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Background & Etiology

The piriformis muscle is located within the gluteal muscles, it is used to abduct and laterally rotate the leg. It originates at the base of the spine (scrum) and attaches to the greater trochanter (top) of the femur (leg bone.) The sciatic nerve typically runs underneath the piriformis muscle, but in some patients may run through the muscle. Piriformis Syndrome occurs when the piriformis muscle irritates the sciatic nerve, causing pain and discomfort in the buttocks that runs along the course of the sciatic nerve. Pain along the sciatic nerve is referred to as sciatica.

The piriformis muscle typically affects the sciatic nerve when it experiences a spasm, shrinks or contracts. Common causes of piriformis syndrome include:

  • Tight abductor muscles in the leg that transfer stress to the piriformis
  • Malfunctioning gluteal muscles that transfer stress to the piriformis
  • Repetitive strain through use of the legs in a sitting position like bicycling or rowing
  • Changes in gait
  • Traumatic injury such as a fall
  • Pain directly in the center of the buttocks
  • Tenderness in the area of the muscle
  • Pain that radiates down the back of the leg along the path of the sciatic nerve
  • Reduced range of motion of the hip and effected leg

If an individual suspects they have Piriformis Syndrome, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation.

If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the nerve irritation.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Piriformis Syndrome include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the hip and leg.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the hip and effected muscles.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running or kicking activities) in daily use of the involved lower extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the hip and nerve site.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy that include:

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the nerve pain

Prognosis

Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Piriformis Syndrome.

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Real People, Real Testimonials.

The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

Constance C.

"I feel that the physical therapy at the Union office is above and beyond the best that I have ever received. They helped me so much and I hope to return as a visitor and utilize their equipment when I am fully recovered from surgery. Thank you Nicole, Elaine and the entire staff for always going the extra mile to make sure I received treatment. Never had a problem with billing either. I have been to a few PT facilities and highly recommend Twin Boro!"

Linda R.

“Thanks to Twin Boro I can still engage in activities and sports that I would not be able to had I not received high quality PT.”

Mitchell

"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

Victor S.

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