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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]
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.
Piriformis syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve. [8] This referred pain is known as sciatica. Seventeen percent of the population has their sciatic nerve coursing through the piriformis muscle.
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.
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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.
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