| What's problematic about the term "sciatica"? | It's not specific.
(... because it may refer to inflammation of the nerve or compression of the nerve in the lumbar spine, in the gluteals or at another distal point along the pathway of the nerve.) |
| Where does the piriformis muscle attach (2 places)? | The sacrum and the greater trochanter of the femur. |
| Name 1 function of the piriformis muscle. | • restrain rapid or vigorous internal rotation of the hip, such as occurs with running or in the stance phase of walking
• Externally rotate the femur when the hip is extended or in neutral
• Horizontally abduct the thigh when the hip is flexed to 90*
• Internally rotate the femur when the hips is fully flexed |
| Why are some people more prone to piriformis syndrome than others? | Because some people's sciatic nerve goes THROUGH the piriformis muscle, rather than under or around it. For people who's nerve goes through the muscle, they are at the greatest risk. |
| Name 2 causes for piriformis syndrome. | - Anomalies in the course of the sciatic nerve (nerve goes through the piriformis)
- Trauma to the muscle.
- Overuse
- Inflammation
- Postural/Positional changes (Pregnancy, esp 3rd trimester. Spending excess time in certain positions, like sitting)
- Hyperlordosis of the lumbar. |
| Piriformis syndrome can cause painful intercourse for women (dysparuenia), impotence in men, general pain of the genital area and sometimes incontinence. The sciatic nerve, which is the nerve that is compressed in PS, does not have connections in the pubic area. Why might PS cause issues in this area? | Piriformis syndrome can cause stress on the SACROTUBEROUS LIGAMENT, which can pinch/impede the PUDENDAL NERVE, which separates into nerves of the sex organs. Parts of the pudendal nerve also can run under or through the piriformis muscle.
(know the basics in caps) |
| Can piriformus syndrome cause paresthesia, numbness or both, in the posterior thigh, calf and sole of foot? | Both |
| Why is there often gluteal pain associated with piriformis syndrome, especially in the center of the gluteal cheek? | Because the (inferior) gluteal nerve passes under the piriformis, (and if the piriformis is inflamed/irritated, it will inevitably cause issues for nearby structures. This causes gluteal trigger points). |
| True or false:
SI joint dysfunction is often present in Piriformis Syndrome due to lengthening & tension in the piriformis muscle. This type of dysfunction can also be a cause of trigger
points & nerve entrapment | FALSE:
SI joint dysfunction is often present in Piriformis Syndrome due to SHORTENING & tension in the piriformis muscle. This type of dysfunction can also be a cause of trigger points & nerve entrapment.
Shortening of the piriformis muscle can even lead to Piriformis Syndrome on its own. |
| True or false:
In piriformis syndrome, in cases of both nerve entrapment & active trigger points, standing and/or prolonged sitting causes pain, and is exacerbated by any kind of activity involving the area... so generally, the pain is pretty consistent. | True.
Why, according to slides: in cases of both nerve entrapment & active trigger points, the pain is increased by sitting or any position with prolonged hip flexion, adduction & medial rotation, by arising from a seated position or by standing. Symptoms are generally aggravated by activity. Any internal rotation of the hip will exacerbate symptoms, especially of the muscle is split and the nerve passes between its two bellies |
| Which of these movements is most likely going to reduce piriformis syndrome pain? | Flexion |
| Which is NOT a main function of the piriformis muscle:
1) Externally rotate the femur when the hip is extended or in neutral
2) Horizontally abduct the thigh when the hip is flexed to 90o
3) Externally rotate the femur when the hip is fully flexed
4) Internally rotate the femur when the hips is fully flexed | #3 Externally rotate the femur when the hip is fully flexed.
The other three were taken directly from the slides. |
| True or false:
Foot drop and ataxic gait are BOTH possible signs of piriformis syndrome. | True |
| Why does tibial torsion occur in piriformis syndrome (images a & b. Image c is normal)? | It is due to sacroiliac joint dysfunction (due to too much, or too little movement of said joint).
(Reason: "The piriformis is a small muscle in the buttock that stabilizes the sacroiliac joint".
With client supine there is excessive external rotation of the leg on the
affected side) |
| Piriformis syndrome causes trigger points and tenderness along the piriformis muscle, and its attatch points (the sacrum and around the greater trochanter)... but what other place might there be pain or, especially, adhesions? | The buttock |
| What is one test for Piriformis Syndrome? | Pace abduction test
Piriformis length test |
| Does Piriformis Syndrome often affect the strength of the area? | Yes. |
| True or false:
Compression of the nerve at lumbar spine from a herniated disc may also be referred to as sciatica. Sources do not agree as to which location is most common for the nerve compression -- the lumbar or piriformis | True |
| Compression of the nerve at lumbar spine from a herniated disc may also be referred to as sciatica. Compression of what nerve root is concerned with the following: Symptoms are numbness and tingling which radiate to the lateral foot & SMALL toe? | S1 nerve root compression |
| Compression of the nerve at lumbar spine from a herniated disc may also be referred to as sciatica. Compression of what nerve root is concerned with the following: Symptoms are numbness and tingling which radiate to the lateral foot & BOTTOM of the foot. | S5 nerve root compression |
| Compression of the nerve at lumbar spine from a herniated disc may also be referred to as sciatica. Compression of what nerve root is concerned with the following: Symptoms are numbness and tingling which radiate to the medial calf | L4 nerve root compression |
| True or false
Weakness & difficulty are apparent in the performance of repeated toe walking (S2), heel walking (S1) or one sided
deep knee bends (L4 to L5). | False. Weakness & difficulty are apparent in the performance of repeated toe walking (S1), heel walking (L5) or one sided deep knee bends (L3 to L4). |
| Why might Lumbar spinal stenosis be part of sciatica? | Because, like sciatica, it can cause numbness and tingling down the legs. |
| Inflammatory arthritides such as ________ ________ (usually bilateral pain) have similar symptoms to both nerve entrapment & trigger points to piriformis syndrome | ankylosing spondylitis |
| True or false:
When treating Piriformis Syndrome, decreasing compression on sciatic nerve via traction technique is not effective. | False, it is effective treatment. |
| True or false:
if piriformis syndrome is a systemic condition or due to pregnancy, you can only treat the soft tissue & compensatory structures & not the cause | True |
| True or false:
if piriformis syndrome is a systemic condition or due to pregnancy, you can only treat the soft tissue & compensatory structures & not the cause | True |
| True or false:
You should tell the patient to avoid stretching the piriformis muscle in piriformis syndrome, because you don't know if their sciatic nerve goes through or around the muscle. Therefore, they could damage the nerve. | False.
Stretching is vital.
(The rest of the question is just false information to throw you off) |
| True or False:
It's helpful for the patient to have a corticosteroid injection the day before you treat the area. | False!!!
Absolutely NO local work for 10 days after a corticosteroid injection! |
| True or false:
Avoid compression of sciatic nerve when massaging buttocks | True |
| Hip and sacral mobilizations are avoided in third trimester of pregnancy, BUT are not performed when osteoarthritis or degenerative conditions affecting the hip or sacrum are present. | False.
Hip and sacral mobilizations are avoided in third trimester of pregnancy AND performed with extreme caution with osteoarthritis or degenerative condition affecting the hip or sacrum |
