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1、AnAlternativeTreatmentApproachtoPiriformisSyndromeKoreyPieper,DPT,OCSMariePotter,DPT,OCS,ATCRickJRafael,DPT,OCS,CSCSJasonTonley,DPT,OCSKaiserPermanenteWestLosAngelesOrthopaedicResidencyProgramSeptember2008PiriformisSyndromeDefined“Neuritisofthebranchesofthesciaticnerve,causedbypressureofani
2、njuredorirritatedpiriformismuscle1.”SymptomsRadiatingpainfromthelowbackdownoverthesacrumintothebuttocksandhipregion,aswellasdowntheposteriorportionoftheupperlegtothepoplitealregion1.Imagefrombp1.blogger.comAnatomyimagefromwww.tpmassageball.comPossibleCausesofPiriformisSyndromeAnatomicalvari
3、ationL/SdysfunctionMuscletightnessand/orspasmOverusePostsurgicalinjurySIJdysfunctionTrauma/fallDifferentialDiagnosisDifferentialDiagnosisofHippain7,8:Intra-articular&Extra-articular(OftenManagedOperatively):LabralTearsLooseBodiesFemoroacetabularImpingement(FAI)HypermobilityCapsularLaxityLig
4、amentumTeresTearChondralDamageSnappingHipSyndromeITBandSyndromeGreaterTrochantericBursitisGlutealTendonInjuryDifferentialDiagnosisDifferentialDiagnosisofHippain7,8:Extra-articularCauses(OftenManagedNon-Operatively):FemoralNeckStressFractureAdductorStrainPiriformisSyndromeSacroiliacJointSynd
5、romeTendonitis(hipflexors,abductors,adductors)DifferentialDiagnosisOtherCompetingDiagnosis:LumbarFacetSyndromeLumbarDiscHerniationNerveentrapmentIschialTuberosityBursitisLumbarradiculopathySpinalstenosisSpondylolisthesisOsteoarthritisCommonTreatmentOptionsTreatmentOptions:2,3,4,5,6Injection
6、sL/SstabilizationexercisesMobilization/manipulationL/SMobilization/manipulationSIjointFootorthoticsSofttissuemobilizationStrengtheningStretchingSurgical/arthroscopicreleaseUltrasoundCommonassumptionguiding treatmentapproachesThepiriformisisshortenedorin“spasm”andiscompressingthesciaticnerve
7、PurposeofstudyTocreateacaseseriesusinganalternativetreatmentapproachtopiriformissyndromeInclusionCriteria: ObjectiveExamUnilateralpainfromlowerlumbar/buttockregiontothelegSymptomsnotreproducedfromlumbar,SIjoint,and/orhipjointexaminationsInclusionCriteria
