Introduction:
Piriformis syndrome (PS) is a neuromuscular condition with a special combination of several characteristic manifestations mainly highlighted by gluteal pain(1). Others may involve pain in the lower back area down to buttocks, paraesthesia, numbness and limitations to some weight-bearing activities like walking for long periods, standing and sitting to some degrees(1-5). Other symptoms may also include: the sciatic notch tenderness, swelling, sexual dysfunctions and splayfoot with a dominant external rotation in supine lying indicating tightness of the muscle(6). In general, four primary manifestations had the highest tendency to be found as was reported by a recent systematic review. These include: posterior buttock pain, increased sciatica symptoms with sitting, tenderness over the greater sciatic notch and positive results of Piriformis muscle tension tests
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Overuse can also result from powerful activities involving either forward moving or sitting and continuous activity of the lower limbs like running or bicycling especially with lack of stretching and strengthening exercises. In these cases, impingement of the sciatic nerve is a high possibility especially in conditions where the Piriformis size is increased by 40%. Some studies have shown some involvement of the Pedundal nerve as well presented with symptoms of incontinence in addition to groin tingling and numbness(13). Furthermore in advanced case, unilateral weakness of several hip muscles supplied by nerves arising from the sacral plexus (e.g. Gluteus Maximus, Medius & Minimus, Tensor Fascia Lata and Quadrates Femoris) was associated with chronic stages of Piriformis syndrome. This could explain the decreased internal rotation range of motion in ipsilateral hip joint with increased severity and continuity of the