Physio Solutions

22/01/2025

Priformis Syndromes

🗣️Relationship bw Piriformis Muscle and Sciatic Nerve:

👉The sciatic nerve generally exits the pelvis below the belly of the muscle, however many congenital variations may exist.

✍️The relationships between the Piriformis Muscle and sciatic nerve have been classified by Beaton and Anson using a six category classification system.

🗣️Variations in the relationship of the sciatic nerve to the piriformis muscle shown on the diagram below:

🏋️Type A:
The sciatic nerve exiting the greater sciatic foramen along the inferior surface of the piriformis muscle; the sciatic nerve splitting as it passes through the piriformis muscle with the tibial branch passing.

🏋️Type B:
Inferiorly.

🏋️Type C:
Superiorly.

🏋️Type D:
The entire sciatic nerve passing through the muscle belly.

🏋️Type E:
The sciatic nerve exiting the greater sciatic foramen along the superior surface of the piriformis muscle. The nerve may also divide proximally, where the nerve or a division of the nerve may pass through the belly of the muscle, through its tendons or between the part of a congenitally bifid muscle.

🏋️Type F:
Diagram showing an unreported additional B-type variation consisting of a smaller accessory piriformis (AP) with its own separate tendon. SN sciatic nerve, P piriformis muscle, SG superior gemellus muscle.

20/01/2025

Piriformis syndrome

🗣️Examination

A complete neurological history and physical assessment of the patient is essential for an accurate diagnosis.

The physical assessment should include the following points:

👉an osteopathic structural examination with special attention to the lumbar spine, pelvis and sacrum, as well as any leg length discrepancies.
👉diagnostic tests.
👉deep-tendon reflex testing, strength and sensory testing.

🗣️Palpation

👉The patient reports sensitivity during palpation at the greater sciatic notch, in the region of sacroiliac joint or over the piriformis muscle belly. It is possible to detect the spasm of the PM by careful, deep palpation.

👉With deep digital palpation in the gluteal and retro-trochanteric area, there may be tenderness and pain with an exacerbation of tightness and leg numbness.

🗣️Observation:

👉Patients with piriformis syndrome may also present with gluteal atrophy, as well as shortening of the limb on the affected side.In chronic cases, muscle hypotrophy is present in the affected extremity.

🗣️Special test:

👉Lasèque sign / Straight Leg Raise Test.
👉FAIR test.
👉Hughes test.
👉Hip Abduction Test.
👉Trendelenburg Test.
👉Beatty’s Manoeuver
👉Freiberg Sign
👉Pace sign

19/01/2025

Piriformis syndrome

🗣️Physical Therapy Management:

According to Tonley et al , the most commonly reported physical therapy interventions include:

👉ultrasound thepray
👉soft tissue mobilization
👉piriformis stretching
👉 hot packs or cold spray
👉various lumbar spine treatments.

In addition, Tonley et al. describe an alternative treatment approach for piriformis syndrome.

The intervention focused on functional exercises Therapy Exercises for the Hip aimed at strengthening the hip extensors, abductors and external rotators, as well as correction of faulty movement patterns.

To achieve a 60 – 70% improvement, the patient usually follows 2 – 3 treatments weekly for 2-3 months.

➡️Ultrasound therapy:

First of all, the patient must be placed in the contralateral decubitus and FAIR position (Flexed Adducted Internally Rotated). Start with an ultrasound treatment: 2.0-2.5 W/cm2, for 10-14 minutes. Apply the ultrasound gel in broad strokes longitudinally along the piriformis muscle from the conjoint tendon to the lateral edge of the greater sciatic foramen.

➡️Hot or Cold Pack:

Before stretching the piriformis muscle, treat the same location with hot packs or cold pack or spray for 10 minutes. The use of hot and cold before stretching is very useful to decrease pain.

➡️Stretching:

1️⃣: After that, begin with stretching of the piriformis which can be executed in a variety of ways. Stretch the piriformis muscle by applying manual pressure to the muscle’s inferior border. It is important not to press downward, rather directing pressure tangentially, toward the ipsilateral shoulder. When pressing downward, the sciatic nerve will compress against the tendinous edge of the gemellus superior. However, when applying tangential pressure, the muscle’s grip will weaken on the nerve and relieve the pain of the syndrome.

2️⃣: Another way to stretch this muscle is in the FAIR position. The patient lies in a supine position with the hip flexed, adducted and internally rotated. Then the patient brings his foot of the involved side across and over the knee of the uninvolved leg. We can enhance the stretch, by letting the physical therapist perform a muscle–energy technique. This technique involves the patient abducting his limb against light resistance, which is provided by the therapist for 5-7 seconds, with 5-7 repetitions.

➡️Myofascial Release:

After stretching, continue with myofascial release at the lumbosacral paraspinal muscles and McKenzie exercises. When the patient lies in the FAIR position, the lumbosacral corset can be used.

➡️Hip Muscles strengthening:

PS is caused when the tight piriformis is forced to do the work of other large muscles (like the gluteus maximus, the gluteus medius), An alternative treatment approach for piriformis syndrome using a hip muscle strengthening program especially of the weak gluteal musculature with movement re-education can help in pain relief.

➡️Patient Education:

The therapist can also give several tips to avoid an aggravation of the symptoms. This includes:

♿Avoid sitting for a long period; stand and walk every 20 minutes,
♿Make frequent stops when driving to stand and stretch.
♿Prevent trauma to the gluteal region and avoid further offending activities.
♿Daily stretching is recommended to avoid the recurrence of the piriformis syndrome.

➡️Home exercises:

The patient can also perform several exercises and treatments at home including:

✴️Rolling side to side with flexion and extension of the knees while lying on each side.
✴️Rotate side to side while standing with the arms relaxed for 1 minute every few hours.
✴️Take a warm bath.
✴️Lie flat on the back and raise the hips with your hands and pedal with the legs like you are riding a bicycle.
✴️Knee bends, with as many as 6 repetitions every few hours.

18/01/2025

All About Piriformis Muscle

18/01/2025

Piriformis Muscle

➡️An Overview

The piriformis muscle is a small, flat, pear-shaped skeletal muscle that resides in the deep gluteal region of the pelvis. It is part of the group of six external rotator muscles of the hip. This muscle plays a critical role in lower limb movement, hip joint stability, and overall biomechanics by facilitating coordinated movements of the pelvis and femur.

➡️Anatomy

Location:

The piriformis is situated deep in the buttock, beneath the large gluteus maximus muscle.
It is found in the posterior pelvic region, connecting the lower spine (sacrum) to the upper femur (thigh bone).
The muscle passes through the greater sciatic foramen, one of the primary openings in the pelvis.

Origin:

The muscle originates from:
The anterior (front) surface of the sacrum: Specifically, it arises from the second to fourth sacral vertebrae (S2–S4).
The sacrotuberous ligament, a fibrous band connecting the sacrum to the ischial tuberosity (sitting bone).

Insertion:

The muscle tapers and inserts into the greater trochanter of the femur, the prominent bony projection on the lateral (outer) side of the thigh.

Innervation:

The piriformis is innervated by the nerve to piriformis, which arises from the sacral plexus and is composed of nerve roots from:
L5, S1, and S2 spinal levels.

Blood Supply:

The blood supply to the piriformis muscle is extensive, ensuring proper oxygenation and function:
Superior gluteal artery: Supplies the upper portion of the muscle.
Inferior gluteal artery: Supplies the lower portion.
Internal pudendal artery: Contributes smaller branches for additional perfusion.

Structural Relationships:

The sciatic nerve (largest nerve in the body) passes close to or through the piriformis muscle in most individuals, making the muscle clinically significant in cases of sciatic nerve compression.
Other neurovascular structures, such as the inferior gluteal nerve and pudendal nerve, also run near the piriformis.

Functions

1. External Rotation:
The piriformis is a key external rotator of the hip joint.
When the hip is in an extended position, the muscle rotates the thigh laterally (outward). This function is essential for stabilizing the pelvis and orienting the lower limb.
2. Abduction:
During hip flexion (e.g., while sitting, climbing stairs, or running), the piriformis assists in abducting the thigh.
Abduction is the lateral movement of the thigh away from the midline of the body.
3. Hip Stabilization:
The piriformis stabilizes the hip joint during dynamic movements such as walking, running, or standing on one leg.
It helps maintain proper alignment of the femoral head in the acetabulum (hip socket), preventing hip instability.
4. Proprioception:
Like other muscles, the piriformis contributes to proprioceptive awareness, providing sensory feedback to help coordinate movement and balance.

14/11/2024

Frozen Shoulder

⚛️Definition/Description:

Adhesive capsulitis (AC), often referred to as Frozen Shoulder, is characterized by initially painful and later progressively restricted active and passive glenohumeral (GH) joint range of motion with spontaneous complete or nearly-complete recovery over a varied period of time.

♿Common names for AC include:

➡️Frozen Shoulder
➡️Painful stiff shoulder
➡️Periarthritis

🛐Causes of Frozen Shoulder:

1️⃣. Insidious:

This means the condition occurs for no apparent reason at all. You may simply wake up with pain and limited motion. I have seen this many times in my clinical experience, and it is hard to understand why it comes on. You will see markedly limited motion within a few weeks. There is some evidence to indicate a genetic link to this condition as well.

2️⃣. Trauma :

In this scenario, a person often experiences significant trauma related to a fall, motor vehicle accident or other blunt trauma to the shoulder. I once worked with a patient who was knocked down by a wall of water in the ocean and subsequently developed adhesive capsulitis.

3️⃣.Diabetes:

Research has shown that people with Diabetes are 2-5x as likely to develop this condition and more likely to have it in both shoulders. The condition is often more severe in these situations as well.

4️⃣. Inflammation coupled with immobilization:

This case may involve someone who suffers an injury or is recovering from a surgery and is placed in a sling. Subsequently, the individual avoids moving the affected arm because of pain and spasm. Over time, the capsule becomes shortened and tightens up. I have seen this with patients following shoulder dislocations, humerus fractures, severe tendonitis and rotator cuff surgery. However, immobilization alone does not cause this condition.

5️⃣. Autoimmune reaction :

In some cases it appears tendon degeneration may trigger a response by your own body in which the capsular tissue becomes thickened and fibrotic (hardened). Some feel this explains why most people affected are older (between the ages of 40 and 60).

🗣️Frozen shoulder is more prevalent in women than in men and typically affects the nondominant arm.

12/11/2024

Frozen Shoulder

⚛️Definition/Description:

Adhesive capsulitis (AC), often referred to as Frozen Shoulder, is characterized by initially painful and later progressively restricted active and passive glenohumeral (GH) joint range of motion with spontaneous complete or nearly-complete recovery over a varied period of time.

♿Common names for AC include:

➡️Frozen Shoulder
➡️Painful stiff shoulder
➡️Periarthritis

🛐Causes of Frozen Shoulder:

1️⃣. Insidious:

This means the condition occurs for no apparent reason at all. You may simply wake up with pain and limited motion. I have seen this many times in my clinical experience, and it is hard to understand why it comes on. You will see markedly limited motion within a few weeks. There is some evidence to indicate a genetic link to this condition as well.

2️⃣. Trauma :

In this scenario, a person often experiences significant trauma related to a fall, motor vehicle accident or other blunt trauma to the shoulder. I once worked with a patient who was knocked down by a wall of water in the ocean and subsequently developed adhesive capsulitis.

3️⃣.Diabetes:

Research has shown that people with Diabetes are 2-5x as likely to develop this condition and more likely to have it in both shoulders. The condition is often more severe in these situations as well.

4️⃣. Inflammation coupled with immobilization:

This case may involve someone who suffers an injury or is recovering from a surgery and is placed in a sling. Subsequently, the individual avoids moving the affected arm because of pain and spasm. Over time, the capsule becomes shortened and tightens up. I have seen this with patients following shoulder dislocations, humerus fractures, severe tendonitis and rotator cuff surgery. However, immobilization alone does not cause this condition.

5️⃣. Autoimmune reaction :

In some cases it appears tendon degeneration may trigger a response by your own body in which the capsular tissue becomes thickened and fibrotic (hardened). Some feel this explains why most people affected are older (between the ages of 40 and 60).

🗣️Frozen shoulder is more prevalent in women than in men and typically affects the nondominant arm. It may take anywhere form 6 months to 2-3 years to completely resolve, but it will eventually go away on its own. Physical therapy is often prescribed and may have limited results based on the individual.

03/11/2024

⚛️WHAT IS MALLET FINGER?

Mallet finger, also known as baseball finger, is a tear in one of the tendons in your hand. Tendons are strong bands of tissue that connect muscle to bones.

The tendon that usually tears is called an extensor tendon, which attaches muscles in your hand to the bone near the tip of your finger. Extensor tendons are used to extend or straighten your fingers.

♿WHAT IS THE CAUSE?

Mallet finger is usually caused by a jamming injury to the tip of the finger. This can happen with any activity where there is a blow to the tips of your outstretched fingers, such as catching a ball in baseball, basketball, or volleyball. The stress of the injury can pull the tendon off the bone, tear a small piece of bone off the finger, or tear the tendon itself.

✴️WHAT ARE THE SYMPTOMS?

You may have pain and swelling at the tip of the finger. You may not be able to straighten the tip of your finger. If you don’t get medical care for within a week or two after the injury, you may permanently lose the ability to straighten your finger.

👀HOW IS IT DIAGNOSED?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. You may have X-rays or other scans.

➡️HOW IS IT TREATED?

Your healthcare provider will straighten your finger and put it in a splint for 6 to 12 weeks. This will allow the tendon to reattach to your finger bone or, if a piece of bone has been pulled off, to allow the bone to heal.

Your provider may recommend stretching and strengthening exercises to help you heal after the splint is no longer needed.

If the injury is severe, you may need surgery to repair the tendon or reset the bone.

🏋️HOW CAN I TAKE CARE OF MYSELF?

To reduce swelling and pain for the first few days after the injury:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth, on the area every 3 to 4 hours for up to 20 minutes at a time.
Keep your hand up on a pillow when you sit or lie down.
Take pain medicine, such as acetaminophen, ibuprofen, or other medicine as directed by your provider.
Follow your healthcare provider's instructions, including any exercises recommended by your provider.

03/11/2024

⚛️WHAT IS MALLET FINGER?

Mallet finger, also known as baseball finger, is a tear in one of the tendons in your hand. Tendons are strong bands of tissue that connect muscle to bones.

The tendon that usually tears is called an extensor tendon, which attaches muscles in your hand to the bone near the tip of your finger. Extensor tendons are used to extend or straighten your fingers.

♿WHAT IS THE CAUSE?

Mallet finger is usually caused by a jamming injury to the tip of the finger. This can happen with any activity where there is a blow to the tips of your outstretched fingers, such as catching a ball in baseball, basketball, or volleyball. The stress of the injury can pull the tendon off the bone, tear a small piece of bone off the finger, or tear the tendon itself.

✴️WHAT ARE THE SYMPTOMS?

You may have pain and swelling at the tip of the finger. You may not be able to straighten the tip of your finger. If you don’t get medical care for within a week or two after the injury, you may permanently lose the ability to straighten your finger.

👀HOW IS IT DIAGNOSED?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. You may have X-rays or other scans.

➡️HOW IS IT TREATED?

Your healthcare provider will straighten your finger and put it in a splint for 6 to 12 weeks. This will allow the tendon to reattach to your finger bone or, if a piece of bone has been pulled off, to allow the bone to heal.

Your provider may recommend stretching and strengthening exercises to help you heal after the splint is no longer needed.

If the injury is severe, you may need surgery to repair the tendon or reset the bone.

🏋️HOW CAN I TAKE CARE OF MYSELF?

To reduce swelling and pain for the first few days after the injury:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth, on the area every 3 to 4 hours for up to 20 minutes at a time.
Keep your hand up on a pillow when you sit or lie down.
Take pain medicine, such as acetaminophen, ibuprofen, or other medicine as directed by your provider.
Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

How and when you will hear your test results
How long it will take to recover
What activities you should avoid, including how much you can lift, and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.

🚫HOW CAN I HELP PREVENT MALLET FINGER?

Mallet finger is caused by a direct blow to the end of the finger during an accident that may be hard to prevent. Follow the safety rules for your work or sport and use protective equipment, such as gloves, taping, splinting, or protective strapping before a game.

🏋️EXERCISES
You may do these exercises right away.

1️⃣Finger passive range of motion:

Gently bend the injured finger with your other hand. Then gently try to straighten out the injured finger with help from your other hand. Repeat slowly, holding for 5 seconds at the end of each motion. Do this 10 times. Do these exercises 3 to 5 times a day.

2️⃣Fist making:

Make your hand into a fist. If the injured finger will not bend into the fist, try to help it with your other hand. Hold this position for 5 to 10 seconds. Repeat 10 times.

3️⃣Object pick-up:

Practice picking up small objects, such as coins, marbles, pins, or buttons, with your thumb and injured finger.

4️⃣Finger extension:

With your palm flat on a table and your fingers straight out, lift each finger straight up one at a time. Hold each finger up for 5 seconds and then put it down. Continue until you have done all 5 fingers. Repeat 10 times.

5️⃣Grip strengthening:

Squeeze a soft rubber ball and hold the squeeze for 5 seconds. Do 2 sets of 15.

Picture 5 shows how to protect the finger immediately after injury on playground.picture 6 shows different types of readymade splints that are available.

23/10/2024

THE HIGH COST OF HIGH HEELS

High-heeled shoes are a popular fashion choice that is designed to point the foot down to give your leg an attractive look. Wearing high heels has many detrimental effects on human health. It causes pain, deformities, and different serious problems with your feet, lower back, knees, and legs. Wearing high heels for a long period exert pressure and stress on various parts of the body.

🔵 When you wear high heels,

🔸 They crowd the toes.
🔸 Force the body’s weight onto the ball of the foot. This may cause pain while walking.
🔸 High heels push the body's center of gravity and distrust the body’s alignment.

🔵 Posture and high heels

High heels push the center of the mass in the body forward, taking the hips and spine out of alignment.

Heels mimic the way a person walks in a ramp, increasing the pressure on balls of the feet through a downward pressure.


🔵 Weight pressure

A heel’s height determines the weight carried by the footwear. as the heel gets higher, the pressure increases on the forefoot.

🔺 3 inch Heels – 76%

🔺 2 inch Heels- 57%

🔺 1 inch Heels- 22%

🔵 How high heels affect your body parts

✴️ Feet

💠 Hallux valgus

The big toe deviates towards the other toes in this condition.

💠 Corns and Calluses

Corns and Calluses can be seen especially under the ball of the foot and then on the top of the toes. Corns form from repeated pressure on the skin. Women with foot deformities suffer from corns as the top of the bent toes rub against the top or sides of shoes.

💠 Metatarsalgia

High heels push your body weight onto the ball of your foot. Prolonged wearing can lead to Metatarsalgia joint pain in the ball of the foot.

💠 Plantar fasciitis

The pain directly under the heel is called plantar fascitis.

💠 Hammertoes

Crowd the toes together can contribute to hammertoes. The second, third, fourth, or fifth toes become bent. When the condition becomes severe it may require surgery to relieve pain.

💠 Haglund’s deformity or “Pump Bump”

A pump Bump is a bony protrusion on the back of the heel. Common in women who wear high heels for a prolonged period. It can lead to blisters, bursitis, or Achilles tendonitis.

💠 Neuromas

Neuromas are a painful condition that is developed due to pointed toe and high-heeled shoes. Nerves in the foot can compress and swell especially between 3 rd. and 4 th toes. Common symptoms are tingling, burning, numbness and pain.

✴️ Ankles

💠 Ankle sprain

Wearing high heels increases the instability of the ankle and risk for an ankle sprain. Sprains occur when ligaments are stretched or torn.

✴️ Knees

Wearing high heels produces much more pressure and load in the inside edge of the knee.

Medial compartment of the knee is the most common place for knee arthritis.

✴️ Legs

The leg muscles are more active in walking in high heels. The muscles at the back of the leg tend to shorten and tighten. It can become uncomfortable to wear flat shoes as a result of your calf muscles adjusting to the height of the heel.

High heels create a reduction in the efficiency of the calf muscle pump which leads the legs and ankles to swell.

✴️ Lower back

Lumbar lordosis increases with high-heeled shoes. There is a lot of evidence for an increase in muscle activity in the lower back.

High heels push the lower back forward by affecting the alignment of the ankles, knees, hips, and lower back. Poor alignment may lead to muscle overuse and back pain.

🔵 Injuries related to wearing high heels

In high heels, the foot is pointed down, which makes it easy to sprain or turn the ankle. Wearing high heels affects your center of mass by taking the balance point of your body to a higher level. The wearer must lean backward and use lower leg muscle power to maintain balance. Wearing a high heel has a higher risk of losing balance.

A sprain in the foot or the ankle is the most common injury. Some cases may be serious, requiring surgery.

🔴 Recommendations for waring high heels

Some common injuries and pains associated with wearing high heels may be prevented by the following steps.

❌ Avoid wearing high heels for a long period.

❌Avoid shoes with pointed toes.

✅ Wear a lower height heel less than two inches.

✅ Wear a heel with a wider sole.

✅ Stretch leg muscles before and after putting them.

✅ Recognized foot pain as warning signs.

🔵 Treatments for foot problems related to wearing high heels

Foot pain is a common problem related to wearing high heels, one of the most common musculoskeletal conditions that are treated by a physical therapist.

⭕ Changes in shoe wear
⭕ Padding
⭕ Orthotics
⭕ Pain medication

22/10/2024