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The main approaches to conservative treatment of deep gluteal syndrome are rest, activity modification, physical therapy for 6+ weeks, analgesic / anti-inflammatory drugs, and injections. [2] [4] Conservative therapy fails in as many half of patients with deep gluteal syndrome. [7]
Although structured exercises provide small, short-term benefit for leg pain, in the long term no difference is seen between exercise or simply staying active. [48] The evidence for physical therapy in sciatica is unclear though such programs appear safe. [3] Physical therapy is commonly used. [3]
Treatment is often dependent on the duration and severity of the pain and dysfunction. In the acute phase (first 1–2 weeks) for a mild sprain of the sacroiliac, it is typical for the patient to be prescribed rest, ice/heat, spinal manipulation, [35] and physical therapy; anti-inflammatory medicine can also be helpful. [1] [4]
A treatment plan would be determined by a physical therapist to specifically manipulate the pudendal nerve through a variety of stretches. Strengthening exercises may also be recommended to relieve the excessive pressure caused by the entrapment, but there is currently limited evidence to support this choice of therapy.
Of these patients, 9 (64%) improved with physical therapy alone. The remaining 5 (36%) improved with injections (steroids or ozone). However, 6 months after the end of treatment, only 5/14 patients (36%) had complete resolution of pain. [52] In a study of 250 patients, medication and physical therapy led to complete pain relief in 51% of patients.
While both procedures are effective, the neurectomy has better outcomes on complete pain relief. [4] [8] [5] In a systematic review, complete pain relief was seen in 85% of neurectomy cases and 63% of decompression cases. [8] A Cochrane review found that complete pain relief in 85-100% of neurectomy cases and 60-99% of decompression cases. [2]
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The McKenzie method is a technique primarily used in physical therapy.It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. [1] [2] [3] In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, diagnosis and treatment for the spine and extremities.