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Piriformis Syndrome

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Piriformis Syndrome

Overview Video

Introduction

Piriformis syndrome is a musculoskeletal condition where the sciatic nerve is sensitised around the Piriformis muscle at the greater sciatic notch.

 

Piriformis syndrome is estimated to account for 6% cases of low back pain and it can be described as primary or secondary. Primary Piriformis syndrome has an anatomical cause, with variations such as a split piriformis muscle, split sciatic nerve, or the path of nerve path runs through the muscle (depicted in the adjacent image). Among patients with this condition, fewer than 15% of cases have primary causes. Secondary piriformis syndrome occurs as a result of a precipitating cause, including injury, repetitive motion, maintaining positions leading to local ischemia (blood flow restriction). It is commonly reported that prolonged: sitting; climbing stairs; walking; cycling or running can increase symptoms.

Signs & Symptoms

  • Pain in the buttock on the same side as the Piriformis lesion.
  • Tenderness over the sciatic notch in almost all instances.
  • The buttock pain can radiate into the hip, the posterior aspect of the thigh and the proximal portion of the lower leg.
  • There may be an aggravation of pain with activity, prolonged sitting or walking, squatting, hip adduction and internal rotation and manoeuvres which increase the tension of the Piriformis muscle.
  • 50% of the cases are caused by falling onto the buttocks, leading to inflammation of soft tissue, muscle spasms, or both.

Treatment & Management

  • Life style modifications are vital in managing Piriformis syndrome and the physiotherapist at pure are highly skilled to advice on sitting, running, cycling modifications.
  • Flexibility and strengthening of the Piriformis and abductor and adductor muscles is very important in Piriformis syndrome management.
  • There is limited good quality research but clinically, patients find a combination of muscle flexibility, strengthening, soft tissue work, myofascial release, muscle energy techniques, and  thrust techniques to be effective.

 

Surgical Options (In severe cases where conservative management has been unsuccessful).

  • Release of Piriformis muscle and decompression of the sciatic nerve.
  • Local anaesthetic and/or steroid injection into the piriformis muscle.

References

Fishman, L. M., Dombi, G. W., Michaelsen, C., Ringel, S., Rozbruch, J., Rosner, B., & Weber, C. (2002). Piriformis syndrome: diagnosis, treatment, and outcome—a 10-year study. Archives of physical medicine and rehabilitation, 83(3), 295-301.

 

Hopayian, K., Song, F., Riera, R., & Sambandan, S. (2010). The clinical features of the piriformis syndrome: a systematic review. European Spine Journal, 19(12), 2095-2109.

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