“If I sit too long my left buttock begins to burn.” My entire leg hurts when I walk more then 30 minutes or more.” “It feels like a knife is stabbing me in my lower back.” “Im beginning to feel numbness along the side my leg.” These are just a few of the reported complaints associated with Piriformis Syndrome.
What is Piriformis Syndrome?
The National Institute of Neurological Disorders and Stroke (NINDS) produces informative health-related material about Piriformis Syndrome. NINDS classifies piriformis syndrome as a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve-the largest nerve in the body. Physical Therapists often see patients with this complaint in the clinic. The piriformis muscle is a narrow muscle located in the buttocks. Compression of the sciatic nerve causes pain-frequently described as tingling or numbness-in the buttocks and along the nerve, often down to the leg. The pain may worsen as a result of sitting for a long period of time, climbing stairs, walking, or running. The common causes of this syndrome are sustained piriformis muscle contraction and fibrotic muscle changes secondary to direct trauma, as in posterior dislocation of the hip joint . Multiple trauma over time can produce fibrous adhesions of other muscles along the sciatic nerve as well. Hamstring tendonitis, herniation of a lumbar disc and other related diseases can contribute to piriformis syndrome. The patient can also get musculoskeletal impairments in the, gluteus maximus, ankle, and foot.
What is the Treatment?
Patients coming to physical therapy with piriformis syndrome are instructed in therapeutic stretching exercises for the piriformis, posterior fascia, gluteus maximus and related muscle groups. It is not unusual to find weakness in the major muscles of the leg so the plan of care would include therapeutic strengthening exercises. Manual therapy techniques are beneficial for mobilizing and relaxing a muscle that could be in constant spasm. Physical Therapists can also choose to use cryotherapy, diathermy, and electrical stimulation for pain control or for neuromuscular education. Temporary cessation of running, bicycling or the activities that aggravate the muscle may be advised. Cross training recommendations are given to the patient while the muscle and nerve recovers.
What is the prognosis?
According to the NINDS, the prognosis for most individuals with piriformis syndrome is good. Once symptoms of the disorder are addressed, individuals can usually resume their normal activities. In some cases, exercise regimens may need to be modified or ergonomic corrections may need to be made. It is important that biomechanical problems of the back, hip, knee and foot are addressed. This can reduce the likelihood of recurrence or worsening of symptoms. Within the NINDS research programs, piriformis syndrome is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as piriformis syndrome.
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