Piriformis Research Articles

Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence, and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa.

To examine and identify sciatic nerve variations in relation to the piriformis muscle, its prevalence, pattern and the course of its bifurcation loci. Twenty-eight formalin fixed male cadavers comprising 56 lower limbs were used for this study. Dissection of the gluteal region and posterior compartment of the thigh was conducted to expose the sciatic nerve. Variations in the sciatic nerve anatomy, their relationship to the piriformis muscle and points of bifurcation, and other observable features were noted and recorded. Fifty-two lower limbs (93%) showed normal anatomy of the sciatic nerve. Four regions (7.1%) showed variations in the morphology of the sciatic nerve. Of these, one (1.8%) showed a variation of the sciatic nerve with the piriformis muscle. This single case showed a common peroneal nerve emerging on the left between the heads of a double piriformis muscle - a variant not described in the original Beaton and Anson classification, with the tibial nerve deep to the muscle. In two other limbs, the sciatic nerves showed a normal relationship with the piriformis, but had variations in the bifurcation loci (bilateral). The divisions were in upper third and middle third of the right and left thighs respectively. Knowledge of the level of bifurcation and distribution of the sciatic nerve and its location is important. This nerve is commonly encountered by neurologists, orthopaedics, and anaesthesiologists. The uncommon anatomical findings described are relevant to surgeons to enable them to perform efficient surgical procedures and avoid errors.

A human donor (cadaveric) observation study of three needle placements in the piriformis muscle

ABSTRACT Objective To compare the safety and accuracy of three dry needling locations in the piriformis muscle using human donors. Design Observational dissection study of embalmed human donors. Methods A licensed physical therapist of 17 years clinical experience and 5 years teaching dry needling placed three needles in a medial, midpoint, and lateral location of 14 piriformis muscles of seven embalmed human donors. Block dissection allowed for observation of tissues the needles traversed and recording of the structures that the needles pierced. Results The lateral needle pierced piriformis in 3/14 trials, and contacted sciatic nerve in 0/14 trials. The medial needle pierced both piriformis and sciatic nerve in 11/14 trials. The midpoint needle pierced the piriformis in 11/14 trials, and contacted sciatic nerve in 3/14 trials. Fisher’s Exact test (p < 0.001) found a nonrandom association between dry needle placement, and dry needle contact. Conclusions When dry needling the piriformis, a lateral approach can avoid the sciatic nerve, but cannot accurately pierce the piriformis tendon. Furthermore, while a midpoint and medial approach finds the piriformis muscle with the same accuracy, the midpoint location avoided the sciatic nerve more often.

The Effect of Core Stability Exercises on Pain and Inflammation of Patients With Piriformis Syndrome

Background and Aim Sciatica is one of the most common diseases of the peripheral nervous system and may be caused by pressure on the sciatic nerve. Due to the fact that piriformis muscle located near the sciatic nerve, piriformis muscle spasm may put pressure on the nerve and cause sciatica and consequently piriformis syndrome. The present study aims to investigate the effect of core stability exercises on pain and inflammation of patients with piriformis syndrome. Methods &amp; Materials This is a randomized clinical trial. The study population consists of all patients with piriformis syndrome referred to medical centers in Arak, Iran from. Of these, 20 were purposefully selected and randomly divided into two groups of control (n=10) and exercise (n=10). The exercise group performed core stability exercises for 6 weeks, while the control group continued their normal life during this period. To examine the differences between the study groups, t-test, Chi-Square test, and McNemar’s test were used. The significance level was set at 0.05. Ethical Considerations This study was approved by the Ethics Committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1400.157) and was registered by Iranian Registry of Clinical Trials (ID: IRCT20211003052662N1). Informed consent was obtained from all participants. Results The Mean pain score in the control group decreased from 95.2 to 90.7 after the exercise, which was not statistically significant (P=0.562). In the exercise group, the mean pain score decreased from 91.7 to 33.4, and this decrease was statistically significant (P=0.0); Therefore, at 95% confidence interval, we can say that core stability exercises had a significant effect on the pain of patients with piriformis syndrome (P&lt;0.05). The number of patients with inflamed nerve in the control group decreased from 10 in the pre-test phase to 8 in the post-test phase, but this decrease was not statistically significant (P=0.5). In the exercise group, it was reduced from 10 to 2, and this decrease was statistically significant (P=0.008); Therefore, we can say that core stability exercises had a significant effect on the inflammation of patients with piriformis syndrome (P&lt;0.05). Conclusion Core stability exercises can reduce pain and inflammation in patients with piriformis syndrome. These exercises can be used in the treatment of these patients.

Ultrasound-Guided Gluteal Fascial Plane Block for the Treatment of Chronic Refractory Greater Trochanteric Pain Syndrome - Technique Description and Anatomical Correlation Study.

Greater trochanteric pain syndrome may often mimic pain generated from other sources. However, it is most commonly caused by gluteus medius and gluteus minimus tendinopathy or tear. The purpose of this technical report was to: 1) describe the ultrasound-guided fascial plane block technique targeting the superior gluteal nerve in the plane between gluteus medius/gluteus minimus to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome; 2) anatomically correlate the procedure with cadaveric dissections demonstrating the structures being imaged and the tissues along the needle trajectory; 3) demonstrate the feasibility of the technique with serial dissection of one cadaveric specimen following injection with color dye. The ultrasound-guided fascial plane block targeting the superior gluteal nerve to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome has been outlined with supporting ultrasound scans and anatomical dissections. The cadaveric dissections are correlated to the ultrasound scans of a healthy volunteer and provide visualization of the tissues in the needle trajectory. The feasibility study in a cadaveric specimen showed adequate stain of the superior gluteal nerve without spread to the piriformis muscle belly, the sciatic nerve, or the inferior gluteal nerve. This ultrasound-guided fascial plane block is a feasible option for blocking the superior gluteal nerve without inadvertent involvement of the sciatic and inferior gluteal nerves. Further randomized controlled clinical trials are necessary to assess the clinical efficacy of the gluteus medius/gluteus minimus fascial plane block to treat moderate-to-severe, chronic, refractory greater trochanteric pain syndrome.

The sciatic nerve and and its relation to the piriformis muscle syndrome regarding daily clinical practice. A review

IntroductionThe sciatic nerve innervates most of the muscles of the lower limb, so any alteration in it'sits function or clinical presentation could directly affect the functioning of the lower limb. Therefore, the normal anatomy, anatomical variants and how these can influence clinical implications in the gluteal region are of importance in daily clinical practice.MethodsodologyA systematic review was carried out in the scientific literature to answer our research question. We searched in the databases MEDLINE, SCOPUS, WOS, Scielo, GOOGLE SCHOLAR and other scientific sources, using search terms in relation to our stated objectives and connected through Boolean terms.ResultsThe results of this study show that the variations of the sciatic nerve can be ample, which associated to the variability in the geographic regions of the studies, sex of the sample and incidence of the variation, will make it necessary to consider different multifactorial components for the anatomical analysis of sciatic nerve variations and for clinical considerations in patients with and without these anatomical variations.ConclusionWith the results of our review, we can infer that the sciatic nerve presents a variability of distribution patterns, which may be presented in the classical anatomical literature as a variability that is found differently in the population. In addition to inferring that the variation of the sciatic nerve can be little attributed to the symptoms of the piriformis muscle syndrome.

Prevalence of Piriformis Tightness in Sciatic Patients

Piriformis muscle is supplied by sciatic nerve and its origin is from sacrum through first to fourth sacral foramina, from the edge of greater sciatic foramen and from pelvic surface of the sacrotuberous ligament. Objective: To calculate the prevalence of piriformis muscle tightness in sciatic patients. Methods: This cross-sectional study was conducted in Gujranwala and physical examination of piriformis tightness in sciatic patients involved piriformis stretch test. Demographic data, Semi-structured questionnaire, and consent form were used to collect data. All data was analyzed by Statistical Package for Social Sciences (SPSS) version 21.0. Sample size for this study was 251. T-test was used for quantitative data and Chi square for qualitative data. P ≤ 0.05 was considered as significant value. All the results were calculated at 95% confidence level. Results: Prevalence of piriformis muscle tightness in sciatic patients is high. Results shows that total 251 sample size, 181(72.1%) patients tested positive for Piriformis stretch test while 70(27.9%) tested negative for piriformis stretch test. Conclusion: Piriformis stretch test was statistically significant and resulted positive in most of the cases

Piriformis syndrome caused by rare intramuscular lipoma: A case report

We present the case of a 73-year-old man with history of back and left sciatic nerve pain, who came to our hospital centre due to perform a lumbar spine MRI. The MRI scan didn’t reveal compression of the left nerve roots by hernia formations, but collaterally showed a well-defined lesion, with MRI characteristics of adipose tissue, localized in the left piriformis muscle, compatible with a lipoma that displaced the ipsilateral sciatic nerve but did not invade it.

The Transgluteal Approach for Decompression of Sciatic Nerve Entrapment (Piriformis Syndrome) with Intraoperative Neurophysiology: A Technical Note

Although the transgluteal approach splitting the gluteus maximus muscle has been reported as a posterior approach for sciatic nerve entrapment (piriformis syndrome), detailed descriptions of the surgical steps and intraoperative findings have not been published. Thus, the objective of this study was to present the transgluteal approach for decompression surgery of sciatic nerve entrapment in the subgluteal space. A method of circumferentially decompressing the sciatic nerve from the surrounding piriformis muscle was devised by decompressing it to the level of the sacrotuberous ligament, which was more proximal than the existing decompression range. Surgical findings are presented step-by-step in the stages of localization, exposure, and decompression of the sciatic nerve during surgery. We also emphasize the importance of intraoperative nerve monitoring to identify the sciatic nerve and its branches and the inferior gluteal nerve during surgery performed under general anesthesia. Our observations of intraoperative electromyographic responses by individual nerve stimulation are summarized and reported.

The Single Posterior Approach for Resection of Sacral Chordoma: A Case Report

Chordoma is a relatively rare primary malignant neoplasm that originates from ectopic notochordal cells, and most chordomas arise in the sacrococcygeal and clivus regions. Due to the poor response to adjuvant therapy, complete tumor resection is the treatment of choice. This case report describes a 57-year-old male patient who presented with a very large sacral chordoma involving the S2-S5 bodies, extending to the right piriformis and gluteal muscles. He was successfully treated with a single-stage posterior approach and was free of local recurrence at a 5-year follow-up examination, without neurological deficits. A single posterior approach is a feasible option for the treatment of sacral chordomas.

Effect of simulated changes in pelvic tilt on hip joint forces

Musculoskeletal modeling is commonly used to simulate and compare various movements between individuals. For conditions such as femoroacetabular impingement syndrome (FAIS), individuals tend to walk with more anterior pelvic tilt than those without FAIS. However, it is unknown whether accounting for pelvic tilt in musculoskeletal modeling would lead to a change in muscle forces and in turn, joint forces. Gait data of six individuals were collected and processed using Vicon and Visual3D. Each participant’s pelvic tilt was adjusted by ± 10° at all time points during gait. Three analyses were performed per individual: no adjustment in tilt, one posterior (positive) tilt, and one anterior (negative) tilt. The resulting data were imported into OpenSim to determine muscle forces and the resulting femur-on-acetabulum (hip joint) forces in the pelvic and femoral reference frames. Data for each participant were normalized for gait cycle and body weight in MATLAB, and statistical parametric mapping was used to determine if the differences in joint and muscle forces were significant across different pelvic orientations. Shifting from posterior to anterior pelvic tilt reduced resultant forces. In the pelvic reference frame, anteriorly-directed joint forces decreased, while medially-directed forces increased. In the femoral reference frame, anteriorly- and medially-directed joint forces increased, while superiorly-directed forces decreased. Anterior gluteus medius and iliacus muscle forces decreased, while quadratus femoris, piriformis, and gemellus muscle forces increased. Given these results, future studies using musculoskeletal modeling should account for pelvic tilt in musculoskeletal models to obtain more realistic comparisons between healthy and pathological conditions.

Morphometric study of sciatic nerve and its topographic anatomical variations in relation to landmark structures around pelvis: a Nigerian population study.

Sciatic nerve (SN) presents significant variations that pertain to its topography and divisions. The topographic variation shows sex effect due to differences in the dimension of pelvis that makes for the adaptability of female pelvis for pregnancy and childbirth. The objective therefore was to evaluate the SN morphology and its topographical variations in relation to landmark structures in the pelvis of both sexes. Ninety-eight lower limb adult cadavers, 66 males and 32 females devoid of any gross pathology from Nigerians were used for the study. The cadavers were dissected to expose the SNs and the variations recorded. Anthropological measurements were taken and analysed using a Spearman's rank-order correlation model. The relationships between SN and the piriformis muscle shows five varied types with the typical type comprising 83.0%. The largest thickness of SN in males and females were 18.5 cm and 17.3 cm, respectively while the smallest thickness were 8.6 cm and 11.9 cm, respectively. The dimensions between posterior superior iliac spine and greater trochanter (PSIS-GT) and between lateral edges of SN intersection with piriformis to the tip of greater trochanter (LESN-GT) shows inverse correlation relationship between the two sexes. In males, there was a weak positive correlation (rs = 0.165) between LESN-GT (4.75 ± 1.52) and PSIS-GT (15.3 ± 2.90) which was not statistically significant at 0.01 level (p = 0.989). In females, the relationship between LESN-GT (6.39 ± 0.59) and PSIS-GT (12.2 ± 3.70) shows moderate negative correlation (rs = -0.476) which was not statistically significant at 0.01 level (p = 0.195). The dimension of LESN-GT which was observed to be longer in females was deemed to account for the deviation of sciatic nerve of females from the males' topographic anatomical relations.

365 Sciatica of Non-Disc Origin

INTRODUCTION: Sciatica resulting from piriformis muscle compression may respond to surgical decompression of the sciatic nerve via piriformis release. The topic has been very controversial. Pre-operative evaluation with MRI is useful to identify potential changes in either the piriformis muscle or the sciatic nerve that may help confirm the diagnosis of piriformis syndrome. METHODS: A retrospective analysis of all patients who underwent piriformis release to decompress the sciatic nerve. All surgeries were performed using a transgluteal approach. All patients (15) had preoperative localization of the piriformis muscle via percutaneous wire placement by interventional radiology using either CT or ultrasound guidance. 30 patients, who had MRI scans of their pelvis unrelated to sciatica, served as the control cohort. We also looked for signal changes in the sciatic nerve seen on MRI, piriformis muscle thickness, and pre versus post-operative numeric rating scale (NRS) assessment. RESULTS: Between treatment and control cohorts, there was no difference in basic demographics (other than age). In comparing the surgical and control cohorts, we found that a significant number of patients in the surgical cohort had the sciatic nerve riding over the ischial spine. Distance between the midpoint of the sciatic nerve to the ischial spine was also significantly lower in the surgical cohort. Piriformis thickness was essentially identical between the cohorts. In comparing pre and postoperative NRS pain scores, the aggregate of surgically treated patients had a significant improvement in their pain scores by approximately 4 points. Subgroup analysis of the surgical cohort demonstrated trends toward a larger improvement in NRS when the distance between the midpoint of the sciatic nerve to the ischial spine was &lt;9mm, BMI &lt;25, and piriformis thickness &lt;2cm. CONCLUSION: Identifying clear MRI findings related to the sciatic nerve and its trajectory through the pelvis can potentially help identify patients who will better respond to surgery.

PIRIFORMIS SYNDROME

Piriformis syndrome is a disease characterized by inflammation of the peripheral nerves in the sciatic nerve caused by abnormal conditions in the piriformis muscle. Piriformis syndrome is caused by excessive or excessive contraction of the piriformis muscle. Piriformis syndrome is underdiagnosed and considered as common back pain and causes 6% of similar symptoms to Low Back Pain (LBP) and the incidence rates in LBP patients varying, from 5% to 36%. The incidence of PS is about 2.4 million new cases each year and it is more common in women than men. Piriformis syndrome usually happened in the 4th and 5th decades of life. There are various variations of the relationship between the sciatic nerve and the piriformis muscle where this anatomical shape is a risk factor for piriformis syndrome. The diagnosis of piriformis using functional (Fair Test, Beatty Maneuver, Modified Beatty Maneuver, Pace Test, Freiberg Test, Braggard Test, Straight Leg Raise Test, Bonnet Test, Micrine Test) and imaging modalities (USG, EMG, CT-Scan, MRI). The management of piriformis syndrome is carried out in the order of warning management, medical management, physical therapy, steroid spraying, botulinum spraying, and surgical technique. The prognosis of piriformis syndrome depends on the severe condition of each patient, a study reports that even patients who have undergone surgery can still get piriformis syndrome again

Endoscopic Sciatic Neurolysis for Deep Gluteal Space Syndrome

Background: Deep gluteal syndrome (DGS) encompasses a spectrum of pathologies causing symptomatic sciatic nerve compression deep to the gluteus maximus muscle. Endoscopic sciatic neurolysis is an option for management of DGS when conservative treatment fails. Indications: Endoscopic sciatic neurolysis is indicated for retro-trochanteric pain, sciatica-like burning in the posterior thigh, and sitting discomfort that is reproducible on physical examination after failing conservative management. Technical Description: The technique presented here introduces a standard endoscopic sciatic neurolysis technique with an accessory posterolateral portal placed distally and in line with the sciatic nerve. Use of a switching stick through an accessory distal posterolateral portal can allow for in-line protection and retraction of the sciatic nerve while it is carefully released from compressive fibrous bands using an arthroscopic shaver. It is important that the accessory portal be placed under direct visualization with caution not to injure the sciatic nerve. An arthroscopic radiofrequency device can be used for hemostasis and further release of fibrous bands. At the end of the procedure, the sciatic nerve should be visualized fully released and freely mobile from the piriformis muscle to the level of the lesser trochanter. Results: In properly selected patients, the procedure is very successful. In a series of 35 cases, the procedure reduced sitting pain (present in 97% of patients preoperative, 17% of patients postoperative), reduced narcotic use, improved visual analog scale (VAS) pain scores, and improved modified Harris hip scores without major complications. Discussion: Although rare following hip arthroscopy, postoperative scarring and fibrous bands are a common cause of DGS which can be effectively treated by endoscopic sciatic nerve decompression. Results of endoscopic sciatic neurolysis have thus far been encouraging with improvements in patient reported outcome scores and high rates of satisfaction. However, complications do occur and can result in neurologic deficits. Nevertheless, with careful patient selection and meticulous sciatic nerve dissection, endoscopic sciatic neurolysis for DGS is a safe and effective technique for decompression of fibrous bands and adhesions that can lead to sciatic neuralgia.

Prevalence of Piriformis Muscle Tightness among Undergraduate Medical Students

Objectives: To determine the prevalence of piriformis muscle tightness among allied health students, and its relationship with age, gender and year of study. Methods: A cross sectional study was conducted. A sample size of 259 was calculated using Open Epi v3.01. Allied health students from physical therapy, occupational therapy and prosthetics &amp; orthotics programs participated in this study, which lasted 4 months. After obtaining informed consent, data was collected through a self-developed questionnaire. Piriformis muscle tightness, and symptom recurrence, was determined using the FAIR test. Results: Average age of participants was 21.94±1.81 years. Females comprised of 79.9% of the study population. High percentage (85.3%) were from the physical therapy program. Most common posture was crossed leg sitting (48.3%). Positive FAIR test was found in 41.7% of the population. Strong correlation between age-group with FAIR test was noted (p=0.036). Conclusion: Piriformis muscle tightness is prevalent in those who engage in prolonged sitting postures. Furthermore, strong association of piriformis tightness with age is present, whereas no relationship with gender and year of study has been observed. Keywords: Piriformis muscle tightness, Piriformis muscle syndrome, Low back pain, Sedentary individuals, FAIR test.

Prevelance of Piriformis Syndrome among female Physiotherapy students of Gujranwala, Pakistan, A Cross-Sectional Survey

Piriformis syndrome is a neuromuscular disorder that is caused when piriformis muscle compresses the sciatic nerve. Its prevalence is very high in sedentary population and young people have more risk factors of getting affected with piriformis tightness that causes piriformis syndrome and later on lower back pain. Its etiology can be primary or secondary. Primary will be anatomical variation and secondary will be due to any other causes (trauma or local ischemia). It is more common in females with ratio of 3 to 1. Objectives: To determine the prevalence of piriformis syndrome among the female physical therapy students of Gujranwala. Material and methods:It was a cross-sectional study conducted in physical therapy female students of different physiotherapy institutes of Gujranwala. Data was collected from 195 students with Convenient sampling technique. The Diagnostic tool used was Piriformis syndrome diagnostic criteria. Results: Out of 195 female physical therapy students 72 (36.9%) had a high score and had a high probability of having piriformis syndrome. Only (4) 2.1% were unlikely of having piriformis syndrome while in majority of the participants 119 (61%) piriformis syndrome was not considered. Conclusion: This study concludes that female physical therapy students of Gujranwala have a low to moderate probability of having piriformis syndrome, with increased probability of buttock pain associated with prolonged sitting.

МАНУАЛЬНАЯ ТЕРАПИЯ И ФАРМАКОТЕРАПИЯ В РЕАБИЛИТАЦИИ ПАЦИЕНТОВ С СИНДРОМОМ ГРУШЕВИДНОЙ МЫШЦЫ

Piriformis syndrome (PS) is the low back pain manifestation that is accompanied by reversible compression of the sciatic nerve by the hypertrophied piriformis muscle. Among other low back pain manifestations the PS accounts for 6–35%. However, the PS diagnosis as well as its treatment is still difficult. There are many methods for the rehabilitation of patients with PS including invasive and non-invasive treatment. The drug therapy, injections of botulinum toxin A, sciatic nerve neurolysis, and piriformis muscle tenotomy are widely used, but they do not always lead to recovery, thereby making it necessary to search for new methods of treatment. Manual therapy has long been used in the rehabilitation of patients with low back pain. However, most often it is prescribed only as an additional therapy to the main treatment and not fully implemented. The manual therapy effectiveness as a monotherapy has not adequately been studied.

ОЦЕНКА ЭФФЕКТИВНОСТИ ДИАГНОСТИКИ И КОМПЛЕКСНОГО ЛЕЧЕНИЯ СИНДРОМА ГРУШЕВИДНОЙ МЫШЦЫ

94 patients with piriformis syndrome were examined. The description of clinical tests of piriformis syndrome used in manual therapy and instrumental research methods is carried out. The possibility of using ultrasound as a diagnostic technique for lesions of the piriformis muscle and sciatic nerve is noted. The combination of classical manual therapy and the use of medical blockades with dynamic ultrasound control is a therapeutic choice in patients with primary and secondary piriformis syndrome.

Endoscopic Treatment of Piriformis Syndrome Results in a Significant Improvement in Pain Visual Analog Scale Scores

PurposeTo survey the clinical satisfaction of patients who have had an endoscopic piriformis release with a sciatic nerve neurolysis.MethodsPatients with piriformis syndrome (PS) who were treated with an endoscopic piriformis release combined with a sciatic neurolysis between 2013 and 2018 were identified. All patients had a minimum follow-up of 1 year. Patients were contacted by telephone in 201,9 whereby the rate of satisfaction and pain were evaluated with the Benson surgery scale and the visual analog scale (VAS).ResultsThe average duration of symptoms at first presentation was 34 months (range 16-54 months). Thirty-seven cases (82,2%) had an EMG that showed sciatic compression around the piriformis muscle. The average preoperative VAS pain score was 7.4 (± 0.8). The mean VAS score at the time of the survey was 1.9 (± 2.4). The difference in median preoperative and postoperative VAS was 6. Using the Wilcoxon signed-rank test, we found there was a significant improvement of VAS score (with P < .001). Using the Benson operative scale, we found that outcomes at the time of the survey were excellent in 23 patients (24 cases, 53.4%), good in 10 (22.2%), fair in 3 (6.7%), and poor in 8 (17.7%). Three patients with a poor result had a wrong diagnosis of PS and ended up needing treatment for a different diagnosis. In total, 33 patients answered affirmative on the question if they would undergo the procedure again. Apart from 3 local wound infections, no major complications were observed.ConclusionsOnce a diagnosis is made, the endoscopic release of the piriformis tendon results in significant improvement in Pain VAS scores for patients with refractory symptoms despite conservative treatment.Level of EvidenceLevel IV, therapeutic case series.

Management of a patient with myofascial pain syndrome (piriformis syndrome): clinical follow-up

The article considers a clinical case of treatment of one of the variants of myofascial pain syndrome – piriformis syndrome without signs of sciatic nerve neuropathy. The peculiarity of the case is the comorbidity of the opioid syndrome with diabetic sensorimotor polyneuropathy and osteoporosis, which required the appointment of complex therapy. The diagnosis was confirmed by additional research methods: spondylography, MRI of the lumbosacral spine, ultrasound of the piriformis muscle, electroneuromyography. A patient management tactic was chosen based on federal clinical guidelines for the treatment of patients with nonspecific back pain. Treatment included non-medicinal and medicinal methods. In order to relieve pain, dexketoprofen was prescribed 2 ml intramuscularly per 2 ml of 0.5% lidocaine solution – 1 time а day No. 2 – under navigation by ultrasound. Subsequently, the transfer was made to oral administration of 25 mg 3 times а day for 3 days. A step-by-step scheme of prescribing dexketoprofen: its introduction into the piriformis muscle with subsequent transfer to oral administration allowed to significantly reduce the severity of pain after 5 days of treatment. The complex effect on the spasmodic piriformis muscle with the help of a tableted muscle relaxant in combination with postisometric relaxation made it possible to quickly stop the pain syndrome and prevent its chronization. The administration of the preparation of thioctic acid pursued two goals: to improve the metabolism of the spasmodic muscle and restore the energy metabolism of peripheral nerves. As a result of the use of complex, pathogenetically based therapy, a positive effect was achieved.