This syndrome will not be evident on CT or MRI Scan. Rather, the diagnosis is made clinically by a specific examination of the piriformis muscle. Here’s how it works:
In a sitting position (or while lying flat on the back), flex the knee on the painful side, and pull the knee across the body and slightly upward. As the hip rotates, the tight piriformis muscle is stretched, yielding increasing pain as the spastic muscle is stretched. (In contrast, a herniated disc usually causes pain when, lying on the back, the patient flexes one knee against the chest and then straightens the leg).
There are two home exercises that will help to relieve pain by stretching both the piriformis muscle and the hamstring muscles (the hamstring muscles are located in the back of the thigh and can also increase pressure on the sciatic nerve):
1. Lie down, face up, on a comfortable, flat surface (such as a thick rug on the floor). Make sure that your shoulders, legs, and mid-back are flat against the surface. Bring the knee up (on the affected side) to waist level and plant the foot next to but just outside the opposite knee. Gently pull the bent knee down toward the floor, across the body, without moving the anchoring foot. In the presence of piriformis spasm, this maneuver will cause some pain. Carefully continue pressing the bent knee downward, releasing the pressure if the pain becomes too intense. Do this 8-10 times per session, twice a day. As the piriformis spasm lessens (from the stretching), the exercise will hurt less and the hip will rotate more easily.
2. Again, lie down face up on a flat surface. Flex the affected knee up toward the chest, keeping the “good” leg flat, thus forming a right angle with the thighs. Gradually, straighten the affected knee, while keeping the “down” leg flat. Repeat 8-10 times, twice a day.
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