אולטרסאונד בשימוש סיאטיקה

Soft tissue ultrasound orthopedics imaging has advanced significantly in recent years, and it is successful, advantageous, and essential in both diagnosis and treatment. With the progress of technology, sonography examination became more widespread in pathological assessments, primarily of soft tissues in the field of the musculoskeletal system.

Pyriformis Syndrome is a pathology of a neuromuscular problem that occurs when the piriformis muscle presses or stimulates the sciatic nerve, causing pain and a sensation of porting in the buttock area and down the leg along the sciatic nerve's path. The piriformis muscle and the sciatic nerve are both involved in the phenomenon. (Jamaly et al., 2018)

The diagnosis is difficult due to a lack of validated tests and reliable screening tools. Two common ones are the piriformis test (FAIR test) and the EMG test for evaluating and recording the electrical activity produced by the piriformis that can indicate nerve inflammation. The differential diagnosis can be a source of pressure/irritation of the nerve root in the spinal cord, such as when a herniated disc happens. The sciatic nerve beneath it may be compressed when the piriformis muscle shortens or enters a defensive spasm due to trauma or overload. This is referred to as nerve Entrapment. (Filler et al., 2005)

For all conditions above, several treatment methods are available for this phenomenon, including the administration of pain and anti-inflammatory drugs, rehabilitation exercises, soft tissue techniques, and neurodynamic therapies.

In some cases, dry needling can help ease pain in the pelvic region.

A trigger point (TrP) is a hyper irritable spot, a palpable nodule in the taut bands of the skeletal muscles' fascia. Direct compression or muscle contraction can elicit jump signs, local tenderness, local twitch response, and referred pain, usually resulting from a pattern distant from the spot. (Furlan et al., 2005)

In the dry needling technique, a thin needle is inserted into the muscles identified as being related to the phenomenon; without using any substances or medications, dry needling penetrates directly through the skin to the relevant trigger point in the muscle.

In the early stages of rehabilitation, dry needling reduces pain while improving movement and disability. Dry needling improves the muscle's ability to lengthen and shorten physiologically by releasing trigger points. Dry needling is a unique method of neural stimuli that evokes sensory nerve impulses that activate endogenous pain mechanisms. (Furlan et al., 2005)

Ultrasound is a simple and non-invasive technology that allows real-time imaging of soft tissues such as muscles and can be operated on after qualification by physiotherapists.

A treatment that combines dry needling and ultrasound imaging is uncommon and is in its early stages; however, it allows for greater accuracy and is an excellent supplement to the existing treatment of the phenomenon.

I've been using ultrasound to diagnose musculoskeletal pain since 2018, and I combine this technology in my treatment sessions with dry needling techniques.

There is a dynamic need to investigate this treatment method further to establish reliable evidence base gold standards and norms.

References:

Filler, A. G., Haynes, J., Jordan, S. E., Prager, J., Villablanca, J. P., Farahani, K., Mcbride, D. Q., Tsuruda, J. S., Morisoli, B., Batzdorf, U., & Johnson, J. P. (2005). Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. Journal of Neurosurgery: Spine, 2(2), 99–115. https://doi.org/10.3171/spi.2005.2.2.0099

Furlan, A. D., van Tulder, M., Cherkin, D., Tsukayama, H., Lao, L., Koes, B., & Berman, B. (2005). Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine, 30(8). https://journals.lww.com/spinejournal/Fulltext/2005/04150/Acupuncture_and_Dry_Needling_for_Low_Back_Pain__An.18.aspx

Jamaly, A., Mohsenifar, H., & Amiri, A. (2018). The Effects of Dry Needling in Combination with Physical Therapy on Improvement of Pain and Hip Internal Rotation Range in Patients with Piriformis Syndrome. Journal of Clinical Physiotherapy Research, 3(3), 118–122. https://doi.org/10.22037/jcpr.v3i3.21739