136: PIRIFORMIS SYNDROME

PATIENT PRESENTATION

A 27-year-old woman presenting with complaints of left ischial/hip pain with sciatic radiation of the pain. She reports that the pain has been present for approximately 5 months with onset following a 13-mile run in older running shoes. Since the onset of symptoms, the ischial/hip pain has not decreased in intensity. The sciatic pain radiation has also not improved, however has not progressed or moved further distally.

Since the onset of symptoms she has had extensive medical workup, including an MRI and CT scan that were both negative for lumbar radiculopathy. Her primary complaints of pain are with sitting (especially while driving) or prolonged standing. There is relief of symptoms when lying down. She has modified but continued her daily workouts including 30 minutes on the stair master and runs of 6 miles or less, despite her persistent pain. She admits poor or absent stretching habits and frequently returns to her sedentary work routine immediately following exercise. Observation of lower extremity alignment reveals excessive femoral external rotation, lateral tibial torsion, and excessive pronation of both feet. There is tenderness in the left buttock region between the sacrum and the greater trochanter. Active range of motion (AROM) is within normal limits (WNL) for the lumbar spine. Hip AROM is limited in internal rotation.