Piriformis Syndrome
Overview: Pain or discomfort in the buttock, typically described as sharp or achy. May or may not be associated with radiating pain with sciatic distribution of the ipsilateral side.
Causes/Risk Factors/Pathogenesis: Typically unknown or considered to be multi-factorial causes that create piriformis spasm or pressure on the sciatic nerve. Trauma to the area or anatomical anomalies of sciatic nerve pathway can also lead to syndrome.
Physical activity
Neurological conditions that involve spastic muscles
Local surgery
Sitting on hard surfaces
Females greater than males
Contraindications/Precautions: Precaution should be used creating pressure on the sciatic nerve.
Examination:
--History: Insidious, gradual, or trauma to the region.
-Past Hx, Family Hx, Meds, Recurrent Illnesses: Unremarkable.
--Diagnostic Tests: Piriformis test - Patient in side lying, effected side up with hip and knee flexed, bottom leg straight.
Apply pressure downward at knee while stabilizing the hip.
Positive with reproduction of symptoms.
Pace's test - Patient seated. Resist abduction with pressure at lateral knee.
Positive with pain or weakness on ipsilateral side.
Freiberg test - Passively extend patient's leg and internally rotate hip.
Positive with pain increase in buttock.
SLR - (Lasegue's sign) with adducted and internally rotated hip.
Positive with reproduction of symptoms. ***Can also indicate pathology from the lumbar area.
Flexion, internal rotation, adduction in conjunction
Prolonged H-reflex with FAIR and FADIR
--Tests and Measures: ROM - Goniometric measurements of flexion, internal rotation, and adduction may be helpful to assess change in muscle tightness.
Palpation of piriformis muscle
Joint assessment of lumbar segments, SI, pubis, hip, and tibial-femoral
MMT of gross hip movements - compare sides
Sensory testing - compare sides
Gait deviations have been seen if severe enough
--Imaging: Has not been found to be very helpful.
See Piriformis Syndrome References
Causes/Risk Factors/Pathogenesis: Typically unknown or considered to be multi-factorial causes that create piriformis spasm or pressure on the sciatic nerve. Trauma to the area or anatomical anomalies of sciatic nerve pathway can also lead to syndrome.
Physical activity
Neurological conditions that involve spastic muscles
Local surgery
Sitting on hard surfaces
Females greater than males
Contraindications/Precautions: Precaution should be used creating pressure on the sciatic nerve.
Examination:
--History: Insidious, gradual, or trauma to the region.
-Past Hx, Family Hx, Meds, Recurrent Illnesses: Unremarkable.
--Diagnostic Tests: Piriformis test - Patient in side lying, effected side up with hip and knee flexed, bottom leg straight.
Apply pressure downward at knee while stabilizing the hip.
Positive with reproduction of symptoms.
Pace's test - Patient seated. Resist abduction with pressure at lateral knee.
Positive with pain or weakness on ipsilateral side.
Freiberg test - Passively extend patient's leg and internally rotate hip.
Positive with pain increase in buttock.
SLR - (Lasegue's sign) with adducted and internally rotated hip.
Positive with reproduction of symptoms. ***Can also indicate pathology from the lumbar area.
Flexion, internal rotation, adduction in conjunction
Prolonged H-reflex with FAIR and FADIR
--Tests and Measures: ROM - Goniometric measurements of flexion, internal rotation, and adduction may be helpful to assess change in muscle tightness.
Palpation of piriformis muscle
Joint assessment of lumbar segments, SI, pubis, hip, and tibial-femoral
MMT of gross hip movements - compare sides
Sensory testing - compare sides
Gait deviations have been seen if severe enough
--Imaging: Has not been found to be very helpful.
See Piriformis Syndrome References