Department of Physical Medicine and Rehabilitation, Kaiser Permanente West Los Angeles, Los Angeles, CA, USA.
J Orthop Sports Phys Ther. 2010 Feb;40(2):103-11. doi: 10.2519/jospt.2010.3108.
Case report.
To describe an alternative treatment approach for piriformis syndrome using a hip muscle strengthening program with movement reeducation.
Interventions for piriformis syndrome typically consist of stretching and/or soft tissue massage to the piriformis muscle. The premise underlying this approach is that a shortening or "spasm" of the piriformis is responsible for the compression placed upon the sciatic nerve.
The patient was a 30-year-old male with right buttock and posterior thigh pain for 2 years. Clinical findings upon examination included reproduction of symptoms with palpation and stretching of the piriformis. Movement analysis during a single-limb step-down revealed excessive hip adduction and internal rotation, which reproduced his symptoms. Strength assessment revealed weakness of the right hip abductor and external rotator muscles. The patient's treatment was limited to hip-strengthening exercises and movement reeducation to correct the excessive hip adduction and internal rotation during functional tasks.
Following the intervention, the patient reported 0/10 pain with all activities. The initial Lower Extremity Functional Scale questionnaire score of 65/80 improved to 80/80. Lower extremity kinematics for peak hip adduction and internal rotation improved from 15.9 degrees and 12.8 degrees to 5.8 degrees and 5.9 degrees, respectively, during a step-down task.
This case highlights an alternative view of the pathomechanics of piriformis syndrome (overstretching as opposed to overshortening) and illustrates the need for functional movement analysis as part of the examination of these patients.
Therapy, level 4.
病例报告。
描述一种使用臀部肌肉强化计划结合运动再教育治疗梨状肌综合征的替代方法。
梨状肌综合征的干预措施通常包括梨状肌伸展和/或软组织按摩。这种方法的前提是梨状肌缩短或“痉挛”导致坐骨神经受压。
患者为 30 岁男性，右侧臀部和大腿后侧疼痛 2 年。体格检查发现，梨状肌触诊和拉伸时可诱发症状再现。单腿台阶下降时的运动分析显示髋关节过度内收和内旋，这会再现他的症状。肌力评估显示右侧髋关节外展和外旋肌力量减弱。患者的治疗仅限于臀部强化运动和运动再教育，以纠正功能任务中髋关节过度内收和内旋。
干预后，患者所有活动的疼痛评分为 0/10。最初的下肢功能量表评分为 65/80，提高至 80/80。台阶下降任务中，髋关节最大内收和内旋的下肢运动学分别从 15.9 度和 12.8 度改善至 5.8 度和 5.9 度。
本病例强调了梨状肌综合征病理机制的另一种观点（过度伸展而非过度缩短），并说明了在这些患者的检查中需要进行功能运动分析。
治疗，4 级。
