment will be started and an ice pack or ice massage may help reduce inflammation.

Rest is usually recommended and, at least, a two or three week break from all sports or activities that cause pain.

Anti-inflammatory medications like ibuprophen and naproxen are helpful in treating the pain and inflammation caused by the nerve irritation.

Corticosteroid injections with an anesthetic medication may be injected into the piriformis muscle.

Oral cortisone may also be prescribed to reduce the sciatic nerve inflammation.

Heat Packs ease muscle spasms and reduce the inflammation.

TENS is helpful and, sometimes, a low voltage current to the area is combined with a cold application.

Ultra-sound Treatments provide deep heating and are ideal preparation for deep massage.

Deep massage and specialized soft tissue mobilization may be useful.

Custom foot orthotics can help with both treatment and prevention. Gait correction can reduce the use of the piriformis muscle, allowing the muscle to relax and begin to heal.

A Botox injection may be used which actually paralyzes the piriformis muscle, causing it to relax, taking pressure off the sciatic nerve. Both types A and B botulinum toxin have been used.

The injection is done using either Ultra-sound or a CAT 9 (computerized axial tomography) for guidance. Both toxins are effective and pain relief usually lasts for more than 3 months.

During this time, a stretching program may be started which may correct the problem.

Prevention of Piriformis Syndrome

The more you can do to prevent this syndrome, the better off you will be. The most important things to remember are:

A thorough and correct warm-up to prepare the muscles and tendons for activity. Without a warm-up, muscles are stiff and there is reduced blood flow to the hip area, making it more injury-prone.

Let muscles rest and recover after any strenuous activity.

Strengthening and conditioning the muscles of the hips, buttocks, lower back will help prevent this disorder.

Keep muscles and tendons supple and flexible through a structured stretching routine.

Piriformis Syndrome

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