Presentation is loading. Please wait.

Presentation is loading. Please wait.

An Alternative Treatment Approach to Piriformis Syndrome

Similar presentations


Presentation on theme: "An Alternative Treatment Approach to Piriformis Syndrome"— Presentation transcript:

1 An Alternative Treatment Approach to Piriformis Syndrome
Korey Pieper, DPT, OCS Marie Potter, DPT, OCS, ATC Rick J Rafael, DPT, OCS, CSCS Jason Tonley, DPT, OCS Kaiser Permanente West Los Angeles Orthopaedic Residency Program September 2008

2 Piriformis Syndrome Defined
“Neuritis of the branches of the sciatic nerve, caused by pressure of an injured or irritated piriformis muscle1.”

3 Symptoms Radiating pain from the low back down over the sacrum into the buttocks and hip region, as well as down the posterior portion of the upper leg to the popliteal region1. Image from bp1.blogger.com

4 Anatomy image from

5 Possible Causes of Piriformis Syndrome
Anatomical variation L/S dysfunction Muscle tightness and/or spasm Overuse Post surgical injury SIJ dysfunction Trauma/fall

6 Differential Diagnosis
Differential Diagnosis of Hip pain7,8: Intra-articular & Extra-articular (Often Managed Operatively) : Labral Tears Loose Bodies Femoroacetabular Impingement (FAI) Hypermobility Capsular Laxity Ligamentum Teres Tear Chondral Damage Snapping Hip Syndrome IT Band Syndrome Greater Trochanteric Bursitis Gluteal Tendon Injury

7 Differential Diagnosis
Differential Diagnosis of Hip pain7,8: Extra-articular Causes (Often Managed Non-Operatively): Femoral Neck Stress Fracture Adductor Strain Piriformis Syndrome Sacroiliac Joint Syndrome Tendonitis (hip flexors, abductors, adductors)

8 Differential Diagnosis
Other Competing Diagnosis: Lumbar Facet Syndrome Lumbar Disc Herniation Nerve entrapment Ischial Tuberosity Bursitis Lumbar radiculopathy Spinal stenosis Spondylolisthesis Osteoarthritis

9 Common Treatment Options
Injections L/S stabilization exercises Mobilization/manipulation L/S Mobilization/manipulation SI joint Foot orthotics Soft tissue mobilization Strengthening Stretching Surgical / arthroscopic release Ultrasound

10 Common assumption guiding treatment approaches
The piriformis is shortened or in “spasm” and is compressing the sciatic nerve

11 Purpose of study To create a case series using an alternative treatment approach to piriformis syndrome

12 Inclusion Criteria: Objective Exam
Unilateral pain from lower lumbar/buttock region to the leg Symptoms not reproduced from lumbar, SI joint, and/or hip joint examinations

13 Inclusion Criteria: Objective Exam
Lumbar Exam Negative AROM with OP Negative PA exam Neurological testing negative for nerve root lesion SIJ Exam Negative cluster Hip Exam Negative ROM, excluding quadrant

14 Inclusion Criteria: Objective Exam
Reproduction of symptoms with: Palpation of piriformis muscle Piriformis stretch test FAIR Test Demonstrates movement dysfunction of ADD and/or IR and reproduction of symptoms with step down test Decreased reproduction of symptoms with corrected movement during step down test

15 Objective Exam Patient to fill out disability questionnaires:
Oswestry Disability Index Lower Extremity Functional Scale

16 Treatment Approach Isolated strengthening for hip extensors, abductors, and external rotators Functional movement re-education for decreasing hip adduction and internal rotation NO!!!!! Stretching Soft tissue massage Modalities

17 Treatment Approach Examples
Hip strengthening: Clams Bridging Prone hip extension Quadruped hip extension Hip abduction

18 Treatment Approach Examples
Movement Re-education: Postural correction Sit to stand transitions Single leg sit to stands Lunges Plyometrics if indicated

19 Patient Data 7 Patients Age: mean 56 (range 31 - 69)
Duration of symptoms: 197 days (range 45 – 730) # of visits: 5 (range 2-8) Duration of visits: 9 weeks (range 3-16)

20 Average LE Functional Scale
Range: initial (37-70) discharge (54-80)

21 Average VAS (Pain Scale)
Range: initial (6-10/10) discharge (0-4/10)

22 Analysis Movement assessment allowed proper physical therapy diagnosis and treatment Patient’s can have multiple positive tests, but movement reproduces primary pain complaint Ceiling effect of questionnaires affects data analysis

23 Future Research Prevalence of movement dysfunction in patient’s diagnosed with piriformis syndrome Most effective treatment modality for movement dysfunction: strength training vs. movement re-education

24 Conclusion Movement re-education and strengthening can be a successful way to treat piriformis syndrome when a patient presents with a coordination deficit.

25 References Edwards, F.O.: Piriformis syndrome. Academy of Applied Osteopathy. Yearbook, 1962, pp Parizale JR, Hudgins TH, Fishman LM: The Piriformis Syndrome. Am J. Orthrop, 1996:25: Parizale JR, Hudgins TH, Fishman LM: The Piriformis Syndrome A Review. Paper.” The. Am J of Orthop. 2002:25:1-11 Bird JW: Piriformis Syndrome. Oper Tech Sports Med Mayrand N, Fortin J, Descarreaux M, Normand MC. Diagnosis and management of posttraumatic piriformis syndrome: a case study. J. Manipulative Physiol Ther Jul-Aug;29(6):486-91 Keskula DR, Tamburello M: Conservative Management of Piriformis. Syndrome. J Athl Train. 1992; 27(2):102, 104, , 110 Lisa M Tibor, Jon Sekiya. Differential Diagnosis of Pain Around the Hip Joint. The Journal of Arthroscopic and Related Surgery. 2008;19:1-15 Michael K Shindle, Benjamin G Domb, Bryan T Kelly. Hip and Pelvic Problems in Athletes. Oper Tech Sports Med. 2007; 15:


Download ppt "An Alternative Treatment Approach to Piriformis Syndrome"

Similar presentations


Ads by Google