A 52/M Patient came for Back pain treatment.. - Tenderness at Lt Sacroiliac joint and Lt gluteal region.. - Radiating pain in Lt LL, while walking he complains. - Piriformis shortness + - Plz feel free to diagnose the radiograph and express ur views on Physiotherapy management... ...Thank u



history suggestive of piriformis syndrome. do pressure trigger release for piriformis, mfr for back extensors & QL, IFT/ TENS, stretch- piriformis,glut, Neural tissue mobilization of sciatic n. all components, later core stability exercises.

suspected case of lumbar spondylosis with sciatica deep heating modality like S.W.D followed by lumbar traction and mobilization and TENS for radiating pain will work for first few days followed by back extensor exercises thereafter

Physiotherapy with following exercises:- Stretching of lower limbs- hamstrings, calf , piriformis,adductors. Nerve flossing for radiating pain and nerve stretch. -Back Core strengthening exercise which include static back, static abs, static glutei, static adductors in crook lying. -Mulligan mobilisation for sacroiliac joint in supine & also u can give while walking with maintain & sustain your distraction. Ice pack for pain relief.

Rule out sciatica n radiculopathy,get X-ray LS spine n MRI if patient affordable,as per now SWD n TENS is enough with stretching exercise n muscle relaxant

Need xray lumbosacral spine ap and lateral

reduced lt si joint space with mild sclerosis of articular margin, suggest, it sides sacroillitis. sacral hiatus is noted.

sacral spinal dysraphism. mri will help

In x-ray chiropractic spirography evaluation suggestive of anterior superior ilium and left rotated sacrum with L5 left rotation. femur head height and changed obturator foramen suggestive of anterior superior ilium, change in width of ilium wing suggestive of ilium internally rotated. these are the misalignment of ilium, sacrum and L5. my treatment would be to adjust sacrum only to reduce all misalignment collectively. to work on iliopsoas, quadratus lumborum, piriformis and latissimus dorsi release along with core strengthening programme. I hope it helps.

sorry its spinography

piriformis shortness often leads to radiating pain in d limb esp in walking n standing; d area of tenderness also coincides with location of piriformis. For piriformis release giv Continuous Ultrasound to greater sciatic notch, manipulate d muscle to break adhesions and then stretch it. Further give sciatic nerve stretch to decrease any tension on d nerve. Finally go for core strengthening of back for permanent resolution

Rx- 1st u hv to do piriformis stretching, harms stretching, glutes stretching... 2nd UST pulsed mode 3rd TENS (this z enough rx for sciatic nerve diformity) 4th lumbar mobilisation (grade 2) 5th avoid to lift heavy weight, forward bending, dont wear tight undergarments 6th SWD for 7 days only 7th hot fermentation in home Thank U

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