The objective of this study is to describe the efficacy of spinal manipulation therapy in the clinical management of a patient with sciatica symptoms due to piriformis syndrome. This condition is overlooked or misdiagnosed easily in clinical practice.


Clinical features

A 35-year-old male visit in the clinic with chronic pain over the right lower back and the gluteal region. The pain becomes worse with prolong sitting. Physical examination showed reduced and painful lumbar movement on combined extension, right side rotation, and right side bending. Also, there is an increased right buttock pain on flexion, adduction and internal rotation of the right hip.

Intervention and outcome

A high-velocity low-amplitude thrust (HVLAT) spinal manipulation was used as a primary treatment along with muscle stretching, strengthening and neuromuscular training exercise as a home exercise program. The patient received 3 treatments over a period of 4 weeks. However, we could not evaluate the long term effect.


Spinal manipulative therapy can be used to treat the effect and possibly the cause of piriformis syndrome. Further, studies are warranted.



Piriformis syndrome (PS) is a peripheral neuritis of the sciatic nerve caused by the compression of nerve trunk due to or related to, the excessive contraction, spasm, injury or inflammation of the piriformis muscle (Windisch & Braun, 2007; Cummings, 2000; Parziale, Hudgins & Fishman, 1996). Piriformis syndrome is frequently overlooked or misdiagnosed as it can mimic other common somatic dysfunctions such as sacroiliac (SI) dysfunctions, lumbar facet joint dysfunctions, sciatica, herniated intervertebral disc etc (O’Neill, McClain, Coleman & Thomas, 2008).

Piriformis syndrome is generally characterized by pain in the buttock, hips and lower limbs which worsen after sitting for longer than 15-20 minutes (Papadopoulos & Khan, 2004; Foster, 2002; Parziale et. al., 1996). Chronicity of PS may lead to pathologic conditions of the sciatic nerve, other surrounding nerves, vessels, and chronic somatic dysfunctions. This can eventually result in chronic radiating pain, paresthesia, hyperesthesia and muscle weakness. (Chaitlow, 1988 as cited in O’Neill et al., 2008). Delay in addressing PS may lead to compensatory or facilitative changes which can contribute to cervical, thoracic and lumbosacral dysfunctions and pain (Steiner, Staubs, Ganon & Buhlinger, 1987; TePoorten, 1969).

The aim of this study is to evaluate the effect of high-velocity low-amplitude thrust (HVLAT) manipulation in the treatment of piriformis syndrome along with other traditional physical therapy approach such as stretching and strengthening exercises.

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