Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe an alternative treatment approach for piriformis syndrome using a hip muscle strengthening program with movement reeducation. BACKGROUND: 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. CASE DESCRIPTION: 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. OUTCOMES: 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. DISCUSSION: 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. LEVEL OF EVIDENCE: Therapy, level 4.