Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach

Abstract

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.

Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report

“…1,2,3,5,8,13,17,27,32 Yet only 2 of these reports included hip abduction strengthening as part of the treatment program, 1,17 with 1 of the 2 authors noting that hip abduction exercises "seemed to hasten recovery." 17 Therefore, a treatment program addressing hip strength and movement reeducation to control the femur in the frontal and transverse planes during functional activities may play a role in the treatment of patients with piriformis syndrome who demonstrate excessive frontal and transverse plane motions at the hip.…”

“…[ case report ] syndrome is reported in the literature to include injections, 1,3,5,8,11,15,16,26,27,30 prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants, 1,5,8,11,15,16,26,27 surgical release, 1,5,8,11,14,16 and referral to physical therapy. 1,5,11,15,20,27,30 The most commonly reported physical therapy interventions include ultrasound, 1,5,11,16,19 soft tissue mobilization, 1,5,11,15,16,19,30 piriformis stretching, 1,11,15,16,19,26,27,…”

“…1,5,11,15,20,27,30 The most commonly reported physical therapy interventions include ultrasound, 1,5,11,16,19 soft tissue mobilization, 1,5,11,15,16,19,30 piriformis stretching, 1,11,15,16,19,26,27,30 hot packs or cold spray, 5,11,15,16,19 and various lumbar spine treatments. 1,5,8,10,13,26,30 As noted above, a common assumption guiding physical therapy intervention for piriformis syndrome is that the piriformis is shortened or in spasm, creating compression of the sciatic nerve. Our alternate theory is that the piriformis muscle may be functioning in an elongated position or subjected to high eccentric loads during functional activities secondary to weak agonist muscles.…”

Piriformis syndrome after percutaneous endoscopic lumbar discectomy via the posterolateral approach

“…PS occurs most frequently during the fourth and fifth decades of life [14]. There was no difference in frequent age of PS between patients who received PELD (p group) and general patients who visited the pain clinic for LBP with/without lower leg pain (g group).…”

“…To consider causative factors, primary congenital anatomic variations, such as a split piriformis muscle, split sciatic nerve, or an anomalous sciatic nerve path, can be excluded. Secondary PS occurs because of a precipitating cause, including trauma, ischemic mass effect, and local ischemia [14]. Microtrauma may result from the overuse of the piriformis muscle, such as in walking or running.…”