PIRIFORMIS syndrome

Question 1

PIRIFORMIS SYNDROME classic presentation

Answer 1

• middle-aged female who sits a lot
• comes in complaining of deep dull glute pain tingling down into back of thigh
• worse when sitting, driving and better when walking or resting

Question 2

similar DDX’s

Answer 2

• trochanteric bursitis
• lumbar disc herniation
• lumbar facet syndrome

Question 3

supporting factors

Answer 3

• skier, truck driver, long distance cyclists
• hyperlordosis
• women
• numbness
• mid gluteal pain radiating down into post. thigh or lower leg, occasionally in foot
• deep dull ache
• externally rotated leg on affected side
• sharp pain on piriformis palpation

Question 4

refuting factors

Answer 4

• abnormal reflexes or dec. myotomes
• sharp pain at rest

Question 5

relevant orthos

Answer 5

• piriformis tests (PACE, freibergs, F.A.I.R, beatty’s)

Question 6

referrals

Answer 6

• trigger point work
• physiotherapy
• acupuncture

Question 7

contraindications

Answer 7

• avoid lying on affected side in side posture

Question 8

technique

Answer 8

• check and adjust lower limb chain (hip, knee, ankle)

Question 9

care plan

Answer 9

• 2 x a week for 3 weeks

Question 10

recommendations

Answer 10

• trigger point therapy
• piriformis stretches

Question 11

prognosis

Answer 11

• excellent if modifies triggering factors