I have treated at least 3 cases of piriformis syndrome in the past 18 months that had been misdiagnosed as disc-herniations and were due to have spinal surgery. The key to diagnosing piriformis syndrome is using a basic osteopathic tenant – listening to the patient.
The osteopaths questions need to be focused and gleaning of information. The basic osteopathic case-history questions are sufficient. The most revealing questions are; cause of onset and aggravating and relieving factors. Together with a good osteopathic active and passive examination the osteopath can save a patient from taking increased doses of medication, cortisone injections and at the very least the surgeon's knife.
A point that may be important to the new graduate of osteopathy is that indeed in each case that I saw with piriformis syndrome either a disc herniation was present on MRI or there was a case of disc thinning on X-ray. Whilst imaging has a vital use in today's medical world there is always the danger that it will be a sunbstitute for good case history. The osteopath must never rely on someone else's diagnosis.
The main diagnosis between which piriformis syndrome needs to be differentiated is sciatica caused by nerve root compression as both have similar symptoms of radiation down the back of the leg. In pirifomis syndrome the sciatic nerve is compressed by the piriformis muscle as the nerve passes through it on its journey into the leg.
My treatment plan is to first approach the problem globally. I start at the feet and work my way up the body to the cranium paying particular attention to the function of the sacro-illiac joints bilaterally and their relationship to the lumber spine, pelvis and surrounding muscles. Don't be afraid to give due attention to the neck, dorsal spine, ribs and dorso-lumbar junction. Remember that these all exert strong forces through the sacrum and pelvis and may call upon pirifomis to secure the stability of the area.
The osteopaths questions need to be focused and gleaning of information. The basic osteopathic case-history questions are sufficient. The most revealing questions are; cause of onset and aggravating and relieving factors. Together with a good osteopathic active and passive examination the osteopath can save a patient from taking increased doses of medication, cortisone injections and at the very least the surgeon's knife.
A point that may be important to the new graduate of osteopathy is that indeed in each case that I saw with piriformis syndrome either a disc herniation was present on MRI or there was a case of disc thinning on X-ray. Whilst imaging has a vital use in today's medical world there is always the danger that it will be a sunbstitute for good case history. The osteopath must never rely on someone else's diagnosis.
The main diagnosis between which piriformis syndrome needs to be differentiated is sciatica caused by nerve root compression as both have similar symptoms of radiation down the back of the leg. In pirifomis syndrome the sciatic nerve is compressed by the piriformis muscle as the nerve passes through it on its journey into the leg.
My treatment plan is to first approach the problem globally. I start at the feet and work my way up the body to the cranium paying particular attention to the function of the sacro-illiac joints bilaterally and their relationship to the lumber spine, pelvis and surrounding muscles. Don't be afraid to give due attention to the neck, dorsal spine, ribs and dorso-lumbar junction. Remember that these all exert strong forces through the sacrum and pelvis and may call upon pirifomis to secure the stability of the area.
The osteopath can cause significant changes by applying sustained inhibition to the piriformis attachments either by the sacrum or the hip, with or without muscle-energy resisted movement. The osteopath must of course pay due care and attention not to aggravate the sciatic nerve further by watching the patient and using his ostoepathic palpatory skills.
1 comment:
Thanks for your info. Being a remidial musculoskeletal therapist I find it most helpful. Thanks for posting your info on the web.
Chavah
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