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Piriformis Syndrome in athlete
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Piriformis Syndrome in athlete - March 31, 2008 3:47:11 AM
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tal O
Posts: 3
Joined: March 31, 2008
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I'm treating a female long distance runner with Piriformis Syndrome. She started having simptoms about 6 weeks ago which include pain in the left buttuck with stiffness and sometimes refered pain to the Hams. The pain started during up hill training in the mountains. I treat her with massage therapy, streatching and mobilization. She lowered her intensity of practice to low and medium running speed and only on flat ground and she does a lot of streatcing by her self.
What other treatment modalities would you suggest and how to get back to regular running and competing (it is now racing season) ???
Thanks
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RE: Piriformis Syndrome in athlete - March 31, 2008 8:22:21 AM
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Shill
Posts: 1044
Joined: February 13, 2003
From: Madison WI USA
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Tal,
What do you do for a living, i.e. what form of rehabilitation specialist are you? Just curious. I would first question the diagnosis, as I really dont think it actually exists in anywhere NEAR the numbers we hear of. What objective information is there to confirm this diagnosis other than pain in the buttock when someone pushed a thumb there? What is she stretching and why? Is there a lack of ROM that would necessitate lengthening of an adaptively shortened tissue?
I hate to answer a question with multiple questions....Ok, no I actually dont hate this. Its a necessary part of digging deeper.
_____________________________
Steve Hill PT
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RE: Piriformis Syndrome in athlete - April 1, 2008 2:25:44 AM
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tal O
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Joined: March 31, 2008
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Steve,
Thank you for your directing questions and direct attitude. I'm a physical therapist, fresh out of university, and the paitent is my wife.
I also question the diagnosis. I simply took the simptoms - pain, spesific movements that irritate the pain, palpated tight piriformis and pain while pressing trigger points of piriformis muscle- and looked for a diagnosis that fits the simptoms. As for objective information I don't have any and I didn't find objective means that are agreed upon in research (MRI ?).
ROM- full ROM. Stretching - Glut. max + Hams., external & internal rotators of thigh, Ilio-psoas.
My main question was is there anything else that I can do (ice, hot pack, electro ?), but I'm happy to hear any comment as a mean of learning from more experienced rehabilitaion specialists.
Thanks,
Tal
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RE: Piriformis Syndrome in athlete - April 1, 2008 9:31:08 AM
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Shill
Posts: 1044
Joined: February 13, 2003
From: Madison WI USA
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Tal,
I kind of had that impression that this was either you or someone you knew. Anyway, unless she lacks ROM, stretching will not likely serve a useful purpose, but could keep her busy for a while while you think of other things to do. While that may sound funny, thats my opinion on stretching. Its overused, and over rated. What I suggest is to take her through a full evaluation, and include the lumbar spine. It is my opinion that "piriformis issues" are usually and nearly always lumbar related, and you can confirm this by running through a thorough lumbar evaluation as well. Symptom behaviors that can assist in developing the lumbar spine as the source include the following, which is not an exclusive list of course;
Pain in the AM, pain with donning socks and shoes in the AM, but not later in the day. Radiation to the posterior thigh and further while sitting, sneezing, etc. Try a slump test as well. SLR tests too. Repeated movements evaluation of the lumbar spine is a great way to determine just how much the spine contributes to these symptoms. It may take 3 sets of 10 standing flexion, standing extension, supine flexion and prone extension to get a change in symptom behavior. If you have had a repeated movements course, that would help, unless you had a lot of that in school. Remember you are looking for a positive change and/or centralization as a result of a movement, and not necessarily too concerned with what she feels during the movements.
Last but not least, as you probably already know, it may not be best that you take this on completely by yourself, but instead she may want to see a therapist you trust. While we are always well meaning when we try to help out a friend, relative, etc, we are often not quite as thorough as we would otherwise be.
In regards to local treatment with Estim, ice, I am an old school advocate for ice for pain control, as it is cheap, and will always bring about some pain relief. There is a fair number of people who dont like it, as they cant tolerate the achiness phase, but if they can convince themselves to do so, it may well be a useful pain control tool.
And a final note. Driven athletes often prevent themselves from getting better by trying to plow through the pain and continuing to train aggressively. Make a sign in your kitchen that says "Relative rest from the aggravating stresses", and hopefully she will adhere and allow things to heal.
_____________________________
Steve Hill PT
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RE: Piriformis Syndrome in athlete - April 1, 2008 2:30:14 PM
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Tom Reeves DPT ATC
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My two cents, look for a leg length discrepancy. Often it is overlooked and a long leg will cause pronation on that side, chronic hip IR on that side and will piss off a piriformis muscle. sometimes a lift is all it takes.
let the ridicule begin.
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RE: Piriformis Syndrome in athlete - April 1, 2008 4:36:25 PM
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Shill
Posts: 1044
Joined: February 13, 2003
From: Madison WI USA
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Now who would ridicule on this site? That never happens, does it? I am of the belief that a heel lift costs about $5 bucks, so whether one agrees with the pathology or not is completely immaterial, tossing in a heel lift is certainly reasonable!
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RE: Piriformis Syndrome in athlete - April 1, 2008 10:32:06 PM
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Sebastian Asselbergs
Posts: 1062
Joined: September 29, 1999
From: Barrie, Canada
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In addition to Steve's post, I would also look for some neural testing (ala Butler), and you did not say whether she was getting better with what you were doing. If she is, don't mess with what works right now.
It has been my experience that even in high level sports, recovery time cannot always be sped up.
_____________________________
Mundi vult decipi
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RE: Piriformis Syndrome in athlete - April 23, 2008 9:09:26 PM
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RoosaPT
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Joined: October 21, 2007
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Rule out sacral stress fracture with bone scan. I had a similar athlete and it turned out to be a stress fracture. Good luck
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RE: Piriformis Syndrome in athlete - May 11, 2008 9:51:42 PM
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melliott
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Joined: May 8, 2008
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Just a quick comment about diagnosis. First of all, diagnosis is not that important, it just makes you chase the pain. The further you get from PT school the more you will realize that one. Why does Piriformis syndrome occur? Because something somewhere else along the chain probably isn't doing it's job so now the Piriformis is overworked and pissed off as someone commented. What is important as a new grad is to continue your education and learn a system of evaluation that looks at the entire body, specifically movement patterns. Learn to find the weak links in the chain, correct these, and problem solved. Not that it is always that easy but you must have a game plan going in to develop an effective treatment plan. Personally I use the SFMA(Selective Functional Movement Assessment). You can find more info online.
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