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Piriformis syndrome Favorites Over
Piriformis sacrum from the pelvis before the hole in front of the lateral sacral 2,3,4, out through the greater sciatic hole up under the buttocks, to the greater trochanter tendon ends, is the hip external rotation muscles. Above the piriformis and superior gluteal vessels piercing the superior gluteal nerve, below the inferior gluteal nerve and vessels have passed through, and slightly outside the sciatic nerve in its adoption. Therefore, the variation piriformis, spasm, inflammation, edema and other factors could have on the sciatic nerve compression symptoms. Variation piriformis (Figure 178) is an important reason for causing this disease. Since anatomical variation, such as vulnerable to injury or inflammation of the piriformis contracture stimulation, while squeezing the sciatic nerve, so that the nutritional blood circulation disorder sciatic nerve, resulting in arterial insufficiency and venous obstruction and other pathological changes. Furthermore, sciatic nerve in the piriformis stimulated by inflammatory factors, local adhesion formation, nerve can reduce the scope of displacement, the tension increased.
Clinical manifestations
The ipsilateral hip and lower extremity sciatica based. The pain often due to the cold, walking or activity after the increase, cough, bowel and other abdominal pressure increases, there may be lateral to the foot after lower leg radiating pain intensified; bed rest, the symptoms may be al


leviated. Piriformis tension test positive are important signs of this disease.
Diagnosis and differential
There side of the hip and lower extremity symptoms of sciatica, with straight leg raising test is limited, piriformis piriformis tension test was positive and the surface projection of the buttocks area (Figure 179) of these signs of deep tenderness, the exclusion of the basis of bone and joint diseases can be diagnosed on the disease. Differential diagnosis as follows:
Treatment
1. The principle of sparse muscle spasm treatment, blood stasis and meridians. 2. The common points and parts of sub-liao, the Liao, the next liao, ring jump, Yin door, Venezuela, Yang Ling and other points, buttocks, thigh and lower leg lateral and other units. 3. Rubbing the heel of common law practice, press law, refers to the rubbing method, plucked method, rubbing method and the hot method. 4. How piriformis muscle deep in the gluteus maximus, when the vast majority of patients have significant injury sciatica symptoms, so the gluteus maximus is generally more intense, it brings to the massage treatment of the disease difficult. Effect of manipulation to make the deep tissue hip piriformis, we must first lift the gluteus maximus spasm problems. The method is as follows: (1) Patients were prone position, hips and legs to relax the affected side, doctors stand in the affected side. Applied first in the buttocks rubbing the heel of law, not a large amount of stimulation techniques, but to be soft, which is used to relax the hip muscles, which improve the local blood supply and return favor. Then, after the stock. Leg rubbing the heel of the rear to impose the same method, from top to bottom and from 3 to 5 minutes. Then refers to the rubbing Venezuela, Cheng Shan, Kunlun various points. (2) The above treatment of hip muscle relaxation techniques, based on the surface projection of the area and then applied in the piriformis compression method and plucked law. Means the amount of stimulation must be from light to heavy, to avoid the gluteus maximus of the resilience force; plucked with the piriformis vertical direction. This method can alleviate the piriformis spasm, blood stasis and collaterals, is the focus of treatment. Can press the heel rubbing with the piriformis, plucked three methods combined alternately about 5 to 8 minutes. To avoid the gluteus maximus of the anti forces, the method can be used knee flexion and, through internal and external rotation of the hip passive motion (Figure 180) to improve the methods of treatment. (3) The surface projection of the piriformis muscle in the hip area, along the rubbing method to use to heat intensity. Severe symptoms of pain can be localized to heat treatment.
Self-care
Piriformis part because of the deeper self is more difficult to achieve the desired effect of practice, so I can use the following two methods: 1. Ipsilateral hip to adhere to the moist heat. 2. The middle fingers to rub the affected side that Yangling, Kunlun various points.
Note
1. Limb warm, more rest and less activity. 2. For those with conservative treatment fails, surgical exploration can be used to remove the cause.


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