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What is the definition of Piriformis Syndrome?
Compression of sciatic nerve by piriformis muscle
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What are of the body does the sciatic nerve supply motor&sensory functions?
Posterior thigh, leg, & foot
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What are the actions of piriformis?
- Eccentric internal rotation during gait
- External rotation with hip in extended or neutral position
- Horizontal abduction in a seated position
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Trigger points for piriformis are located:
- Near lat border of sacrum
- 1/3 way from greater trochanter
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Causes of PS are:
- Direct/indirect trauma to piriformis
- Overuse
- Postural/positional issues
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Compression of sciatic nerve from piriformis affects what region of body?
Progressively from thigh down to foot
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TPs in piriformis refer to where?
SI region, buttocks, hip & posterior thigh
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The following are common observations seen w PS:
- Difficulty sitting for long periods of time
- Swelling in lower limb may be observed
- Guarding affected leg
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What is a positive result w resisted testing of piriformis?
Pain and/or weakness
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What special test is positive for piriformis involvement?
Piriformis length test
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What tests are (-) for PS but (+) for compression of sciatic nerve at lumbar spine?
- Kemps
- Valsalva
- Straight Leg Raise
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The following are contraindications of PS:
- No local massage up to 10days after cortisone injection
- No fx strokes if client on anti-inflam
- Avoid hip mobs during 3rd trimester
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Where do GlutMax TPs refer?
Locally to buttock along SI jt & Sup to IschTub
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What Ms need to be warmed up & treated for TPs before piriformis?
GlutMax
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TX freq for PS:
1x/wk for 4-6wks
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What is the definition of ITB Contracture?
A contracture/thickening of ITB
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When ITB becomes contractured, what other structures can be affected?
- Hip&knee
- SI jt & ankle
- Trochanteric bursae
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What MS of hip directly attach to ITB?
GlutMax & TFL
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What is likely to lead to shortening of ITB?
- Activities involving prolonged sitting
- Ant pelvic tilt/hyperlordosis
- Consistent weight bearing/shifting weight to one side
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What symptoms are common w ITBC?
- Pain felt along lat side leg into lat knee
- Trigger/TPs in Ms attached to ITB may contribute to tightness in ITB
- Ct may present w valgus knee positioning
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All the following are true of ITBC:
- Ct may show lat tilt to affected side from Ant view
- Ct may present w Ant pelvic tilt w bilat ITBC
- Ct may present w pes planus on affected side
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With Active Flex testing of hip, what actions show reduced ROM w ITBC?
Extension & Abduction
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What special test used for shortening of TFL or ITB?
Modified Ober's
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What hydro most appropriate following fx on ITBC?
Ice
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What is the length of initial tx plan freq for ITB?
1x/wk for 6wks
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What is definition of strain?
Overstretch injury to musculotendinous unit
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During what kind of contraction is Ms more predisposed to injury?
Eccentric
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What grade strain is described as minor stretch & tear to musculotendinous unit w minimal loss of strength & ability to continue w activity suffering mild discomfort?
Grade 1
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What grade strain is known as a moderate strain?
Grade 2
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What is appropriate course of action if health history presents significant Ms weakness, loss of fx or palpable gap in tissue?
Refer ct out to physician
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What area of body most freq affected by strains?
Lower extremity
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During acute phase all grade strains, what appropriate form testing indicated?
AF ROM
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In early & late subacute stages, when performing resisted testing on Ms, grade 2 strains reveal:
Moderate loss of strength & pain
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When performing PROM on early & late subacute stage of strain, the affected Ms is tested:
Last
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Which tx contraindicated w Ms strains?
- Distal circulatory tech to strain should be used in acute/early subacute stages
- Remove all protective Ms splinting/spasming around acute strain to relieve discomfort
- Use hot therapy w grade 3 strains that are casted immediately proximal to cast
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