Nerve Tension Tests and Piriformis Syndrome

[@bewellwithdr.jasleen790]

Thank you for this helpful video. I'm a chiropractor in Toronto and am currently treating a patient with a rehab program. Based on her presentation, I suspected posteromedial disc. I showed her this video as part of my report of findings and it really helped her understand her condition better. Keep doing what you're doing!

[@hazzae]

Another great video! It would e fantastic to get the sensitivity and specificity of these tests included :)

[@NeuroDocUniverse]

Considering that the positive finding is based on patient report only, the pain in the back of the leg may be caused by sciatic nerve tension OR hamstring tightness, OR movement of the sacroilica or femoral acetabular joint. As such, as with almost all orthopedic tests, these tests should be combined with other tests. Use Bowstring Sign to confirm hamstrings and use Sicard's and Braggard's to confirm nerve tension. Goldthwait and Smith Peterson can confirm sacroiliac...(continued)

[@NeuroDocUniverse]

The best treatment is the one that matches the problem. It's essential that the diagnosis be determined first. Let me know if I can be of any further help. Best regards, LB

[@reagantan4300]

I need your differential diagnosis in in actual clinical approach. This is how State board exam are usually asking. Please, please, please make more of theses videos. It's interesting and very much helpful comparing just memorising anatomy. Thank you!

[@NeuroDocUniverse]

Without MRI confirmation of whether or not the piriformis is pierced by the sciatic nerve (14% of the population) or not, we can only test and see if stretching the piriformis increases the symptoms and approximating the origin and insertion passively (putting slack into the piriformis) eases the symtoms.

[@truerocker]

I'm 19 and have always been active through soccer/rollerblading/biking. But two years ago, after injuring my calves severely, i couldn't perform these activities. As a result, my legs became prone to numerous injuries when I tried to get back to being active last year, so I basically stopped and didn't keep my legs active. I tried to progress, but then another injury would show up. Anyway, my left leg was always a bit less flexible than the right. And I believe a sudden stretch of these

[@NeuroDocUniverse]

Hi Truerocker, I cannot provide a treatment for you without a proper history and examination, but it sounds like there is a long standing mechanical imbalance. It would help you to see a chiropractor or PT in your area that would do a proper examination to determine the cause of your trouble. It could be as simple as your shoes or as complex as a muscular imbalance (continued...).

[@NeuroDocUniverse]

and Patrick's can confirm femoroacetabular. Regarding sensitivity for piriformis syndrome, anatomical variations can get in the way so it is difficult to confirm absolute sensitivity of these tests. I prefer to use relative sensitivity; i.e., based of common understanding of the biomechanics of the test, does this work on the individual patient or not? (continued)

[@truerocker]

Thank you for your prompt response, and I definitely check up with a chiropractor. Hopefully it's not a major problem. Anyways, thank you again.

[@truerocker]

inactive areas could have caused some kind of spasm, which was a recurring idea mentioned in articles regarding piriformis syndrome. Sorry for the long post, but I hope you can provide me with some information and insight to treat this. (Stretches/ just walking?) Thank you.

[@NeuroDocUniverse]

Hi MrMuso, Can you tell me where the scalpel was inserted? Thanks!

[@truerocker]

hello Doc, just a week ago, without proper warm-up, I did a couple of stretches for my (groin/abductor, adductor, hamstrings, quads, and glutes.) Then I performed a shoulder hand squat, followed by a groin stretch. Suddenly I felt a sharp pain in the top part of my glute (only left butt.) Soon that faded away, but I started feeling a sharp pain at the midsection of the left butt. Over a few days, I felt throbbing sensations on the left part periodically, & at the moment, it feels numb ..continue

[@wonseokchoe8082]

excellent video! thanks!

[@truerocker]

but somewhat uncomfortable. I ruled out sciatica because I don't have any kind of pain radiating towards my back or down my legs. Then I assumed it would be piriformis syndrome, but when I performed your test I couldn't feel any painful sensation. Since this started, I have been wary of doing anything dynamic. I really don't know what I'm facing, how severe it may be and how I can treat it.

[@MrMuso1563]

The scalpel was inserted in the outer upper right buttock region at about belt line level close to the hip. This was to 'treat' an active 'trigger point' the pain has not resolved since this treatment, the areas which are painful were non tender before the treatment. Neurosurgeon found no evidence of nerve damage and stated that the area where the incision was made was in an 'anatomically ' safe zone. Stretching the piriformis muscle helps initially but then aggravates it making it worse!

[@truerocker]

hello Doc, I performed stretches demonstrated in a KZbin video "How to fix Piriformis Syndrome" by Brett Blanker last night. And this morning I feel I've recovered almost 80%! However, I'll visit a chiropractor to figure out the root of what caused this.

[@NeuroDocUniverse]

Hi, It's really not possible for me to advise you, however it sounds like your piriformis might be facilitated (activated). Since stretching make the piriformis problem worse, you might benefit from some reciprocal inhibition work. This would activate the internal rotators to inhibit the external rotators (like the piriformis). Best to contact a chiropractor or physical therapist in your area to help you with this.

[@MrMuso1563]

I have a positive for the bonnett test as in internal foot rotation increases symptoms and external (turning foot outwards) decreases symptoms. I had a Nesfield's treatment (google Nesfield's treatment) performed on the outer right Gluteal region for back pain with some right leg referred pain in Melbourne Australia 18 years ago in 1995. As soon as the doctor put the blade in I felt a horrible new type of deep aching pain and my right foot turned outward the pain never went away Piriformis??

[@tenminutetokyo2643]

What about extreme tiredness?

[@NeuroDocUniverse]

Hi Hazzae, If you dig through the research, sensitivity and specificity ratings are often somewhat arbitrary in the literature. With this understanding it is best to fully understand the criteria for each. Regarding nerve tension tests, specificity is rather low only because the biomechanics of these moves include multiple tissues.... (continued)

[@NeuroDocUniverse]

Sounds good!