Piriformis Syndrome Treatment by Physiotherapists
Physiotherapists and other manual therapists recognize piriformis syndrome as a cause of buttock and leg pain that sometimes mimic sciatic symptoms. The piriformis muscle is very close to the sciatic nerve that runs through the buttock and compression or irritation of the nerves have been presented as reasons for the pain. Piriformis syndrome is not universally recognized outside of physical therapy and other professions, but the diagnosis is gaining credibility.
The piriformis muscle is flat and small, located in the center of the buttock, having their origin in the sacral area and insertion in the upper part of the greater trochanter of the thigh, the bony prominence easily felt in the side of the leg below of the hip. It becomes either leg moves outward from the body or the thigh, depending on the position of the hip. The sciatic nerve and piriformis muscle varied in their structure and position in the buttocks. Normally, the muscle behind the nerve, but in some cases, the piriformis is divided into two parts with the sciatic nerve that passes between them.
There is no clear causal factors for piriformis syndrome that seems to accompany other lumbar or pelvic pain. Blunt trauma to the area can cause bleeding and scarring around the nerve and muscle, consistent with pressure on the buttock may affect the function of nerve. The syndrome can also be associated with increased lordotic posture, hip replacement or vigorous activity mimics and back pain syndromes such as sciatica. Physiotherapists diagnose and treat piriformis syndrome purely on clinical grounds as there is no agreement on the criteria for diagnosis, imaging and other tests.
Piriformis syndrome is often not considered a cause of low back and leg pain, but you can simulate the compression of the sciatic nerve, giving symptoms similar to back pain with or L5 nerve compression S1 disk or sets of changes. Trochanteric cases of bursitis can be connected to this syndrome as a muscle inserted into the trochanter. Clinical physical examination is intense pain during the piriformis trigger point in the buttock, the reduction of lateral rotation of the hip, pain and weakness in the hip resisted the abduction and lateral rotation and a difficulty sitting in the buttocks affected.
Physiotherapists use many methods to improve treatment of piriformis symptoms, but partly because of a lack of a clear diagnosis, no agreement on the treatment scientific approach. Physiotherapists verify the results, such as tightness in the piriformis, hip external rotator and adductor muscles, hip abductor weakness, sacro-iliac and lumbar dysfunction, hip externally rotated in the foot, reduction in apparent leg and a shorter stride duration.
If the physiotherapist believes that the piriformis and other muscles are tight then the treatment is to loosen up the hip followed by stretches of the muscle. Stretch the muscle is done in lying with the hip flex, pulling in the hip adduction and internal rotation. A home stretching program is important with regular stretching every two or three hours in the acute phase. If the piriformis is more flexible than expected, the physicist, may exercise the muscle to strengthen it up and stretch tight structures that are opposed to this trend.
Local manipulation is a treatment directly on the most painful in the buttock, which can be very tender indeed. Transverse and longitudinal mobilizations in the muscle is the technique used, maintaining the constant pressure of up to 10 minutes initially. Treatment of back and sacro-iliac joints is important to address any dysfunction that may contribute. Changing the position and activity, muscle injections, stretching and mobilizations are usually successful in reducing the symptoms. In cases resistant to surgery for muscle or tendon in the greater trochanter can be contemplated.
