The AAO Journal, 2024/06, 34(2):17. doi: 10.53702/i2375-5717-34.2.16, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/16/500954/LBORC-NUFA-Poster-Abstracts-2024-Students)

Keywords:

buttocks [3]
case report [736]
female [655]
hip [394]
OMT [3925]
osteopathic manipulative treatment [3946]
piriformis syndrome [9]
women [608]

Abstract:

Introduction/Background: Piriformis syndrome frequently causes buttock and hip pain, comprising up to 6.0% of sciatic-like syndromes. It impairs quality of life by causing physical, mental, and emotional distress due to its chronicity. Despite its prevalence, treatment using manual therapies is not well-documented. After ruling out emergent pathology, a strong understanding of anatomy helps distinguish this from other musculoskeletal pathologies and guides manual treatment. Osteopathic Manipulative Treatment (OMT) modalities such as Fascial Distortion Model (FDM), Strain-Counterstrain (SCS), and Muscle Energy (ME) may play an important role in alleviating distress where other methods have failed. Case: A 28-year-old female presented with a one-month course of left buttock and hip pain exacerbated by sitting, standing, and laying down, associated with left leg paresthesia and insomnia. She was found to have piriformis hypertonicity with a corresponding SCS tenderpoint, and fascial distortions including several herniated trigger points (HTPs) and a triggerband (TB). Anti-inflammatories, alternative medicine modalities, physical therapy (PT), ME, and SCS provided minimal transient relief. Results: With subsequent FDM implementation to the HTPs and TB, as well as lifestyle modifications, standing pain resolved completely and seated pain improved substantially. Additionally, she reported multiple objective sleep improvements from baseline. Objective improvement in both outcome measures demonstrated treatment success. Discussion: This report presents a case of piriformis syndrome superimposed by fascial distortion viewed through the Osteopathic perspective. After ME and SCS had proven ineffective, identification of the HTPs and TB allowed for a natural stepwise treatment progression to FDM while prone and seated. Overall, use of OMT resulted in meaningful improvements in outcome measures of pain and sleep. This case highlights the necessity of applying Osteopathic principles in assessment, diagnosis, and treatment of piriformis syndrome.