Piriformis Syndrome Treatment by Physiotherapists

Physiotherapists and other manual therapists recognise piriformis syndrome as a cause of buttock and leg pain which sometimes simulates sciatic symptoms. The piriformis muscle is very close to the sciatic nerve as it traverses the buttock and nerve compression or irritation have been put forward as reasons for the pain. Piriformis syndrome is not recognised universally outside physiotherapy and other therapy professions but the diagnosis is gaining credence.

The piriformis muscle is flat and small, lying in the centre of the buttock, taking its origin from the sacral area and inserting on to the top of the greater trochanter of the thigh, the bony prominence easily felt on the side of the leg below the hip. It either turns the leg outwards or moves the thigh away from the body, depending on the position of the hip. The sciatic nerve and the piriformis muscle vary in their structure and position in the buttock. Typically the muscle lies behind the nerve but in some cases the piriformis is divided into two parts with the sciatic nerve passing between them.

There are no clear causative factors for piriformis syndrome which seems to accompany other lumbar or pelvic pains. Direct trauma to the area can cause bleeding and scarring around the nerve and the muscles, with consistent pressure to the buttock perhaps affecting the nerve's function. The syndrome can also be associated with an increased lordotic posture, hip replacement or vigorous activity and mimics back pain syndromes such as sciatica. Physiotherapists diagnose and treat piriformis syndrome on purely clinical grounds as there are no agreed diagnostic criteria, imaging or other tests.

Piriformis syndrome is often not considered as a cause of low back and leg pain but can mimic sciatic nerve compression, giving symptoms similar to back pain with L5 or S1 nerve compression from disc or joint changes. Cases of trochanteric bursitis may be connected to this syndrome as the muscle inserts onto the trochanter. Physio clinic examination will find intense pain over the piriformis trigger point in the buttock, reduced lateral rotation of the hip, pain and weakness on resisted hip abduction and lateral rotation and a difficulty sitting on the affected buttock.

Physiotherapists use many treatment modalities to improve piriformis symptoms but partly due to the lack of a clear diagnosis there is no agreed scientific treatment approach. Physios check the findings such as tightness in the piriformis, hip external rotator and adductor muscles, hip abductor weakness, sacro-iliac and lumbar dysfunction, externally rotated hip in walking, apparent leg shortening and a shorter stride length.

If the physiotherapist finds that the piriformis and other muscles are tight then treatment consists of loosening up the hip joint followed by stretches of the muscle. Stretching the muscle is performed in lying with the hip flexed, pulling the hip into adduction and internal rotation. A home stretching programme is important, with regular stretching every two or three hours in the acute phase. If the piriformis is looser than expected the Physio may exercise the muscle to tighten it up and stretch out the tight structures which oppose this tendency.

Local manipulation is a common treatment directly over the most painful point in the buttock, which can be very tender indeed. Transverse or longitudinal mobilisations over the muscle is the technique used, maintaining the pressure steadily for up to 10 minutes initially. Treatment of the back and sacro-iliac joints is important to address any dysfunction which might contribute. Modifying posture and activity, muscle injections, mobilisations and stretching are commonly successful in reducing symptoms. In resistant cases surgery to the muscle or the tendon at the greater trochanter may be contemplated.

Simple Tips to Find a Reliable Physiotherapist

Without question, a physiotherapist i can really help treat your physical problems. Whether it is a neck issue, headaches, back pain or a sprained ankle, a phyios can help relief your problem. Below are 6 simple tips you can use today to find a suitable phyisotherapist -

1. Ask your friends or relatives if they have had any god experience with a physiotherapist. From my own personal experience, I found my physiotherapist through a recommendation from my Mother. As both of us suffer from back problems, she was my first natural choice about her treatment. Till today, I have been using the same physiotherapist. For sure, references from your circle of trust is simply the best. So ask around from people you know and trust.

2. If you can't find any kind of reference, try online. With internet communication being so instant, finding actual reviews from customers, both good and bad, are quite easy to find. The first place you should start with is - Google Places. Not only does it contain company information, it will also list user ratings and comment from third party sites, like Truelocal or any other third party sites. By displaying comments from non biased sites, you can more or less take note of the feed-backs

3. Is the Physio a member of a Industry watchdog like APA - Australian Physiotherapy Association. An association simply sets the standard that every physiotherapist should adhere to

4. Don't just ask for one physiotherapist, ask for at least 3. That way, you can compare the service they can offer, and the standard rate they charge. But do find physiotherapist who can treat your specific problem. For example, some physiotherapist specializes in back problems, others specializes in back pain for pregnant women. Hence, make sure you are dealing with the right kind of physio treatment.

5. Do they offer needling - aside from muscle massage therapy, does the physio offer any kind of other treatment like dry needling. postural correction or pilates. Often, these treatment can compliment the current treatment you are receiving.

6. Another good place to check out a physio clinic is via their website. Often, they will list the qualifications of the physiotherapist and their specialty. By assessing their website, you can get a feel of what the clinic can offer.

If you are looking to ease your pain via a physiotherapy treatment, then a qualified and professional physiotherapist can help greatly. Therefore, if you want to cure your problem for good, it is recommended that a time is put aside for research and simple asking around for a good physio clinic. By spending the time, you may find the right kind of therapy for your pain. And the first place to start is by opening your mouth, and ask your friends, relatives or anyone you trust to get their recommendation. Often, by asking you will find the best care for your problem.

Is SaeboFLEX the Best Hand Treatment System For Neuro Physios

The SaeboFlex device has been marketed for people with a neurological condition that have limited their hand movement. Some injuries (like a stroke or spinal injury) can leave the person unable to open their hand and until now physiotherapists could do little to help. People were left unable to use their hand properly and so were disabled. Simple everyday tasks like picking up a glass or opening a door become impossible as the brain has, in effect, forgotten how to use the hand properly.

SaeboFlex was developed in 2002 in the United States by a group of Occupational Therapists who were frustrated by the lack of treatment options available to improve the grip and release functions of the hand.

It is a purely mechanical based device that is simple to understand. By using a system of springs attached to the forearm the hand is pulled open. The patient can then use their own muscles to close the hand; resulting in a 'functional' hand. The spring system can be altered to add or reduce the level of assistance.

Impaired individuals can re-learn how to use their hands properly over a few months of therapy. The SaeboFlex takes over the 'forgotten' skill of opening the hand. It still demands a considerable commitment, twice a day for 45 minute sessions and the results can take months.

By using a series of exercises to build the use of the arm, shoulder and hand improve strength, range of movement and motor skill in the affected limb. For example picking up a soft ball, about the size of a grapefruit, and move it from one basket to another. Although apparently pointless they are supposed to slowly re-educate the use of the hand and to regain some of the lost function.

It is claimed by the inventors that even individuals over 20 years post neurological injury can benefit from the SaeboFlex. Although they do admit that the longer the time between your injury and the treatment then the longer any improvement are likely to take. In addition, the ability to use the hand has understandably been described as being extremely motivating during the long recovery process.

But SaeboFlex doesn't work for everyone, there are a range of people that are unlikely to benefit. For example you need to have some shoulder and elbow movement. You must also be able to flex (close) your fingers and ideally have some ability to open your fingers to get the best results.

It's also gaining credibility as a number of American Private Medical Insurance companies will now cover the expense of the SaeboFlex equipment and treatment.

There are only a few alternatives to chose from. One is the Constraint Induced Movement Therapy (C.I.M.T.). This technique involves restraining the less-impaired arm (by placing the entire arm in a sling or placing the hand in a mitt). The philosophy is that you are in effect 'choosing' not to use the 'bad' arm or hand as it is too difficult. So by disabling the 'good' arm you are forced to use the 'bad' one. With similar shaping and repetitive task exercises to the SeaboFLEX system the brain relearns how to use the 'bad'. With the same idea as the SaeboFLEX therapy the brain effectively gets re-wired so that you can regain use of your arm.

The advantage of this system is it is simple and therefore easy to administer. Clinical Trials have proved that it does produce results, and that those results last. The disadvantage is that during treatment you are functionally worse off - so this needs a stronger, more durable level of self confidence otherwise it could be quite depressing.

Another alternative is the NESS H200 device. Created by the American Bioness company it is a system that uses mild electrical stimulation to improve the way your arm works. It is intended to help reeducate your muscles over time, giving you the use of your hand by delivering the 'missing' electrical stimulation your muscles will work in a natural way. The advantages are similar to the SaeboFLEX in that you gain functionality (rather than losing it with the CMIT system). It does require expert help to install, although the Functional Electrical Stimulation (FES) system has been around for a number of years and is widely trusted by the therapeutic profession. What is new is applying this to the forearm and hand function.

It is important to acknowledge that these three systems all produce results. The easiest solution to use is the CMIT system. The NESS 200 device is certainly less bulky, and looks better, than the SaeboFLEX and achieves the same results. Each require expert training, the SaeboFLEX is simpler to install but requires a made to measure device. The real difference is likely to be as a result of the experience and expertise of your Therapist.