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Abstract

This case study examines the treatment journey of a 19-year-old male who presented with bilateral buttock pain, lower limb weakness, and instability caused by piriformis syndrome and asymptomatic Prolapsed intervertebral disc (PIVD) herniation. The intervention strategy was guided by clinical assessments, including neurological and musculoskeletal evaluations, as well as confirmatory magnetic resonance imaging (MRI) findings. The patient's treatment plan adopted a comprehensive approach that incorporated neuromuscular training and neurodynamic solutions. The former focused on strengthening the core and lower limb muscles to correct biomechanical imbalances associated with piriformis syndrome. Concurrently, neurodynamic solutions, such as targeted stretching and mobilization exercises, were employed to alleviate sciatic nerve compression related to asymptomatic PIVD. The results demonstrated significant improvement in symptoms, highlighting the effectiveness of the individualized rehabilitation program. This case report underscores the success of a multifaceted approach in addressing the intricate interaction between muscular and neural components in piriformis syndrome and asymptomatic PIVD. However, further research is necessary to validate the broader applicability of this combined therapeutic strategy.

Introduction

Piriformis syndrome and prolapsed intervertebral disc (PIVD) are two distinct musculoskeletal conditions that can have an impact on an individual's functional abilities and quality of life. According to the joint statement of the American Society of Neuroradiology, the American Society of Spine Radiology, and the North American Spine Society, disc herniation is "localized or focal displacement of disc material beyond the limits of the intervertebral disc space". Three-quarters are degenerative cases and one-fourth of disc pathology instances are true disc herniations [1]. Lumbar nerve root mechanical compression or chemical irritation results in discomfort on one side of the body [2]. A twisting mechanism in combination with an axial load or flexion in connection with an axial force may be involved in the biomechanics of lumbar PIVD [3]. The incidence of a herniated disc is around five to twenty cases per thousand persons annually, with a female-to-male ratio of 1:2. It is commonly seen in adults in their 3rd or 5th decade of life [4]. The biology of the intervertebral disc is thought to change in a number of ways that lead to disc herniation. These include an increase in the amount of type I collagen in the inner annulus fibrosus and nucleus pulposus (NP), as well as the retention of water in these structures also the disintegration of collagen and extracellular matrix components [5]. It may happen at any spinal level but the most common lumbar spinal levels to observe it are L4-L5 and L5-S1 [6]. Radicular discomfort can result from pressure on the spinal nerve crossing the disc due to disc herniation and inflammation. The risk factors for PIVD include bad posture, extended periods of sitting, improper lifting technique, obesity, pregnancy and falls from heights [7].

Piriformis syndrome is a common cause of lower back pain and is often misdiagnosed due to its resemblance to various different illnesses. Abnormalities in the piriformis muscle like inflammation, hypertrophy, or anatomical changes, can cause the syndrome. Patients with low back discomfort have reported incidence rates of piriformis syndrome ranging from 5% to 36% [8]. Piriformis syndrome presents as a medical condition where the piriformis muscle becomes swollen, causing compression on the sciatic nerve or its various divisions, including the tibial and common fibular divisions. In specific instances, the common fibular division may pass over the piriformis muscle, resulting in increased hip pain while driving or sitting. Surgical confirmation and an intraoperative electromyography (EMG) study are utilized to diagnose this condition, with a trans-gluteal surgical approach proving successful in...(More)

For more info please read, Effect of Neuromuscular Training and Neurodynamic Solutions for Asymptomatic Prolapsed Intervertebral Disc and Coexisting Piriformis Syndrome, by Cureus