Topic: Piriformis Syndrome
In 1928 Yeoman 1st described this painful often debilitating condition of sciatic nerve entrapment, but wasn’t until later in 1947 that Robinson coined the phrase Piriformis Syndrome (PS). Medical literature is rife regarding the causes and treatments for PS. There is new and different perspective to the biomechanics and recommended treatment that works not only cost effectively, but efficaciously as well.
When reviewing the literature and discussing with other health care providers, it’s time for a fresh look. Most take the same principles of entrapment and try implementing diverse treatment modalities. These are a few of the common protocols implemented by various health care providers: stretching, myofascial release, bands, cortisone injections, foam roller or rigid ball with weight- bearing to provide deep pressure in an effort to release tension in the piriformis muscle squeezing the sciatic nerve.
Often to no avail, patients research and try the same at home. If the patient is lucky they may find a Chiropractor who clearly understands the biomechanical rationale and why the piriformis is contracted. Often this is what is squeezing on the sciatic nerve. The result is a positive outcome for the patient. Without the need for confusing experimentation of various modalities of care all attempting to treat the contracted piriformis muscle surrounding the sciatic nerve and NOT eradicating the “true” cause of PS.
The following is one of many case studies of failed treatment(s) for diagnosed piriformis syndrome. A 45 year old male runner with 5 years of right sciatica is evaluated allopathically and by various other chiropractors. He has endured every test imaginable with MRIs, EMGs and even cortisone injections, physical therapy and extensive massage and stretching procedures plus acupuncture prior to presenting to my office for yet another opinion.
The result of a detailed history of his lower extremity inquiring about inversion sprained ankles, knee, hamstring injuries, etc., disclosed multiple maladies that the patient asked “What does that have to do with my piriformis being so tight it is squeezing my sciatic nerve?”
The patient was desperate for a solution and to understand the biomechanical explanation. A typical inversion sprained ankle results in tibial torsion (externally) and counter-rotation of the femur antero-medially. This reaction is the normal physiology and arthrokinematics of the ginglymus joint of the knee. Hence, when the femur compensates (femoral anteversion) it’s rotation pulls on the piriformis attached to the greater trochanter and sacrum, thereby eliciting the stretch reflex. So, you see the piriformis is adaptively contracting as a result of the stretch reflex. Therefore, does it make sense to stretch an already over-stretched muscle? The answer is clearly, NO!
Do NOT do efficiently, what need not be done! Learn and understand the mechanism of the injury and treat the “root” cause of a condition to eradicate the symptoms. The Mally Method will equip you with “cause and effect” principle that give patients relief. Visit us at ExtremityExperts.com.
