User:PiriformisRT

Piriformis Syndrome: Treatment and Rehabilitation
The piriformis muscle attaches from the front of the sacral vertebrae, the sacrotuberous ligament, and the upper edge of the greater sciatic foramen. This muscle goes through the greater sciatic notch and attaches on the superior surface of the greater trochanter of the femur. Piriformis syndrome is a pain caused by an injury of the piriformis muscle that compresses the sciatic nerve. Treatments include combinations of injections, physical therapy and surgery. Stretching is the key element in rehabilitation in order to prevent reoccurring pain.

Injections
Injections of a local anesthetic, corticosteroid, and botulinum toxin type B (BTX) have been used in conjunction with physical therapy since the relief from pain is only temporary with injections. BTX causes the muscles to become paralyzed by inhibiting the presynaptic release of acetylcholine at the neuromuscular junction. An effective combination of therapy paired injection with physical therapy. An ethyl chloride spray and injection of lidocaine into the piriformis muscle brings temporary pain relief, which allows for the muscle to be manipulated without too much discomfort.

Physical Therapy
Physical therapy for piriformis syndrome includes strength exercises and stretches.

Stretching
Stretching is recommended every 2 to 3 waking hours. For optimal stretching capacity, move the hip joint capsule anteriorly and posteriorly. The muscle is manually stretched by applying pressure perpendicular to the long axis of the muscle and parallel to the surface of the buttocks until the muscle is relaxed. Another stretching exercise is to lie on the side opposite of the pain with the hip and knee of the upper leg flexed and adducted towards the ground while the torso is rotated so that the back of the upper shoulder touches the ground.

Strengthening
Muscle strengthening involves working on the hip abductors, external rotators and extensors. This treatment involves three phases: non-weight bearing exercises, weight bearing exercises, and ballistic exercises. The purpose of non-weight bearing exercises is to focus on isolated muscle recruitment. Ballistic and dynamic exercises consists of plyometrics.

Surgery
When physical therapy has not shown any improvement, surgery is performed to release the piriformis tendon and sciatic neurolysis.