Conservative management of piriformis syndrome

Piriformis syndrome is a questionable clinical entity that has been cited as a cause of buttock pain and sciatica. The intimate relationship between the piriformis and the sciatic nerve has been suspected as being the source of the signs and symptoms that often appear following minor trauma to the pelvic or buttock region. Muscle function is an important consideration in the evaluation and treatment of the athlete with suspected piriformis syndrome. The action of the piriformis muscle on the hip varies as the hip moves from a neutral to a flexed position. While in a flexed position, the piriformis internally rotates and abducts the hip; however, in a neutral position, the piriformis acts as an external rotator of the hip. A comprehensive evaluation provides the information necessary to design a treatment plan specific to the involved structures, while meeting the functional needs of the individual athlete. This paper describes the anatomy, pathomechanics, physical examination, and treatment options relevant to the piriformis syndrome. Treatment protocols stressing exercises that promote strength, flexibility, and functional activities are believed to be essential in restoring the athlete's ability to return to pain-free competition.