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What is the definition of Piriformis Syndrome?
Compression of sciatic nerve by piriformis muscle
What are of the body does the sciatic nerve supply motor&sensory functions?
Posterior thigh, leg, & foot
What are the actions of piriformis?
- Eccentric internal rotation during gait
- External rotation with hip in extended or neutral position
- Horizontal abduction in a seated position
Trigger points for piriformis are located:
- Near lat border of sacrum
- 1/3 way from greater trochanter
Causes of PS are:
- Direct/indirect trauma to piriformis
- Postural/positional issues
Compression of sciatic nerve from piriformis affects what region of body?
Progressively from thigh down to foot
TPs in piriformis refer to where?
SI region, buttocks, hip & posterior thigh
The following are common observations seen w PS:
- Difficulty sitting for long periods of time
- Swelling in lower limb may be observed
- Guarding affected leg
What is a positive result w resisted testing of piriformis?
Pain and/or weakness
What special test is positive for piriformis involvement?
Piriformis length test
What tests are (-) for PS but (+) for compression of sciatic nerve at lumbar spine?
- Straight Leg Raise
The following are contraindications of PS:
- No local massage up to 10days after cortisone injection
- No fx strokes if client on anti-inflam
- Avoid hip mobs during 3rd trimester
Where do GlutMax TPs refer?
Locally to buttock along SI jt & Sup to IschTub
What Ms need to be warmed up & treated for TPs before piriformis?
TX freq for PS:
1x/wk for 4-6wks
What is the definition of ITB Contracture?
A contracture/thickening of ITB
When ITB becomes contractured, what other structures can be affected?
- SI jt & ankle
- Trochanteric bursae
What MS of hip directly attach to ITB?
GlutMax & TFL
What is likely to lead to shortening of ITB?
- Activities involving prolonged sitting
- Ant pelvic tilt/hyperlordosis
- Consistent weight bearing/shifting weight to one side
What symptoms are common w ITBC?
- Pain felt along lat side leg into lat knee
- Trigger/TPs in Ms attached to ITB may contribute to tightness in ITB
- Ct may present w valgus knee positioning
All the following are true of ITBC:
- Ct may show lat tilt to affected side from Ant view
- Ct may present w Ant pelvic tilt w bilat ITBC
- Ct may present w pes planus on affected side
With Active Flex testing of hip, what actions show reduced ROM w ITBC?
Extension & Abduction
What special test used for shortening of TFL or ITB?
What hydro most appropriate following fx on ITBC?
What is the length of initial tx plan freq for ITB?
1x/wk for 6wks
What is definition of strain?
Overstretch injury to musculotendinous unit
During what kind of contraction is Ms more predisposed to injury?
What grade strain is described as minor stretch & tear to musculotendinous unit w minimal loss of strength & ability to continue w activity suffering mild discomfort?
What grade strain is known as a moderate strain?
What is appropriate course of action if health history presents significant Ms weakness, loss of fx or palpable gap in tissue?
Refer ct out to physician
What area of body most freq affected by strains?
During acute phase all grade strains, what appropriate form testing indicated?
In early & late subacute stages, when performing resisted testing on Ms, grade 2 strains reveal:
Moderate loss of strength & pain
When performing PROM on early & late subacute stage of strain, the affected Ms is tested:
Which tx contraindicated w Ms strains?
- Distal circulatory tech to strain should be used in acute/early subacute stages
- Remove all protective Ms splinting/spasming around acute strain to relieve discomfort
- Use hot therapy w grade 3 strains that are casted immediately proximal to cast