Piriformis Syndrome: Pain Management and Stretching Techniques

Q: Piriformis Syndrome: Pain Management and Stretching Techniques

Hello, I still remember your points： <br>1. <br>The focus is not on whether you are suitable for the knee-to-chest position, but rather on how you perform it. <br>When stretching, it should be a gentle stretch, not a forceful one. <br>During the knee-to-chest position, the pelvis

Hip pain

Hello, Doctor: I previously inquired online about my hip pain, and I appreciate your advice despite your busy schedule.
I am experiencing symptoms of Piriformis syndrome and Myofascial Pain, and I have undergone physical therapy (including heat therapy, interferential current therapy, and ultrasound), as well as steroid and Xylocaine injections.
You suggested that I could perform the knee-to-chest stretch, but when I bend my legs, my hip hurts.
I would like to ask: 1.
Is the knee-to-chest stretch suitable for me? 2.
Since I have symptoms of Piriformis syndrome, I need to undergo ultrasound treatment.
What position should the patient adopt during the treatment? How long does each session last, and what is the required intensity? 3.
Can patients with Piriformis syndrome perform Gluteus Stretch and Psoas Stretch? How many repetitions should be done for each stretch, and how long should each hold? 4.
Initially, when my hip pain was severe, I did not experience numbness or tingling in my legs.
However, in the past month or two, my hip has gradually improved, but I have noticed a tingling sensation in my toes.
What could be the reason for this?

Teng tain, 60~69 year old female. Ask Date: 2006/08/23

Dr. Pan Yingda reply Rehabilitation

Hello, I still remember your points:
1.
The focus is not on whether you are suitable for the knee-to-chest position, but rather on how you perform it.
When stretching, it should be a gentle stretch, not a forceful one.
During the knee-to-chest position, the pelvis and spine should remain stable, with movement limited to the hip joint.
It is best to engage the core muscles using your breath to provide support and protection for the spine (it's difficult for me to explain how to do this in words).
If you feel pain, stop at that point and do not continue to stretch or repeat the movement; this can help increase your range of motion without pain.
2.
If you were my patient, I wouldn't typically order an ultrasound.
It's not that it can't be done, but it may not address the underlying issue.
However, many patients prefer to use certain modalities (they feel that this gives them a sense of being treated), so we often accommodate that.
As for the posture, duration, and dosage, I trust your therapist; they are all very professional (there may be some variations due to different equipment).
My advice is that if there is no improvement after 2-3 weeks, it may not be necessary to continue.
3.
Both the gluteal muscles and psoas muscles can be stretched, but the key is how to stretch them.
It's not just about how many times or how many seconds each time, but rather ensuring the posture is correct.
There are many ways to stretch; for static, sustained stretching, holding for 30 to 60 seconds, two to three times is sufficient.
There are also other stretching methods; you can ask your therapist about them.
4.
As for the cause of the numbness and pain in your toes, I'm not entirely sure.
If you come to Taitung, let me examine you in person; I may be able to provide you with more precise advice.

Reply Date: 2006/08/23

More Info

Hello! Thank you for your detailed inquiry regarding your experience with Piriformis syndrome and myofascial pain. It’s great to hear that you are actively seeking solutions and understanding your condition better. Let’s address your questions one by one.

1. Knee-to-Chest Stretch: The knee-to-chest stretch can be beneficial for many individuals, but given your specific situation with Piriformis syndrome, it’s important to approach this with caution. If bending your knee causes significant pain in your buttock, it may not be the right stretch for you at this time. Instead, consider modifying the stretch or trying other gentle stretches that do not exacerbate your pain. Always listen to your body, and if a movement causes pain, it’s best to avoid it until you can discuss it further with your physical therapist or healthcare provider.

2. Ultrasound Therapy Positioning: When undergoing ultrasound therapy for Piriformis syndrome, the positioning can vary based on the area being treated and the comfort of the patient. Typically, lying on your side with the affected side facing up can allow for better access to the piriformis muscle. The duration of each ultrasound session usually lasts about 5 to 10 minutes per area, but this can vary based on the specific treatment plan your therapist has designed for you. The energy settings will depend on the type of ultrasound machine used and the specific protocol your therapist follows, but it is generally set to a level that provides therapeutic benefits without causing discomfort.

3. Gluteus and Psoas Stretching: Stretching the gluteus and psoas muscles can be beneficial for individuals with Piriformis syndrome, as tightness in these areas can contribute to your symptoms. For the gluteus stretch, you can perform it gently, holding the stretch for about 20 to 30 seconds and repeating it 2 to 3 times on each side. For the psoas stretch, a common method is to kneel on one knee while pushing your hips forward gently; hold this position for the same duration and repetitions. Always ensure that you are not pushing into pain, and if you experience discomfort, it may be wise to consult with your physical therapist for personalized guidance.

4. New Symptoms of Numbness and Pain: The development of numbness and pain in your legs could be related to several factors. It’s possible that as your piriformis muscle tension decreases, other underlying issues, such as nerve irritation or compression, may become more apparent. The sciatic nerve runs close to the piriformis muscle, and if it is being compressed or irritated, it can lead to symptoms in the legs. It’s crucial to discuss these new symptoms with your healthcare provider, as they may want to evaluate your condition further to rule out any other potential issues.

In summary, managing Piriformis syndrome often requires a multifaceted approach, including physical therapy, stretching, and sometimes medical interventions. It’s essential to work closely with your healthcare team to tailor a treatment plan that suits your specific needs and to monitor any changes in your symptoms. Always prioritize your comfort and safety during exercises and treatments, and don’t hesitate to reach out for further assistance if needed. Wishing you the best on your journey to recovery!

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