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PROJECT SUMMARY Objective To Determine an Alternate Approach to Treatment of Piriformis Syndrome using Hip Muscle Strengthening and Movement

Re-Education. AIMS: To decrease the demand on piriformis through agonist muscle activity. To prevent hip motion that would increase the strain on piriformis muscle.
STUDY DESIGN: Single Case Report

Background Piriformis syndrome is the neuritis of branches of sciatic nerve by pressure of irritated or injured piriformis muscle. It is usually attributed to shortening or spasm of the muscle due to direct trauma, post surgical injury, lumbar or SI joint dysfunction or overuse. Traditional Physical therapy management aims at reducing the spasm and inflammation through ultrasound therapy, soft tissue manipulation, stretching, and hot or cold packs. Alternate Hypothesis Weak agonists Gluteus Maximus and Gluteus Medius lead to excessive hip adduction and internal rotation thereby exerting eccentric loads on the piriformis muscle that leads to its over lengthening and thus, compression of the sciatic nerve. Tools: Lower Extremity Functional Scale (LEFS) is a set of 20 questions on the persons ability to perform everyday tasks. It acts as a measure of patients initial function, ongoing progress, outcomes and setting functional goals. The total score is 80. Lower the score, greater the disability. Minimal clinically important difference is (MCID) is 9 points. Visual Analogue Scale (VAS) Methodology The patient attended physical therapy department for a period of 3 weeks and with a total of 12 sittings. The therapy focused on strengthening of hip abductors, extensors and external rotators. Exercises were carried out in 3 phases: Non-weight bearing phase Weight bearing phase Functional training phase Patient was then evaluated 3 weeks after the treatment.

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Outcomes There was a significant improvement in the patients condition. Clinically important difference was observed in both VAS and LEFS. Objective tests for piriformis syndrome turned negative. There was a significant improvement in the strength of hip abductors, extensors and external rotators. Soft tissue palpation revealed no tenderness in the muscle. A summary of patients status before and after the interventions is listed below: TOOL Visual Analogue Scale LEFS Hip Abductor Strength Hip Extensor Strength Hip External Rotator Strength Special Tests BEFORE 9/10 65/80 3+/5 3+/5 3+/5 Positive AFTER 3/10 80/80 4+/5 4+/5 4+/5 Negative

Discussion The current case report suggests that piriformis syndrome can be managed without stretching, electro physical agents and soft tissue manipulation. Excessive adduction and internal rotation are a major cause of this condition. Strengthening of hip musculature reduces the eccentric strain on piriformis muscle. Limitations As the study design is a single case report, results cannot be generalized. Patients improvement may be a result of increased piriformis strength enabling it to withstand greater loads. In this study, biomechanical assessment of gait was not possible. Conclusion Clinically relevant improvements were seen without commonly used treatment strategies. Thus, hip musculature strengthening and movement re-education can be prescribed to patients with piriformis syndrome. However, care must be taken in establishing cause and effect based on a single patient.

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