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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,Piriformis Syndrome Defined,“Neuritis of the branches of th
2、e sciatic nerve, caused by pressure of an injured or irritated piriformis muscle1.”,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 ,Anatomy,image from ,Possib
3、le Causes of Piriformis Syndrome,Anatomical variation L/S dysfunction Muscle tightness and/or spasm Overuse Post surgical injury SIJ dysfunction Trauma/fall,Differential Diagnosis,Differential Diagnosis of Hip pain7,8: Intra-articular & Extra-articular (Often Managed Operatively) : Labral Tears Loos
4、e Bodies Femoroacetabular Impingement (FAI) Hypermobility Capsular Laxity Ligamentum Teres Tear Chondral Damage Snapping Hip Syndrome IT Band Syndrome Greater Trochanteric Bursitis Gluteal Tendon Injury,Differential Diagnosis,Differential Diagnosis of Hip pain7,8: Extra-articular Causes (Often Manag
5、ed Non-Operatively): Femoral Neck Stress Fracture Adductor Strain Piriformis Syndrome Sacroiliac Joint Syndrome Tendonitis (hip flexors, abductors, adductors),Differential Diagnosis,Other Competing Diagnosis: Lumbar Facet Syndrome Lumbar Disc Herniation Nerve entrapment Ischial Tuberosity Bursitis L
6、umbar radiculopathy Spinal stenosis Spondylolisthesis Osteoarthritis,Common Treatment Options,Treatment Options:2,3,4,5,6 Injections L/S stabilization exercises Mobilization/manipulation L/S Mobilization/manipulation SI joint Foot orthotics Soft tissue mobilization Strengthening Stretching Surgical
7、/ arthroscopic release Ultrasound,Common assumption guiding treatment approaches,The piriformis is shortened or in “spasm” and is compressing the sciatic nerve,Purpose of study,To create a case series using an alternative treatment approach to piriformis syndrome,Inclusion Criteria: Objective Exam,U
8、nilateral pain from lower lumbar/buttock region to the legSymptoms not reproduced from lumbar, SI joint, and/or hip joint examinations,Inclusion Criteria: Objective Exam,Lumbar Exam Negative AROM with OP Negative PA exam Neurological testing negative for nerve root lesionSIJ Exam Negative clusterHip
9、 Exam Negative ROM, excluding quadrant,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 symp
10、toms with corrected movement during step down test,Objective Exam,Patient to fill out disability questionnaires:Oswestry Disability IndexLower Extremity Functional Scale,Treatment Approach,Isolated strengthening for hip extensors, abductors, and external rotators Functional movement re-education for
11、 decreasing hip adduction and internal rotation NO! Stretching Soft tissue massage Modalities,Treatment Approach Examples,Hip strengthening: Clams Bridging Prone hip extension Quadruped hip extension Hip abduction,Treatment Approach Examples,Movement Re-education: Postural correction Sit to stand tr
12、ansitions Single leg sit to stands Lunges Plyometrics if indicated,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),Average LE Functional Scale,Range: initial (37-70) discharge (54-8
13、0),Average VAS (Pain Scale),Range: initial (6-10/10) discharge (0-4/10),Analysis,Movement assessment allowed proper physical therapy diagnosis and treatment Patients can have multiple positive tests, but movement reproduces primary pain complaint Ceiling effect of questionnaires affects data analysi
14、s,Future Research,Prevalence of movement dysfunction in patients diagnosed with piriformis syndrome Most effective treatment modality for movement dysfunction: strength training vs. movement re-education,Conclusion,Movement re-education and strengthening can be a successful way to treat piriformis s
15、yndrome when a patient presents with a coordination deficit.,References,Edwards, F.O.: Piriformis syndrome. Academy of Applied Osteopathy. Yearbook, 1962, pp 39-41. Parizale JR, Hudgins TH, Fishman LM: The Piriformis Syndrome. Am J. Orthrop, 1996:25:819-823. Parizale JR, Hudgins TH, Fishman LM: The
16、Piriformis Syndrome A Review. Paper.” The. Am J of Orthop. 2002:25:1-11 Bird JW: Piriformis Syndrome. Oper Tech Sports Med 2005 13 71-79 Mayrand N, Fortin J, Descarreaux M, Normand MC. Diagnosis and management of posttraumatic piriformis syndrome: a case study. J. Manipulative Physiol Ther. 2006 Jul
17、-Aug;29(6):486-91 Keskula DR, Tamburello M: Conservative Management of Piriformis. Syndrome. J Athl Train. 1992; 27(2):102, 104, 106-107, 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: 195-203.,
