Duration of Piriformis Syndrome | Piriformis Syndrome

Duration of Piriformis Syndrome

How quickly a piriformis syndrome heals is hardly predictable. Even with good therapy, healing of the disease can take several weeks or even months. If the pain persists continuously for 3 – 6 months, this is called a chronicity of pain.

The success of the treatments is in any case (especially because of the protracted healing of the pain) strongly dependent on the patient’s cooperation and a consistent treatment. In addition, besides the piriformis syndrome, existing complaints in the spinal area have a worse prognosis, this is especially true for complaints in the lumbar spine and sacrum area. If these are not present, significant pain relief can often be achieved in about 3 weeks with appropriate treatment.

Diagnosis

As described at the beginning, the Piriformis syndrome is often mistaken for a herniated disc, as this is also a more common cause of comparable pain. Nevertheless, after clarification and exclusion of a herniated disc, a Piriformis Syndrome must be considered. Pressure pain in the area of the piriformis muscle, palpation of a hardened muscle belly, as well as when pain occurs during flexion, internal rotation, and when the affected leg is moved towards the other, many criteria speak for the syndrome, which makes appropriate treatment reasonable.

Furthermore, the diagnosis of Piriformis Syndrome can be made by triggering stretching pain. There are several tests for Piriformis Syndrome that can help to make a diagnosis. The Lasegue test, in which an examiner slowly moves the leg stretched in the knee towards the ceiling when the patient is lying on his back, can provide an unspecific indication by provoking pain in the irritated and tensed sciatic nerve.

When performing the test of external rotation, the patient lies on his back. The lower legs hang over the edge of the examination couch. During the test, the doctor presses the inner ankles firmly with both hands and asks the patient to pull his feet inwards.

This results in an external rotation of the hip joint, which is very painful in the presence of Piriformis Syndrome. The diagnosis of Piriformis Syndrome can also be made by checking the abduction. The abduction test is performed in a sitting position.

While the doctor presses his hands to the outside of the patient’s knees, the patient must try to move the legs away from the axis of the body. The success of the treatment is ultimately evidenced by the fact that imaging or other diagnostics do not indicate a painful but non-threatening disease in this case.If the treatment options for Piriformis Syndrome are exhausted, it may be a chronic pain syndrome that has developed, or there may be another cause for the irritation of the sciatic nerve, such as a previously unconsidered slipped disc, a sacroiliac joint blockage, vertebral body slippage, but also other nerve inflammation, such as from Borrelia bacteria. Tests for Piriformis Syndrome aim to stretch the Piriformis muscle.

In this way it can be determined whether there is painful tension in this muscle. The piriformis muscle is needed for abduction (abduction) of the hip when the hip is flexed, and for external rotation in the hip joint when the hip is stretched.

  • Test of abduction: In order to test abduction, the hip must first be flexed, so the examination situation is simplest when sitting.

    The doctor then presses the knee on the painful side from the outside. The affected person tries to bring the leg outwards against this pressure. A reduction in strength compared to the healthy side during this test indicates a malfunction of the piriformis muscle.

  • Test of external rotation: To test external rotation, the affected person lies on his or her back, with the lower legs hanging down over the lower edge of the examination couch.

    To achieve external rotation of the hips, the hanging feet must now be pressed inwards. Again, a reduction in strength or increased pain compared to the opposite side is indicative of Piriformis Syndrome.

  • Freiberg test: The third test is called the Freiberg test. The Piriformis muscle is stretched by the examiner.

    The test is also carried out in a supine position with the lower legs hanging down, the lower legs are pressed outwards by the examiner. If this stretching causes pain in the area of the piriformis muscle, the suspicion of a piriformis syndrome can also be raised.

Piriformis syndrome is usually a diagnosis of exclusion. It is suspected if no other cause for the sciatica symptoms can be found.

For this reason, an MRI of the pelvic region is usually only performed after many examinations have been performed, for example, on the back. Before an imaging is initiated, various functional tests are performed, which specifically involve the piriformis muscle. Thus, the suspicion of a piriformis syndrome can be confirmed.

MRI images do not always clearly identify piriformis syndrome. It is possible to see whether the piriformis muscle is thickened or shortened. However, this only allows the assumption that this is the cause of the sciatic pain.