Piriformis Syndrome: Treatment and Rehabilitation
editThe piriformis muscle attaches from the front of the sacral vertebrae, the sacrotuberous ligament, and the upper edge of the greater sciatic foramen. This muscle goes through the greater sciatic notch and attaches on the superior surface of the greater trochanter of the femur [1]. Piriformis syndrome is a pain caused by an injury of the piriformis muscle that compresses the sciatic nerve. Treatments include combinations of injections, physical therapy and surgery. Stretching is the key element in rehabilitation in order to prevent reoccurring pain [2].
Injections
editInjections of a local anesthetic, corticosteroid, and botulinum toxin type B (BTX) have been used in conjunction with physical therapy since the relief from pain is only temporary with injections [3]. BTX causes the muscles to become paralyzed by inhibiting the presynaptic release of acetylcholine at the neuromuscular junction. An effective combination of therapy paired injection with physical therapy. An ethyl chloride spray and injection of lidocaine into the piriformis muscle brings temporary pain relief, which allows for the muscle to be manipulated without too much discomfort.
Physical Therapy
editPhysical therapy for piriformis syndrome includes strength exercises and stretches.
Stretching
editStretching is recommended every 2 to 3 waking hours. For optimal stretching capacity, move the hip joint capsule anteriorly and posteriorly [4]. The muscle is manually stretched by applying pressure perpendicular to the long axis of the muscle and parallel to the surface of the buttocks until the muscle is relaxed [3]. Another stretching exercise is to lie on the side opposite of the pain with the hip and knee of the upper leg flexed and adducted towards the ground while the torso is rotated so that the back of the upper shoulder touches the ground [5].
Strengthening
editMuscle strengthening involves working on the hip abductors, external rotators and extensors [6]. This treatment involves three phases: non-weight bearing exercises, weight bearing exercises, and ballistic exercises. The purpose of non-weight bearing exercises is to focus on isolated muscle recruitment [6]. Ballistic and dynamic exercises consists of plyometrics.
Surgery
editWhen physical therapy has not shown any improvement, surgery is performed to release the piriformis tendon and sciatic neurolysis [7].
- ^ Klein, M. J. (2012). Physical medicine and rehabilitation for piriformis syndrome. In C. Lorenzo (Ed.),Medscape Reference: Drugs, Diseases and Procedures.
- ^ Klein, M. J. (2012). Physical medicine and rehabilitation for piriformis syndrome. In C. Lorenzo (Ed.),Medscape Reference: Drugs, Diseases and Procedures.
- ^ a b Steiner, C.; Staubs, C.; Ganon, M.; Buhlinger, C. (1987). "Piriformis syndrome: pathogenesis, diagnosis, and treatment". J Am Osteopath Assoc. 87 (4): 318–23. PMID 3583849.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Klein, M. J. (2012). Physical medicine and rehabilitation for piriformis syndrome. In C. Lorenzo (Ed.),Medscape Reference: Drugs, Diseases and Procedures.
- ^ Fishman, LM.; Dombi, GW.; Michaelsen, C.; Ringel, S.; Rozbruch, J.; Rosner, B.; Weber, C. (2002). "Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study". Arch Phys Med Rehabil. 83 (3): 295–301. PMID 11887107.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b Tonley, JC.; Yun, SM.; Kochevar, RJ.; Dye, JA.; Farrokhi, S.; Powers, CM. (2010). "Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report". J Orthop Sports Phys Ther. 40 (2): 103–11. doi:10.2519/jospt.2010.3108. PMID 20118521.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Benson, ER.; Schutzer, SF. (1999). "Posttraumatic piriformis syndrome: diagnosis and results of operative treatment". J Bone Joint Surg Am. 81 (7): 941–9. PMID 10428125.
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