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Piriformis
Pointer Plus

Pointer Plus

The Pointer Plus is an easy to use trigger point (TP) locator which incorporates a push button stimulation feature to immediately treat Trigger point pain.

 

The piriformis is a muscle of the gluteal region.

Anatomical Attachments:

  • Origin: Attaches to the pelvic surface of the sacrum between the anterior sacral foramina, the margin of the greater sciatic foramen, and the sacrotuberous ligament.
  • Insertion: Attaches to the superior margin of the greater trochanter of the femur.

Action: Rotates, abducts and extends the thigh.

Synergist: Gluteus maximus, long head of Biceps femoris, Sartorius, Gluteus medius, Gluteus minimus, Iliopsoas, Gemellus superior, Gemellus inferior, Quadratus femoris, Internal and External obturators.

Antagonist: Semitendinosus, Semimembranosus, Tensor fasciae latae, and Pectineus.

 

Click for Muscle Test 

 

Nerve Supply: Sacral nerve (S1, S2).

Nerve Entrapment: Piriformis entrapment is well acknowledged for causing a broad array of phenomena, due to the impinging force that it can exert on the sciatic and gluteal nerve. This impingement may occur as a result of the muscle either exerting pressure over the nerves or the nerves passing through the muscle, resulting in pain or paresthesia. In addition to the trigger point referral patterns, symptoms may mimic posterior or medial leg pain or a Cauda equina syndrome. Cauda equina syndrome is typified by bilateral sciatic pain, paresthesia or urogenital involvement and may be exacerbated by sitting on a commode for over a couple of minutes.

Vascular supply: Superior gluteal, inferior gluteal, and internal pudendal arteries.

Vascular entrapment: According to Travell and Simons, the piriformis entraps the inferior gluteal and the pudendal vessels.

Travell and Simons Trigger Point Pain Referral:   \

Click on a small image to view an enlarged image

 

Trigger Point Signs and Symptoms: Pain in the low back, posterior thigh and leg, rectum, buttock, hip, ankle/heel, and possible swelling of the affected leg.

Trigger Point Activating and Perpetuating Factors: The piriformis experiences a mechanical overload, when individuals attempt to check their fall by mechanically lengthening and simultaneously contracting the piriformis (such as frequently occurs when an individual slips on a wet surface and attempts to keep their feet underneath them). The triggers may also become active by repetitive lifting and rotating at the thigh as frequently performed by pitching firewood or bags of feed, sustained lifting with legs abducted in a squatting position may also activate triggers. Persistent sitting on one hemipelvis, sustained contractions of the gluteal region either due to tension or guarding due to low back discomfort are probably the most frequently observed causes of piriformis dysfunction. Antalgic gaits have a tendency to illicit piriformis dysfunction on both the affected and non-affected sides. Developmental leg length discrepancy or a small hemipelvis frequently results in piriformis involvement. Biomechanical leg length discrepancy is frequently demonstrated secondary to piriformis dysfunction.

Differential Diagnosis: Degenerative disc disease, (Segmental, Subluxation, Somatic dysfunction) Lower lumbar arthrosis herniation nerve compression (L4 or L5 radiculopathy), Sacral nerve compression, Sciatica, Neurovascular entrapment, Intervertebral stenosis, Hip Dislocation, Hip fracture, Hip Pointer, Sprain/Strain of the ankle or hip, Bruised heel, Achilles tendonitis, Plantar Fasciitis or Bone spur of the heel, Tensor fasciae latae syndrome, Pelvic floor syndrome, Pregnancy, Bone cancer/Osteocarcinoma or Malignant neoplasm of the hip, Deep vein thrombosis (DVT), Phlebitis, Lymphogranuloma venereum, Lymphedema, Lymphatic cancer, Sacroiliac joint displacement, Coccygodynia, Reiterís disease, Ankylosing Spondylitis, Intervertebral stenosis, Trochanteric Bursitis, Coxa plana, Osteoarthritis, Polymyalgia rheumatica, Reflex Sympathetic Dystrophy (Complex regional pain syndrome), Rheumatoid arthritis, Menses, Ovarian or Cervical cancer, Rectocele, Anal fissure, Proctitis, Prostatitis, Prostrate cancer, Crohnís disease, Colitis, Cauda equina syndrome, Eosinophilic fasciitis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

 

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