title: Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report.
abstract: 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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Kaiser Permanente West Los Angeles, Los Angeles, CA, USA.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Tonley
authors.forename: Steven M
authors.initials: SM
authors.lastname: Yun
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Kochevar
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Dye
authors.forename: Shawn
authors.initials: S
authors.lastname: Farrokhi
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Powers
mesh_terms: 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*