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Piriformis Syndrome

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Introduction

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

Information Video

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.

Causes

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). Secondary piriformis syndrome occurs as a result of a precipitating cause, including injury, repetitive motion, maintaining positions leading to local ischemia (blood flow restriction). 50% of the cases are caused by falling onto the buttocks, leading to inflammation of soft tissue, muscle spasms, or both.

Prevalence

Piriformis syndrome is estimated to account for 6% cases of low back pain and it can be described as primary or secondary. Among patients with this condition, fewer than 15% of cases have primary causes.

Assessment & Diagnosis

At Pure, your Physio will take a detailed history of your symptoms followed by a thorough clinical examination to establish an informed hypothesis of the structures contributing to your pain and provide a working diagnosis. A fast and accurate diagnosis will mean that the most effective treatment and management plan can be implemented straight away, helping to achieve optimal outcomes. Your Physiotherapist will want to know how your condition is effecting you day to day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Regular re-assessment will ascertain if your are making progress towards your goals and will allow adjustments to your treatment to be made.

Self-Management

Your Physiotherapist will educate you about your condition and will recommend lifestyle modifications which will be vital in managing Piriformis syndrome. They can offer advice on sitting, running and cycling modifications, allowing you to continue with your normal activities in ways which may help your avoid aggravating your symptoms. You may also be given advice on medication in the form of non-steroidal inflammatory drugs (NSAIDs) which can help reduce your symptoms and allow you to be more functional.

Physiotherapy

Our clinicians are skilled in exercise prescription and will design a bespoke rehabilitation plan comprising of flexibility and strengthening exercises. 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, all of which your Physiotherapist may use, based on your presentation. Acupuncture may also be used as an additional adjunct, helping to reduce pain and facilitate functional restoration. Your Physiotherapist will provide ongoing support so that you are able to effectively manage your symptoms and prevent re-occurrence.

Escalation of Treatment

In severe cases where conservative management has been unsuccessful, other more intrusive treatment options may be explored and this will be discussed at the appropriate time. Local anaesthetic and/or steroid injection into the piriformis muscle may offer symptom relief and allow exercise rehabilitation to be implemented. Surgical release of Piriformis muscle and decompression of the sciatic nerve is another option.

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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