What is the role of physical therapy (PT) in the treatment of acute piriformis syndrome?

Updated: Dec 21, 2018
  • Author: Shishir Shah, DO; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Physical Therapy

After a diagnosis of piriformis syndrome has been made, the patient should be instructed to rest from offending activities and initiate physical therapy treatment. Physical therapy modalities are often beneficial forms of treatment when used in conjunction with stretching and manual therapy.

The use of moist heat and/or ultrasound is often recommended before stretching of the piriformis muscle. The piriformis muscle is stretched with flexion, adduction, and internal rotation of the hip adductors and the knee while the patient lies supine. This stretching is performed by bringing the foot of the affected side across and over the knee of the other leg. To enhance the stretch of the piriformis muscle, the physical therapist may perform a muscle-energy technique. This is completed by having the patient abduct the limb against light resistance provided by the therapist for 5-7 seconds, and then it is repeated 5-7 times.

Soft-tissue massage to the gluteal and lumbosacral regions may help to decrease tightness of the affected musculature and reduce irritation of the sciatic nerve. Some physical therapists may be trained in performing myofascial release techniques for the piriformis muscle as well. In addition to stretching the piriformis, the patient should also be instructed to stretch the iliopsoas, tensor fascia latae, hamstrings, and gluteal muscles.

In addition to the specific stretching exercises, the patient can perform the following at home: (1) Before arising from bed, roll side to side and flex and extend the knees while lying on each side. This exercise can be repeated for a total of 5 minutes. (2) Rotate side to side while standing with the arms relaxed for 1 minute every few hours. (3) Take a warm bath with the full body (to the shoulders) immersed; the buoyancy effect is effective. (4) Lie flat on the back and pedal the legs as if riding a bicycle by raising the hips with the hands. (5) Perform knee bends, with as many as 6 repetitions every few hours. A countertop can be used for hand support.

Cold packs and, occasionally, electrical stimulation are applied after exercise or manual therapy. Cold modalities help to decrease pain and inflammation that may have been further triggered by stretching or massage. Remember to stress to patients the importance of light and gradual stretching techniques for the piriformis muscle to avoid overstretching and possible further irritation to the sciatic nerve.


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