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Piriformis syndrome has been recognised as a supply of buttock and leg pain for Eighty years, but its still a controversial diagnosis. The pain sensation is thought to be related to the proximity from the muscle to the sciatic nerve in the buttock and irritation or compression of the nerve have been suggested as causes. Physiotherapists diagnose and treat piriformis syndrome regularly, as it can certainly often be mistaken for sciatica.

The piriformis muscle Latin for pear-shaped is among the smaller central buttock muscles, passing as a flat layer from the front from the sacral region and ending by its insertion into the top of the femoral greater trochanter, the big bony structure easily found using the hand on the outside of the thigh close to the hip. Its actions vary using the position from the hip joint and can either be external rotation or abduction from the hip. The anatomical relationship between the sciatic nerve and the piriformis muscle is subject to some variation in individuals, using the sciatic nerve commonly passing while watching muscle but in others the nerve can pierce muscle or pass between two bellies.

There are no clear causes for piriformis syndrome which seems to accompany other lumbar or pelvic pains. Direct trauma to the area can cause bleeding and scarring round the nerve and the muscles, with consistent pressure to the buttock perhaps affecting the nerves function. The syndrome can also be of an increased lordotic posture, hip replacement or vigorous activity and mimics lower back pain syndromes for example sciatica. Physiotherapists diagnose and treat piriformis syndrome on purely clinical grounds as there are no agreed diagnostic criteria, imaging or any other tests.

Back pain and leg pain can be lumbar or sacro-iliac in origin, but piriformis syndrome is really a poorly recognised cause of these symptoms, simulating the image of the disc protrusion or joint arthritic change. Trochanteric bursitis occurs over the part of the trochanter which also carries the insertion of the piriformis tendon, linking both syndromes clinically. Physiotherapy examination clinically will note acute trigger point tenderness within the buttock, a reduction in hip lateral rotation, reduced power and pain on testing of hip abductor and lateral rotator strength and difficulty sitting on the affected buttock.

Physiotherapists use many treatment modalities to improve piriformis symptoms but partly due to the possible lack of a definite diagnosis there isnt any agreed scientific treatment approach. Physios check the findings for example tightness within the piriformis, hip external rotator and adductor muscles, hip abductor weakness, sacro-iliac and lumbar dysfunction, externally rotated hip in walking, apparent leg shortening and a shorter stride length.

The physiotherapist may find tightness in the piriformis and hip muscles and institute cure regime of stretches after loosening up the hip muscles. To stretch the piriformis the patient depends on their back, bends in the hip to 90 degrees and moves the hip across the body using the opposite hand, holding at the end of the stretch. A house exercise programme of stretches is placed for regular performance, using the stretches being carried out every couple of hours in the more acute episodes. The Physio may find the piriformis muscle is stretched rather than tight, leading them to work on strengthening up and stretching the opposing tight structures.

Direct manipulation of the most tender spot in the central area of the buttock is a very useful treatment technique popular by physiotherapists. Longitudinal or transverse mobilisation techniques are employed about the muscle, with stronger pressure and longer periods being used as the pain reduces. The Physio will treat any contributory dysfunction of the lumbar spine or sacro-iliac joint. Taking this conservative approach is often helpful in reducing symptoms of this syndrome using mobilisation treatment, deep injections, changing typical activities and postures and setting a stretching regime.






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