Piriformis Syndrome
There are numerous treatments for piriformis syndrome but none are scientifically valid, particularly as accurate diagnosis is not clear. Physiotherapists concentrate on finding physical signs such as a tight piriformis, tight hip external rotators and adductors, weakness of the hip abductors, stiffness of the sacro-iliac joint and lumbar spine problems. The patient may walk with the hip externally rotated, have an apparent leg shortening and a shortened stride.
There may be tightness in the hip and piriformis muscles and in these cases the physiotherapist will start a programme of muscle stretches after warming up the hip muscles. Piriformis stretches are taught in lying, the hip positioned in 90 degrees, stretching the thigh over the other leg and pulling it with the other hand. The patient will need to follow a home exercise programme of muscle stretches, up to every few hours in cases of an acute nature. Stretching the piriformis may not be appropriate if the muscle is loose or stretched, in which case muscle strengthening and stretching of the opposing stiff areas is used.
Local manipulation is a common treatment directly over the most painful point in the buttock, which can be very tender indeed. Transverse or longitudinal mobilisations over the muscle is the technique used, maintaining the pressure steadily for up to 10 minutes initially. Treatment of the back and sacro-iliac joints is important to address any dysfunction which might contribute. Modifying posture and activity, muscle injections, mobilisations and stretching are commonly successful in reducing symptoms. In resistant cases surgery to the muscle or the tendon at the greater trochanter may be contemplated.
Piriformis Syndrome
OTHER RELATED INFORMATION
There are numerous treatments for piriformis syndrome but none are scientifically valid, particularly as accurate diagnosis is not clear. Physiotherapists concentrate on finding physical signs such as a tight piriformis, tight hip external rotators and adductors, weakness of the hip abductors, stiffness of the sacro-iliac joint and lumbar spine problems. The patient may walk with the hip externally rotated, have an apparent leg shortening and a shortened stride.
There may be tightness in the hip and piriformis muscles and in these cases the physiotherapist will start a programme of muscle stretches after warming up the hip muscles. Piriformis stretches are taught in lying, the hip positioned in 90 degrees, stretching the thigh over the other leg and pulling it with the other hand. The patient will need to follow a home exercise programme of muscle stretches, up to every few hours in cases of an acute nature. Stretching the piriformis may not be appropriate if the muscle is loose or stretched, in which case muscle strengthening and stretching of the opposing stiff areas is used.Local manipulation is a common treatment directly over the most painful point in the buttock, which can be very tender indeed. Transverse or longitudinal mobilisations over the muscle is the technique used, maintaining the pressure steadily for up to 10 minutes initially. Treatment of the back and sacro-iliac joints is important to address any dysfunction which might contribute. Modifying posture and activity, muscle injections, mobilisations and stretching are commonly successful in reducing symptoms. In resistant cases surgery to the muscle or the tendon at the greater trochanter may be contemplated.
Piriformis Syndrome
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