a community of practitioners

Piriformis Syndrome NOT ?

I had a new client recently refered to me by another client. She is a runner. Her complaint was left hip pain that radiated pain at times below her knee, all on the lateral side of her leg. She has been seeing Chiropractors and Phyisical therapists for months, and even went to an Orthopedic MD. All told her that she had Piriformis Sysdrome. They all told her that her Piriformis was tight with scare tissue and pinching her Sciatac Nerve. She went for months of therapay all total with those various people with no clinical results.. In other words. What they were doing was not working. A client of mine, her friend , refered her to me. I palpated her entire lumbar back left hip and leg. I found trigger points(tender spots) in her Gluteus Minimus, two spots on her Greater trochanter of the femur, and a big trigger point in her Vastis lateralis. Now the Piriformis connects to the greater trochanter, but the pain pattern for that muscle does not radiate pain down the leg. But the Gluteus Minimus does, along with the Vastus Lateralis. I will attach pictures of all the muscles and their pain patterns. All those other experts had her doing exercises along with gruelling deep tissue work on none of the above areas or muscles Im talking about. My goodness..Anyway within a half hour all those trigger points and tender areas where gone. Now did I help her or not? Only time will tell. If those trigger points come back, I didnt help her. But one thing is for sure. She did not have Piriforis Syndrome. There was no pinched nerve radiateing pain down the leg like those people told her. It was trigger points from the Gluteus Minimus and vastus lateralis causing the lateral leg pain. I told her not to stretch or work out for a few days. We released those trigger points. Now she has to let her body heal. She is coming in on a follow up incase any of them come back. Then she can go on a short run, and I will check her again. Nobody palpated those tender areas on her hip and lateral leg..Thats why they could not help her with months of therapy. Those tender areas remained. And the exercises and manipulations they did only perpetuated those tender areas. If you cut yourself. You clean the cut. Put a bandaid on it, and let it heal. You dont keep pokeing the cut to make it heal. Anyway, look at the pain patterns of the Trigger points she had. I dont think the Piriformis was involved in a major way. The sciatic nerve, certainly not.

Attachments:

Screenshot_2013-07-10-20-40-55.png, 300 KB
Screenshot_2013-07-10-20-40-39.png, 401 KB
Screenshot_2013-07-10-20-40-20.png, 469 KB

▶ Reply to This

Replies to This Discussion

Permalink Reply by Therese Schwartz on July 11, 2013 at 9:10pm

Gordon, this was perfectly timed! I have a client with leg pain we've been working on for a while now. I keep getting it better but I pulled up the 3rd screenshot to look at while I was working on her tonight. It fits a great deal of her pain pattern and sure enough we found trigger points! She also had one in her mid-IT band like you showed here. She injured herself doing one of those "Boot Camp" workouts. Turns out she tore her meniscus and needs surgery, which explains why I haven't been able to eliminate her leg pain. But, I've been able to help her enough that she can cope with it.

▶ Reply

Permalink Reply by Gordon J. Wallis on July 16, 2013 at 12:52am

Just a follow up. The Gluteus Minimus trigger point was no longer there. The two tender spots near the Trochanter were also gone. The Vastus lateralis trigger point had returned, but only at half the intensity as the first session. The lateral leg pain was gone. However there was one symptom I forgot to mention in my original post. When she sits for a short while her left hip aches in a bad way. And it was still a problem. After seeing how I worked on her. She went home and palpated herself. She located a tender spot right about where one of the hamstrings ( cant think of the name now) connects to the pelvis. I somehow missed it durring the first session. Anyway I was able to eliminate the Vastus lateralis trigger point again along with the newly found trigger point on the Ischial Tuberosity where one of the Hamstring muscles connect. Im hopeing the hamstring one is the main source of her hip pain when she sits, and that it wont come back. Im sure I will find out. I like doing this kind of work. I hope I can help her. The Hamstring one might be a Gluteus Max trigger point.

▶ Reply

Permalink Reply by Eliza Desmarais on July 18, 2013 at 12:39am

It sounds like ITB friction syndrome. There's an orthopedic assessment test you can do: Have the client supine. Have them bring their knee up in a bent position while still having the foot keep contact with the table. Take your thumb and press very tightly on the insertion of the ITB, and have them extend leg straight back down again until flat on the table. If there is pain along the bottom of the ITband and/or at the insertion, it's a positive. You can also test the ITB in side lying and have them resist abduction. There's also a test to rule out TFL irritation. IT band gets shortened in a sitting position and will ache in sitting. But a disc inflammation also will radiate in a seated position. That would lead to L4-L5. But you'd have to know the ortho tests to rule those out, and it's too long to text. Look up Straight Leg test, slump test, Valsalva test, lumbar flexion test (I get my clients to do it 15 times followed by 15 times lumbar extension test). After being a Registered Sports Massage Therapist for over 13 years, and having treated numerous marathon runners, it really sounds like IT band friction syndrome. Hope this helps. :)

▶ Reply

Permalink Reply by Eliza Desmarais on July 18, 2013 at 12:56am

I don't remember the names of all the tests, I just know how to do them! Just looked it up for you, it's called Noble's Compression test. THere's a youtube video: