Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, deep-seated left gluteal pain radiating into the posterior thigh, exacerbated by prolonged sitting, stair climbing, and internal rotation of the hip. Symptoms are consistent with sciatic nerve irritation secondary to piriformis muscle hypertonicity. No history of lumbar radiculopathy or trauma.
Clinical Examination Findings
Physical examination reveals localized tenderness over the left piriformis muscle belly. Positive FAIR test (Flexion, Adduction, Internal Rotation) reproducing sciatic symptoms. Negative straight leg raise (SLR) for lumbar pathology. Normal neurological exam of the lower extremities with intact strength, sensation, and reflexes.
Treatment Protocol
Initiate conservative management: targeted physical therapy focusing on piriformis stretching and gluteal strengthening. Prescribe NSAIDs for inflammation. Consider trigger point injections or ultrasound-guided Botox injection if refractory to conservative care. Avoid prolonged sitting and modify ergonomic workspace.