Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report.
METHODS
Case report.


OBJECTIVE
To describe an alternative treatment approach for piriformis syndrome using a hip muscle strengthening program with movement reeducation.


BACKGROUND
Interventions for piriformis syndrome typically consist of stretching and/or soft tissue massage to the piriformis muscle. The premise underlying this approach is that a shortening or "spasm" of the piriformis is responsible for the compression placed upon the sciatic nerve.


METHODS
The patient was a 30-year-old male with right buttock and posterior thigh pain for 2 years. Clinical findings upon examination included reproduction of symptoms with palpation and stretching of the piriformis. Movement analysis during a single-limb step-down revealed excessive hip adduction and internal rotation, which reproduced his symptoms. Strength assessment revealed weakness of the right hip abductor and external rotator muscles. The patient's treatment was limited to hip-strengthening exercises and movement reeducation to correct the excessive hip adduction and internal rotation during functional tasks.


RESULTS
Following the intervention, the patient reported 0/10 pain with all activities. The initial Lower Extremity Functional Scale questionnaire score of 65/80 improved to 80/80. Lower extremity kinematics for peak hip adduction and internal rotation improved from 15.9 degrees and 12.8 degrees to 5.8 degrees and 5.9 degrees, respectively, during a step-down task.


CONCLUSIONS
This case highlights an alternative view of the pathomechanics of piriformis syndrome (overstretching as opposed to overshortening) and illustrates the need for functional movement analysis as part of the examination of these patients.


METHODS
Therapy, level 4.
Tonley
Jason C
JC
Department of Physical Medicine and Rehabilitation, Kaiser Permanente West Los Angeles, Los Angeles, CA, USA.
Yun
Steven M
SM
Kochevar
Ronald J
RJ
Dye
Jeremy A
JA
Farrokhi
Shawn
S
Powers
Christopher M
CM
D000328:Adult; D001696:Biomechanical Phenomena; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D055958:Piriformis Muscle Syndrome / Q000503:physiopathology / Q000534:rehabilitation*; D055070:Resistance Training / Q000379:methods*