Piriformis Syndrome?

[thabiso]

Nerve root "flossing" may help (or exacerbate) symptoms, .

Hi, Hope I dont appear really silly here. My first time for me to hear about this. What is flossing?

[CFSupport]

Flossing, as described, by McGill in Low Back Disorders is a technique that is meant to increase mobility around the point of an inpingment, in this case the periformis. Have the patient sit on a table with the legs bent at the knee and hanging freely. The patient then fully flexes the cervical spine (i.e. tucks chin), then in a coordinated manner, fully extends the knee, and cervical spine. repeat 5 ot 6 controlled reps. This techniques essentially moves the nerve root as a unit (dosent stretch it), literally flossing through possible areas of inpingment between the cervical SC region and the lower leg (sciatic nerve root flossing). i am by no means an expert in this technique but it is meant to relieve symptoms of impingment of the sciatic......let me know how it goes

[sheri]

back to the original point....
1) how is your patient going, takajokomo
2) you needed far more description of the patient if you required a decent response ie: more postural information, nerve testing, neural length testing, muscle length and strength testing...i am sure you did do all these things but in order to appraise it online we need more info!
3) you definitely do need to assess the lumbar joints and movements to rule out disc and facet problems. if these are all clear you need to look closely at the pelvis and work your way through the issues there (a topic i am slowly coming to grasp...textbooks on the way as we speak...). the groin pain and hip external rotation are sending alarms in my head. . .
4) this certainly does not seem like a condition where ultrasound will be of ANY benefit whatsoever so i suggest take that five or so minutes in each session to reassess and prescribe exercises.

keep us posted
Additional Comment I forgot:
message to thabiso

i see you are from botswana. i studied in south africa and since moving to and working in australia i realise how the universities in south africa (not sure of botswana) are quite backward in their research. no need to apologise for your questions. just hit those journals man!

good luck!

[thabiso]

Zimbabwe actually. thanks for encouragement

[takajokomo]

Thanks Sheri. But that patient has since recovered and has been symptom free for months now.

I attended a course on "dry needling" in the interim, and that patient was one of my first trials. Of course the patient was recovering gradually with stretches and myofascial release, but a combination of piriformis needling and stretches did the trick in days. Amazing!

I would also recommend dry needling for all physiotherapists out there. It's quite a useful technique.