Despite the concept of piriformis syndrome being proposed over 80 years ago, the theory is still controversial, with some research questioning its existence entirely. One of the issues surrounding piriformis syndrome is the symptoms are similar to neurological pain referring from the back as well as many other conditions. Symptoms of piriformis syndrome are said to include numbness, or the feeling of pins and needles, pain around the hip and buttocks, an inability to sit for a prolonged period and pain in the buttocks that gets worse with hip movement. 

The theory behind the syndrome is that a taut or abnormally shaped piriformis muscle can compress the sciatic nerve (which passes by the piriformis) and cause sciatic pain. While there are currently no universally accepted tests to diagnose piriformis syndrome, some practitioners argue that stretching, activating or palpating the deep gluteal region and the piriformis can rule in or out piriformis syndrome. Of note however is a recent study found that ultrasound could potentially be a method of diagnosis for piriformis syndrome. This research showed that patients thought to have piriformis syndrome had an enlarged piriformis and sciatic nerve on their injured side, when compared to their asymptomatic side and to healthy volunteers. More research is needed into the topic however. On the basis that there are no reliable ways to diagnose piriformis syndrome, if a diagnosis is made, it is generally done so when all other sources of sciatic pain are excluded.
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Despite the exact pathophysiology of the syndrome being debated, the direction for treatment is relatively straight forward and is treated like most other muscular dysfunction syndromes. Myofascial release, stretching, massage, ergonomic modification, and trigger point release are some of the recommended treatment options for Piriformis syndrome.

Given the anatomy, it is reasonable to believe that piriformis has the possibility of irritating the sciatic nerve and causing sciatic neuralgia. At this stage however, there is no clear-cut diagnostic procedure to diagnose piriformis syndrome. The exception to this is a recent study that found ultrasound could potentially be a method of diagnosis for piriformis syndrome, however further supporting research is required. The diagnosis of piriformis syndrome could be made once all other probable sources of sciatic neuralgia are ruled out. Should this be the case then it would be reasonable to assume the presentation would respond to myofascial release, stretching, massage, ergonomic modification, and trigger point release.

​A recent study found that patients with low back pain who saw a physiotherapist early, had significantly lower out of pocket healthcare costs and decreased use of opioids than those who saw physiotherapist later or not at all (1). When you consult with us, we will work with you to provide an adequate explanation of the nature and prognosis of sciatica. In the early stages, international guidelines suggest that bed rest is not recommended unless pain is significantly disabling. In fact, we will work with you to keep you physically active and doing activities that are important to you. We will combine activity with nerve relief manual therapy and nerve easing position and movements for you to do at home.

Once relief has been achieved, treatment will be more recovery focused, and involve muscle memory tasks and goal specific rehabilitation.

Physiotherapy uses a combination of evidence-based research, clinical experience and clinical training to diagnose and treat your presentation of sciatica. ​For examples of exercises that can be used, remembering that every sciatic presentation is an individual one, check out this exercise video for sciatica below: 

Do you get aches and pains after even 9 holes of golf? Are you getting less movement from your body and it’s costing you your handicap?

Unfortunately, golf is not the exception to sporting injuries with up to 80% of golfers experiencing back pain at some stage. Of this percentage, too many cases are likely to have recurring and relapsing symptoms form a poorly managed condition.

Now more than ever an exercise program is an essential part of your golf game.  A long period of rest followed by a sudden increase in activity is the most efficient way to cause an injury. Without a structured exercise and mobility program you risk strains and sprains to your body that will not only effect your game but also put more demand on other body parts to compensate for any lack of movement. This can change muscle memory and the way you swing, skyrocketing the risk of injuring other parts of your body.

Due to the nature of golf, hips, backs and shoulders are often the most susceptible to injury. Each one of these body parts play a key role in your swing and can make life a nightmare when injured.

SALVAGE OR SAVAGE YOUR HANDICAP
A structured exercise and mobility program can be a lifesaver for your handicap, it can make sure that joints are moving smoothly and muscles are activating correctly. Not only can an exercise program ensure that all body parts are working together but it can also help take your golf swing to the next level.

Getting expert physiotherapy advice on your biomechanics and a program will identify areas to build healthy muscle, ligaments with the right exercises, the right exercising strategies beyond just swinging to make your golf comfortable, minimising the risk of injury and enhancing safety. The benefits are…

• better management of injury and having the tools to look after yourself.
• understanding what your physical limitations are and goal setting overcoming these with a clinically informed treatment plan.
• Alternatives to just golf to train for golf involving other forms of exercise to target the same goals. Think of strength exercises and flexibility work.

If you have ever hurt yourself playing golf and then continue reinjuring yourself keep reading, we are going to touch maintenance and preventative exercises to make sure your body can handle anything golf swings at it!

​Watch out for part 2 next week!