Piriformis Syndrome

Diagnosis and Management of Piriformis Syndrome

SOURCE: J Am Osteopath Assoc. 2008 (Nov); 108 (11): 657-664 ~ FULL TEXT

Lori A. Boyajian-O’Neill, DO, Rance L. McClain, DO,
Michele K. Coleman, DO, Pamela P. Thomas, PhD

Department of Family Medicine, Kansas City University of Medicine,
Biosciences College of Osteopathic Medicine,
1750 Independence Ave, SEP 358,
Kansas City, MO 64106-145, USA.

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.

From the Full-Text Article:

Epidemiologic Considerations

Piriformis syndrome occurs most frequently during the fourth and fifth decades of life and affects individuals of all occupations and activity levels. [7-12] Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%. [3, 4, 11] Piriformis syndrome is more common in women than men, possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the os coxae (pelvis) of women. [3]

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Difficulties arise in accurately determining the true prevalence of piriformis syndrome because it is frequently confused with other conditions.

Anatomic Characteristics (more…)

Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

By Frank M. Painter|September 13, 2012|Chiropractic Care, Low Back Pain, Piriformis Syndrome|

Chiropractic Management of a US Army Veteran With Low Back Pain and Piriformis Syndrome

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2012 (Mar); 11 (1): 24-9

Cynthia Chapman, and Barclay W. Bakkum

Chiropractor, Private Practice,
Occoquan Family Chiropractic, PLLC,
Occoquan, VA 22125

OBJECTIVE: The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care.

CASE REPORT: A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome.

INTERVENTION AND OUTCOME: Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation.

CONCLUSION: A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.

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The Full-Text Article:

Introduction

Piriformis syndrome is an uncommon cause of low back pain and sciatica that results from entrapment and/or irritation of the sciatic nerve in the region of the greater sciatic foramen. [1-4] Although no definitive causative factors are known for this syndrome, the usual source is thought to be an abnormal condition of the piriformis muscle. A common basis of the problem appears to be trauma to the piriformis muscle that results in spasm, edema, and contracture of the muscle, which can cause subsequent compression and entrapment of the sciatic nerve. [2] Other possible etiologies include reflex spasm of the piriformis muscle and an abnormal course of the sciatic nerve through the piriformis muscle. Altered biomechanics of the lower limb, low back, and pelvic regions can lead to stretching and shortening of the piriformis muscle, which can also lead to piriformis syndrome. Although, in 1928, Yeoman [5] first described the clinical picture of what would later be called piriformis syndrome, this diagnosis still remains somewhat controversial. This controversy stems from several factors that include variable and sometimes unclear cause, similarity to other more easily recognizable causes of sciatica, lack of consistent objective diagnostic findings, and relative rarity. Piriformis syndrome had been thought to be a purely clinical diagnosis; but more recently, magnetic resonance imaging (MRI) has begun to be used to help with the diagnosis of this problem. [6] (more…)