RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

Piriformis Syndrome in athlete

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Sports & Fitness >> Piriformis Syndrome in athlete Page: [1]
Login
Message << Older Topic   Newer Topic >>
Piriformis Syndrome in athlete - March 31, 2008 8:47:11 AM   
tal O

 

Posts: 3
Joined: March 31, 2008
Status: offline
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
Post #: 1
RE: Piriformis Syndrome in athlete - March 31, 2008 1:22:21 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
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

(in reply to tal O)
Post #: 2
RE: Piriformis Syndrome in athlete - April 1, 2008 7:25:44 AM   
tal O

 

Posts: 3
Joined: March 31, 2008
Status: offline
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

(in reply to Shill)
Post #: 3
RE: Piriformis Syndrome in athlete - April 1, 2008 2:31:08 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
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

(in reply to tal O)
Post #: 4
RE: Piriformis Syndrome in athlete - April 1, 2008 7:30:14 PM   
Tom Reeves DPT ATC

 

Posts: 1166
Joined: March 15, 2006
Status: offline
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.

(in reply to Shill)
Post #: 5
RE: Piriformis Syndrome in athlete - April 1, 2008 9:36:25 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
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!

(in reply to Tom Reeves DPT ATC)
Post #: 6
RE: Piriformis Syndrome in athlete - April 2, 2008 3:32:06 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
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

(in reply to Shill)
Post #: 7
RE: Piriformis Syndrome in athlete - April 24, 2008 2:09:26 AM   
RoosaPT

 

Posts: 3
Joined: October 22, 2007
Status: offline
Rule out sacral stress fracture with bone scan.  I had a similar athlete and it turned out to be a stress fracture.  Good luck

(in reply to tal O)
Post #: 8
RE: Piriformis Syndrome in athlete - May 12, 2008 2:51:42 AM   
melliott

 

Posts: 2
Joined: May 9, 2008
Status: offline
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.

(in reply to tal O)
Post #: 9
Page:   [1]
All Forums >> [RehabEdge Forum] >> Sports & Fitness >> Piriformis Syndrome in athlete Page: [1]
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.078