Piriformis Syndrome Rehabilitation

Piriformis stretch syndrome is a condition caused by compression of a nerve that runs along the piriformis muscle, a muscle that runs along the buttocks and thigh. Although this condition causes pain and discomfort, rehabilitation techniques can help to reduce this discomfort and heal the patient.

Features

• Piriformis stretch syndrome, or piriformis syndrome for short, is a neuromuscular disorder. The piriformis muscle is the gluteal component of the leg, along the back of the thigh and buttocks. If the piriformis muscle irritates, compresses or strains the nerve running along the piriformis muscle, called the sciatic nerve, the patient usually experiences discomfort, pain, numbness and a strong tingling sensation. Although there is no definitive way to diagnose a patient who suffers from piriformis syndrome, physicians believe the syndrome may be caused by anatomical variations in the muscle-nerve, or by overuse or strain of the muscle.

Diagnosis

• Although there is no definitive way to diagnose piriformis syndrome, symptoms may include sciatica (a radiating pain originating in the posterior thigh and lower leg) and tenderness of the sciatic notch when touched, which is generally assessed by a physician. A medical imaging technique called magnetic resonance neurography is also used to show irritation where the nerve passes beneath the piriformis muscle. This technique can also determine whether the patient suffers from a split piriformis muscle or a split sciatic nerve; this diagnosis is essential for the patient's treatment and home care. Finally, image-guided injections carried out in an open MRI scanner may also assist in diagnosing the condition, since they enable the piriformis muscle to relax and test the muscle's reaction.

Massage Rehabilitation

• Many physicians believe massage therapy is the best form of rehabilitation for patients who suffer from piriformis syndrome. One technique, called neuromuscular therapy or trigger point therapy, aids in eliminating myofascial trigger points in the piriformis muscle. The massage therapist may also employ deep tissue massage techniques or myofascial release techniques, both of which assist in separating the piriformis muscle from surrounding tissues. Muscle energy techniques also help to gently lengthen the piriformis muscle.

Isotonic Rehabilitation Exercises

• A patient suffering from an injured piriformis muscle may experience relief if the muscle is strengthened and stretched quickly. This is often completed through isotonic resistance exercises, usually performed by a chiropractor or physical therapist. Isotonic resistance exercises focus on stabilizing the muscles around the hip and thighs. Isotonic exercises that strengthen and stretch these muscles include forward or backward lunges, partial squats, step-ups, and stair-climbing. Patients should attempt these exercises using their own body weight at first, but as the muscle grows stronger, resistance can be increased using hand-weights or a weighted bar. A leg-press machine may also be used, though these machines are not considered to be as effective as free-weight exercises.

Proprioception and Coordination Rehabilitation

• Patients who suffer from an injured or strained piriformis muscle should also attempt to regain control of the piriformis muscle and surrounding muscles. To do this, physical therapists often recommend that patients spend 10 to 15 minutes a day exercising on one leg with their eyes closed to maintain balance. These exercises can be done while standing on a small trampoline or using a rocking board. These physical therapy exercises ensure that the patient regains joint stability and control of the muscle.