Physical Medicine and Rehabilitation for Piriformis Syndrome Follow-up

Updated: Jan 26, 2017
  • Author: Milton J Klein, DO, MBA; Chief Editor: Consuelo T Lorenzo, MD  more...
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Follow-up

Further Outpatient Care

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  • Piriformis syndrome usually is treated effectively with conservative measures. Please refer to the Treatment section for a discussion of treatment recommendations.

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Further Inpatient Care

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  • Inpatient care is necessary only if surgical intervention is warranted. Surgery is the last-resort treatment for severe cases of piriformis syndrome.

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Deterrence

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  • No method of preventing piriformis syndrome has been demonstrated. The best means of prevention is to maintain biomechanical balance through the restoration of a more physiologic weight-bearing distribution; this necessitates a level pelvis/sacral base and equal leg lengths, which can be achieved by using heel-lift therapy if necessary. This treatment approach also prevents recurrences of piriformis syndrome, especially if the underlying etiology is a leg-length discrepancy. The patient also must engage in a general stretching program that includes the bilateral piriformis muscles.

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Complications

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  • The most significant complication of piriformis syndrome is a failure to recognize, diagnose, and treat this disabling condition. If left untreated, a patient may undergo unsuccessful back surgery for a disk herniation; however, a coexisting occult piriformis syndrome can result in a failed back syndrome.

  • Another complication is inadvertent direct injection of the sciatic nerve, which usually results in a nondisabling and temporary sciatic mononeuropathy.

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Prognosis

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  • The prognosis of piriformis syndrome depends on early recognition and treatment. Because it is a soft-tissue syndrome, the condition has a tendency to become chronic, usually due to late diagnosis and treatment (which lead to a less favorable prognosis).

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Patient Education

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  • For conservative measures to be effective, the patient must be taught, via an aggressive, home-based stretching program, to maintain piriformis muscle flexibility. He/she must comply with the program even beyond the point of discontinuation of formal medical treatment.

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