Piriformis syndrome occurs when the sciatic nerve is compressed by the piriformis muscle. As discussed in a previous blog, “sciatica” is pain in the distribution of the sciatic nerve. This can cause symptoms in the buttock, posterior thigh and or lower leg and foot.

Piriformis Muscle

The pirifomis muscle is a small muscle located in the area of your buttock. It lies beneath the larger, more powerful gluteal muscles. Specifically, it runs from the edge of the sacrum to the top of the femur and functions to externally rotate the hip (the motion of turning your foot outward). The location of this muscle with relation to the sciatic nerve makes it the topic of discussion for many practitioners and researchers alike.

The Sciatic Nerve and Piriformis Syndrome

The sciatic nerve is located underneath the piriformis muscle. For some however, the nerve passes right through the muscle. There is much debate in the literature as to the actual incidence of piriformis syndrome and whether or not it is over diagnosed by manual practitioners. This continues as an ongoing debate.

Symptoms of Piriformis Syndrome

Research has indicated that true piriformis syndrome typically has 4 defining characteristics:

- Pain in the region of the buttock.
- Sciatic pain that is often aggravated by prolonged sitting.
- Tenderness to touch in the buttock area (sciatic notch tenderness).
- Reproduction of pain with active or resisted external rotation of hip.

What causes piriformis syndrome?

Piriformis syndrome can occur for various reasons. Some of these reasons include overuse or thickening of the piriformis muscle, spasm or tightening of the piriformis, continued external pressure to the area, and congenital variations in the piriformis or the course of the sciatic nerve. There are many activities and various sports that place large demands on this relatively small muscle. These demands can cause injury to the muscle or surrounding fascia, leading to adhesions or scar tissue, possibly interfering with the path of the sciatic nerve.

Diagnosing Piriformis Syndrome

It is important to note that although one may have all of the symptoms listed above, there are several other conditions that mimic piriformis syndrome. Lumbar intervertebral disc herniations, stenosis within the lumbar spine or space occupying lesions are just a few of the more common conditions that share similar symptoms. As always, the most important step you can take if you have any of these symptoms is to see a qualified health practitioner who has the education and training to properly diagnose your condition.

Treatment of Piriformis Syndrome

Piriformis syndrome can be treated in a variety of ways. Our clinic has found success using different approaches like active release technique, laser therapy, graston and acupuncture. The approach that is right for you depends on a number of factors…too many to list here. If you think you may have piriformis syndrome and are looking for help, please contact us.

info@burlingtonsportstherapy.com

References
Hopayian K, Song F, Riera R, Sambandan S. The clinical features of piriformis syndrome: a systematic review. European Spine Journal 2010; 19: 2095-2109.

Platelet rich plasma (or PRP as it is often called) is a relatively new technique for treating various musculoskeletal injuries. It is growing in popularity, most likely because many professional athletes have used it.

What is platelet rich plasma or PRP treatment?

The procedure of PRP injection begins with the practitioner drawing blood from the patient and spinning it in a centrifuge to isolate the blood plasma. Among other things, the blood plasma contains certain growth factors that are helpful for tissue healing. Although practitioners may utilize different techniques for preparing the solution, the isolated sample is injected into the injured area to help speed up the healing process.

What is the cost of PRP injections?

Through several of my patients who have tried this technique, the prices seem to range. It seems that most conditions require several injections (spread out over a period of time) with each injection costing approximately two hundred dollars. It is my understanding that it is not usually covered through extended health insurance.

Does platelet rich plasma work?

Perhaps it depends on who or what you listen to. Some notable professional athletes will tell you that it works. If you prefer to listen to the unbiased scientific studies that have been performed, you’d probably say “not sure”. Numerous studies have been performed for different tissues (lateral epicondyle of the elbow, achilles tendon and plantar fascia) yet the results seem to be conflicting. Several studies found saline (placebo) injections to have the same efficacy as platelet rich plasma injections. In my opinion, PRP injections may be a viable treatment option for some patients. Obviously, it has become popular for a reason. I do have to say that it’s interesting how a treatment approach with limited scientific evidence to support its efficacy has become so popular. Hopefully, more randomized controlled trials will be performed using large samples of patients so that we can provide more evidence based recommendations to patients. Nevertheless, I’ve attached a link to an interesting article written in the New York Times about PRP injections and the power of professional athlete endorsements. Thanks to Dr. Mark Kubert of Clearpath Chiropractic in Guelph who tweeted this article!

http://www.nytimes.com/2011/09/05/health/05treatment.html?pagewanted=all

Looking for help with an injury?   Email us – info@burlingtonsportstherapy.com

References
Foster TE, Puskas BL. Platelet-rich plasma: from basic science to clinical application. American Journal of Sports Medicine 2009; 37(11): 2259-2272.

It’s always easier to understand a condition when we simplify it. This happens quite often in the world of physical rehabilitation. An example in the knee would be the diagnosis of patellofemoral syndrome. This is a term that many practitioners use to describe a patients knee pain, yet it doesn’t specifically distinguish between various causes of pain in this area. Quite often patients are diagnosed with a condition in the shoulder called impingement. Again, this is helpful for some patients so that they can understand their condition better, but it is still a very vague term.

Shoulder Impingement Causes

Impingement of the shoulder is much like the name implies; certain structures get pinched which causes pain. This is obviously a very simple explanation of a very complex topic. There are various different types and different causes of impingement in the shoulder. For the practitioners out there, we know there is internal and external impingement. Internal impingement involves compression of tendons (usually) between the head of the humerus and the glenoid labrum. External impingement involves compression of the rotator cuff tendons or the subacromial bursa between the humeral head and the acromion process.

Functional Shoulder Impingement

At this point I’ve probably already confused the average reader, so the rest of this blog will focus on something more interesting; the various causes of secondary or “functional” impingement. This category of impingement is somewhat fixable in a clinical setting with the help of a manual practitioner.

Decreased Shoulder Movement

For some people, their shoulder impingement is associated with a loss of movement in the shoulder. Specifically, it would be a loss of internal rotation (turning your arm inward). This is something we can detect clinically and can give us clues to various dysfunctions in a patients shoulder. Among other things, this loss of movement alters the axis of motion in the shoulder which can lead to impingement.

Altered Shoulder Blade Movement

The scapula (shoulder blade) can move in a sub-optimal pattern leading to impingement of the shoulder. Termed scapular dyskinesis, the altered movement has a cascading effect on various shoulder tissues. Scapular dyskinesis has various causes and types, but the take-home point is that it can eventually lead to internal impingement in the shoulder.

Rotator Cuff Dysfunction

The various rotator cuff muscles have different prime movements. Together they can serve to depress or hold the humeral head down during abduction. When there is dysfunction in the rotator cuff muscles you can lose this ability and the humerus can translate upwards (resulting in impingement). Of note, rotator cuff injury can also lead to external impingement.

SLAP Lesion

A SLAP lesion refers to damage in the cartilaginous labrum of the shoulder. The labrum lies directly against the head of the humerus, so damage in this area can “get in the way” when we move the shoulder.

Shoulder Instability

Some people have too much laxity in their shoulders. This can be from repeated trauma or can simply be the way they are “built”. In this case, the patient’s humerus translates upwards and compresses various tissues (which is impingement).

Treatment for Shoulder Impingement

In an effort to be more specific and delineate the various causes of shoulder impingement this blog may actually confuse many readers. The take-home point is that sometimes your practitioner may simplify things so you understand them easier. Impingement of the shoulder can be a very complex condition with various causes. Due to this, there are various different ways to properly fix it. For some people, manual treatment and the use of therapeutic modalities are necessary. For others, specific exercises and rehabilitation strategies are indicated.  Active Release Technique, Graston and Laser Therapy are all common methods for treating shoulder pain.  Unsure what to do? Give us a call!

To contact our Burlington clinic – info@burlingtonsportstherapy.com

References
Cools AM, Cambier D, Witvrouw EE. Screening the athletes shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British Journal of Sports Medicine 2008; 42: 628-635.
Tate AR, McClure P, Kareha S, Irwin D. Effect of the scapula reposition test on shoulder impingement symptoms and elevation strength in overhead athletes. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(1): 4-11.
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Fascia. Many of you have likely heard this term used more and more over recent years. This is perhaps due to the surge of new research on the topic and therefore the renewed interest within the manual medicine community.

What is Fascia?

Fascia can be defined as a sheet or band of fibrous connective tissue enveloping muscles, organs and other soft tissue structures of the body. Fascia is divided into three separate layers that work closely with one another. The most superficial layer (fascia superficialis) lies directly beneath the skin. The middle layer (fascia profundus) has connections with fascia superficialis and directly overlies the muscles. The deepest layer (deepest fascia or dural tube) directly surrounds and protects the central nervous system.

Why do we care about fascia?

The medical community has long known about the existence of fascia however, the role that it plays in movement and biomechanics of soft tissues has often been over looked. In order to understand this important role, you must first understand the complex anatomy of the layers themselves and their relationship with the other. For the purpose of this blog we’ll keep it short and simple, focusing on the 2 most superficial layers.

Dysfunction in Fascia

Although the primary function of fascia is to sustain and protect the underlying soft tissue with strong connections, it is imperative that each layer maintain a certain degree of independent motion. This is necessary so that our skin has the ability to slide along the muscle as well as all the muscle fibres among themselves. If this were not the case, we would not be able to move our joints to the extent that we can as they would be limited by our skin and muscles.

The Effect of Scar Tissue

So why has there been a shift in focus to fascia when it comes to soft tissue injuries? When a soft tissue injury occurs a process takes place to heal the area which involves alterations to the connective tissue. This process includes the formation of tissue fibrosis and scarring (scar tissue). This scarring within the connective tissue or fascia creates not only a relative weakness in the area (as the new connective tissue has less tensile strength and non uniform alignment) but also creates a bond between tissue layers, leaving a lack of relative movement in the area.

Treatment for Fascia

The focus of treatment for these injuries is to break up the scar tissue at the site of the injury and encourage a proper reorganization of the surrounding connective tissue and fascia. Methods that we commonly use to treat soft tissue injuries involving the fascia are Graston Technique, Active Release Technique and Low Intensity Laser Therapy. If you have a soft tissue injury that just doesn’t seem to be getting better, or an injury that seems to get better but somehow returns, it could mean that there is a change in the fascia or connective tissue in the area which must be returned to normal before proper function can be restored!

Our Burlington Clinic can be reached at – info@burlingtonsportstherapy.com

References
Van der Wal, J. The Architecture of the Connective Tissue in the Musculoskeletal System – An Often Overlooked Functional Parameter as to Proprioception in the Locomotor Apparatus. International Journal of Therpeutic Massage and Bodywork 2009; 2(4):1-15.
Spina, Andreo. Targeting Fascia – Rethinking the approach of soft-tissue treatment. Canadian Chiropractor 2011; 16(3):27-29

Are your knees painful? For many of our patients, the warm weather brings more activity which leads to more stress on irritable arthritic joints. Osteoarthritis of the knee is one of the more common conditions that we see at our clinic. Since it is one of those conditions that can interrupt our activity level, any form of prevention or management is important.

Knee Arthritis

Knee Arthritis

Osteoarthritis is a form of degenerative arthritis that can occur at any age but is more prevalent as we mature. It is often associated with “wear and tear” on the joint, and the symptoms can include pain, swelling, joint deformity and mechanical symptoms like locking or popping. It is important to remember that osteoarthritis affects both the biochemistry (the cells) of the joint and the biomechanics of the joint (the way the joint moves).

Treatment for Arthritis

To treat the cellular level of arthritis our clinic utilizes laser therapy. As mentioned in a previous blog, laser therapy has the ability to assist cellular regeneration and reproduction which reduces pain in arthritic joints. To address the functional or biomechanical changes associated with arthritis, exercise is vital.

Physiotherapy for Osteoarthritis

There have been numerous studies published to support the theory of strengthening the knee in order to decrease the incidence of osteoarthritis. An example is a recent study published in the journal Medicine & Science in Sports and Exercise (see reference below). This study found that strengthening of the quadriceps muscle combined with proprioceptive exercises helped to decrease the incidence of osteoarthritis. The mechanism for this effect was through an improved ability to stabilize the joint dynamically.

Strengthening for Arthritis

Strengthening an arthritic joint is difficult for many patients and is why we recommend consulting a professional who can assist you (like a physiotherapist). Although an individualized plan is ideal, we often recommend trying a standing closed kinetic knee extension using theraband or a pulley system. Although seated open kinetic knee extension can be unhelpful for many knee conditions, it is another option. This exercise may allow a patient with degenerative arthritis to strengthen their quadriceps without compressing the main compartment of the joint. Swimming is also a good option for some patients since it also doesn’t require significant joint compression.

Physiotherapy in Burlington – info@burlingtonsportstherapy.com

Segal NA, Glass NA, Felson DT et al. Effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Medicine & Science in Sports and Exercise 2010; 42(11): 2081-2088.
Bjordal JM, Couppe C, Chow RT et al. A systematic review of low-level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiotherapy 2003; (4).
Brosseau L, Gam A, Harman K et al. Low level laser therapy (classes I, II and III) for treating osteoarthritis (Cochrane Review). The Cochrane Collaboration 2004; 3.
Jamtvedt G, Dahm KT, Christie A et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Physical Therapy 2008; 88(1): 123-136.
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