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Shill -> RE: Piriformis Syndrome in athlete (April 1, 2008 9:31:08 AM)
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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.
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