Issue 24-6, 2025

Original article

https://doi.org/10.38025/2078-1962-2025-24-6-91-99

Functional (Manual) Muscle Testing in the Diagnosis of Peripheral Neuropathies in Piriformis Syndrome: a Single-Center Prospective Non-randomized Study

View article (Download PDF file)



Download XML file

ORCIDMikhail D. Didur1, ORCIDTatiana V. Konchugova2, ORCIDNikolay V. Rasputin3,*, ORCIDAndrey A. Bozhchenko4, ORCIDAntonina M. Golubeva5, ORCIDVladimir V. Vasiliev6

1 N.P. Bekhtereva Institute of the Human Brain, Saint Petersburg, Russia
2 National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
3 S.M. Kirov Military Medical Academy, Saint Petersburg, Russia
4 Military Unit No. 39964, Russia
5 Ivanovo Regional Children's Clinical Hospital, Ivanovo, Russia
6 Ben Weider College of Fitness and Bodybuilding, Saint Petersburg, Russia


ABSTRACT

INTRODUCTION. Piriformis syndrome is one of the most common nosologies encountered by doctors of various specialties. It significantly reduces patients’ quality of life and leads to the formation of an suboptimal motor stereotype accompanied by persistent pain. Early diagnosis and adequate manual and physiotherapeutic correction are difficult due to the lack of generally recognized morphological diagnostic criteria.

AIM. To determine the possibilities of a therapeutic and diagnostic algorithm involving the method of functional (manual) muscle testing based on the developed methodology for examining patients with lower back pain, including those afflicted with various myofascial pain syndromes in the lower extremities.

MATERIALS AND METHODS. Between July 2024 and June 2025 37 patients were under observation (F = 1.04, p < 0.01) — 18 (48.65 ± 4.86 %) women and 19 (51.35 ± 5.14 %) men aged 18 to 52 (34.64 ± 3.46) years with the final clinical diagnosis “piriformis syndrome. G57.0”; The history of the disease ranged from 0.12 to 1.24 (0.51 ± 0.06) years. Each patient was supposed to assess his or her pain syndrome on a visual-analog scale (VAS) of pain from 0 to 10 points. The doctor consistently performed: 1) visual diagnosis of the patient’s postural balance; 2) flexion test; 3) functional (manual) muscle testing of the indicator muscle (anterior [clavicular] portion of the deltoid muscle) in the patient; 4) assessment of the functional state of muscle contraction (hypo-, normal- or hyperreaction); 5) selection of aromatherapy to achieve normoreaction muscle contraction in the patient; 6) functional (manual) muscle testing of the piriformis muscles on both sides of the patient; 7) following the establishment of the side of the fascial shortening of the piriformis muscle, the patient was positioned supine with flexion of the shin in the knee joint. Thereafter, its postisometric relaxation was performed according to Professor V.P. Veselovsky’s methodology.

RESULTS AND DISCUSSION. Hyporeaction was detected in 59.45 ± 5.95 %, and hyperreaction in 40.54 ± 4.05 % of cases. After correction, normoreaction of muscle contraction of the tested muscles was achieved in all observed patients and pain reduction during postisometric relaxation of the affected muscle in 86.49 ± 8.65 % of cases.

CONCLUSION. The use of functional (manual) muscle testing as an express method of early detection of muscle tissue dysfunction has shown its effectiveness in all subjects diagnosed with piriformis syndrome, who have subsequently developed neuropathies.


KEYWORDS: piriformis syndrome, muscle contraction dysfunction, suboptimal motor stereotype, functional (manual) muscle testing, aromatherapy, propaedeutics

FOR CITATION: Didur M.D., Konchugova T.V., Rasputin N.V., Bozhchenko A.A., Golubeva A.M., Vasiliev V.V. Functional (Manual) Muscle Testing in the Diagnosis of Peripheral Neuropathies in Piriformis Syndrome: a Single-Center Prospective Non-randomized Study. Bulletin of Rehabilitation Medicine. 2025; 24(6):91–99. https://doi.org/10.38025/2078-1962-2025-24-6-91-99 (In Russ.).

FOR CORRESPONDENCE:

Nikolay V. Rasputin, E-mail: doc.rasputin@mail.ru


References:

  1. Белевитин А.Б., Фесюн А.Д., Божченко А.А. и др. Медицинская реабилитация в системе медицинского обеспечения силовых структур Российской Федерации: методологические, исторические и организационные аспекты. Медицина катастроф. 2011; 1(73): 26–28. [Belevitin A.B., Fesyun A.D., Bozhchenko A.A., et al. Medical rehabilitation in the medical support system of law enforcement agencies of the Russian Federation: methodological, historical and organizational aspects. Disaster Medicine. 2011; 1(73): 26–28 (In Russ.).]
  2. Божченко А.А. Организационные аспекты медицинской реабилитации различных контингентов раненых, пораженных и больных в Вооруженных Силах Российской Федерации в современных условиях: Учебно-методическое пособие. СПб.: ВМедА. 2022; 67 с. [Bozhchenko A.A. Organizational aspects of medical rehabilitation of various contingents of the wounded, affected and sick in the Armed Forces of the Russian Federation in modern conditions: An educational and methodological manual. St. Petersburg: VMedA. 2022; 67 p. (In Russ.).]
  3. Шиман А.Г., Клочева Е.Г., Шоферова С.Д., Гунзенов Г.Д. Применение сочетанных методов физиотерапии в комплексном лечении больных туннельными компрессионно-ишемическими невропатиями верхних конечностей. Физиотерапевт. 2009; 8: 45–56. [Shiman A.G., Klocheva E.G., Shoferova S.D., Gunzenov G.D. The use of combined physiotherapy methods in the complex treatment of patients with tunnel compression-ischemic neuropathies of the upper extremities. Physiotherapist. 2009; 8: 45–56 (In Russ.).]
  4. Latinovic R., Gulliford M.C., Hughes R.A.C. Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery & Psychiatry. 2006; 77(2): 263–265.
  5. Fuller G. Focal peripheral neuropathies. Journal of Neurology, Neurosurgery & Psychiatry. 2003. 74: 20–24.
  6. Ходулев В.И., Нечипуренко Н.И. Компрессионно-ишемические невропатии: анатомо-морфологические особенности, патофизиологические паттерны, клиника. Медицинские новости. 2018; 1: 27–32. [Khodulev V.I., Nechipurenko N.I. Compression-ischemic neuropathies: anatomical and morphological features, pathophysiological patterns, clinic. Medical news. 2018; 1: 27–32 (In Russ.).]
  7. Tubbs R.S., Levin M.R., Loukas M., et al. Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes. Journual of Neurosurgery of Spine. 2010; 13(3): 356–359. https://doi.org/10.3171/2010.3.spine09747
  8. Канаев С.П. Синдром грушевидной мышцы. Комплексное клинико-инструментальное исследование: новые подходы в диагностике: автореф. дисс. … канд. мед. наук. Москва. 2005; 25 с. [Kanaev S.P. Piriformis muscle syndrome. Comprehensive clinical and instrumental research: new approaches in diagnostics: Abstract. Dissertation of the Candidate of Medical Sciences. Moscow. 2005; 25 p. (In Russ.).]
  9. Романенко В.И., Романенко И.В., Романенко Ю.И. Синдром грушевидной мышцы. Международный неврологический журнал. 2014; 8(70); 91–95. [Romanenko V.I., Romanenko I.V., Romanenko Yu.I. Piriformis muscle syndrome. International Neurological Journal. 2014; 8(70); 91–95 (In Russ.).]
  10. Foster M.R. Piriformis syndrome. Orthopedics. 2002; 25: 821–825.
  11. Kikuta S., Iwanaga J., Watanabe K., Tubbs R.S. Revisiting the middle cluneal nerves: an anatomic study with application to pain syndromes and invasive procedures around the sacrum. World Neurosurgery. 2019; 127: 1228–1231. https://doi.org/10.1016/j.wneu.2019.04.109
  12. Papadopoulos E.C., Khan S.N. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop. Clin. North Am. 2004; 35: 65–71.
  13. Юрковский А.М., Назаренко И.В., Мельникова А.С. Нейропатия верхних и средних ягодичных нервов: методические аспекты диагностических блокад. Проблемы здоровья и экологии. 2020; 4: 5–11. [Yurkovsky A.M., Nazarenko I.V., Melnikova A.S. Neuropathy of the upper and middle gluteal nerves: methodological aspects of diagnostic blockages. Problems of health and ecology. 2020; 4: 5–11 (In Russ.).]
  14. Kim K., Isu T., Morimoto D., Iwamoto N., et al. Anatomic considerations for posterior iliac crest bone procurement. Journual of Oral Maxillofacialis Surgery. 2013; 71(1): 1777–1788. https://doi.org/10.1016/j. joms.2013.03.008
  15. Kuniya H., Aota Y., Saito T., et al. Anatomical study of superior cluneal nerve entrapment. Journual of Neurosurgery of Spine. 2013; 176–80. https://doi.org/10.3171/2013.4.SPINE12683
  16. Loubser L., Raath R.P., VanSchoor A.N. Clinical anatomy of the superior cluneal nerve in relation to easily identiable bony landmarks. Southern African J. Anaesthesia Analgesia. 2015; 21(3): 77–80.
  17. Юрковский А.М., Мельникова А.С., Назаренко И.В., Письменникова Е.И. Нейропатия верхних ягодичных нервов: нерешенные вопросы лучевой диагностики. Проблемы здоровья и экологии. 2021; 18(2): 12–18. https://doi.org/10.51523/2708-6011.2021-18-2-2 [Yurkovsky A.M., Melnikova A.S., Nazarenko I.V., Pisisnikova E.I. Neuropathy of the upper gluteal nerves: unresolved issues of radiation diagnosis. Problems of health and ecology. 2021; 18(2): 12–18. https://doi.org/10.51523/2708-6011.2021-18-2-2 (In Russ.).]
  18. Дидур М.Д., Распутин Н.В., Божченко А.А. и др. Онтология и герменевтика парадигмы функционального мышечного тестирования как субъекта пропедевтики в классической медицинской практике: историко-аналитическое исследование. КЛИО. 2025; 3(219): 69–78. [Didur M.D., Rasputin N.V., Bozhchenko A.A., et al. Ontology and hermeneutics of the paradigm of functional muscle testing as a subject of propaedeutics in classical medical practice: a historical and analytical study. CLIO. 2025; 3(219): 69–78 (In Russ.).]
  19. Распутин Н.В., Шкарупа А.В., Коровин А.Е. и др. Современная диагностика патобиомеханических нарушений опорно-двигательного аппарата при постковидном синдроме. Клиническая патофизиология. 2021; 27(4): 82–87. [Rasputin N.V., Shkarupa A.V., Korovin A.E., et al. Modern diagnostics of pathobiomechanical disorders of the musculoskeletal system in postcovoid syndrome. Clinical pathophysiology. 2021; 27(4): 82–87 (In Russ.).]
  20. Гайворонский И.В., Нечипорук Г.И. Анатомия мышечной системы (мышцы, фасции, топография): Учебное пособие. СПб.: ЭЛБИ-СПб. 2005; 84 с. [Gaivoronsky I.V., Nechiporuk G.I. Anatomy of the muscular system (muscles, fascia, topography): A textbook. St. Petersburg: ELBI-SPb. 2005; 84 p. (In Russ.).]
  21. Iwanaga J., Simonds E., Patel M., et al. Anatomic study of superior cluneal nerves: application to low back pain and surgical approaches to lumbar vertebrae. World Neurosurgery. 2018; 116: 766–768. https://doi.org/10.1016/j.wneu.2018.05.087
  22. Шостак Н.А., Правдюк Н.Г. Миофасциальный синдром (синдром грушевидной мышцы) — подходы к диагностике, лечению. Русский медицинский журнал. 2014; 28: 2022–2024. [Shostak N.A., Pravdyuk N.G. Myofascial syndrome (piriformis syndrome) — approaches to diagnosis and treatment. Russian Medical Journal. 2014; 28: 2022–2024 (In Russ.).]
  23. Zheng D., Lamer T.J. Idiopathic cluneal neuralgia successfully treated with radiofrequency nerve ablation: a case report. A Pract. 2019; 12(10): 352–355. https://doi.org/10.1213/XAA.0000000000000922
  24. Боду Д. Ароматерапия. Лечение эфирными маслами: пер. с фр. М.: Планета Ароматика. 2022; 248 с. [Bodu D. Aromatherapy. Treatment with essential oils: translated from French, Moscow: Planet Aromatika. 2022; 248 p. (In Russ.).]
  25. Batiha A.M. Holistic and Culturally Sensitive Pain Management in Jordanian Intensive Care Settings. Nursing in Critical Care. 2025; 30(4): e70091. https://doi.org/10.1111/nicc.70091
  26. Министерство здравоохранения Российской Федерации. Рубрикатор клинических рекомендаций. Соматическая дисфункция: Клинические рекомендации. 07.02.2023. Доступно на: https://cr.minzdrav.gov.ru/preview-cr/750_1 (дата обращения: 01.07.2025) [Ministry of Health of the Russian Federation. The Clinical Guidelines Rubricator. Clinical Guidelines “Somatic dysfunction” (Accessed: 01.07.2025) (In Russ.).]
  27. Веселовский В.П. Практическая вертеброневрология и мануальная терапия. Казань: Медицинская литература. 2010; 343: 1. [Veselovsky V.P. Practical vertebroneurology and manual therapy. Kazan: Medical Literature. 2010; 343: 1 (In Russ.).]
  28. Мамаев А.Н., Кудлай Д.А. Статистические методы в медицине. М.: Практическая медицина, 2021; 136 с. [Mamaev A.N., Kudlay D.A. Statistical methods in medicine. M.: Practical medicine. 2021; 136 p. (In Russ.).]
  29. Кочетов А.Г., Лянг О.В., Масенко В.П. и др. Методы статистической обработки медицинских данных: Методические рекомендации для ординаторов и аспирантов медицинских учебных заведений, научных работников. М.: РКНПК. 2012; 42 с. [Kochetov A.G., Liang O.V., Masenko V.P., et al. Methods of statistical processing of medical data: Methodological recommendations for residents and postgraduates of medical educational institutions, researchers. M.: RKNPK. 2012; 42 p. (In Russ.).]
  30. Simons D.G. Clinical and etioloigical update of myofascial pain from trigger points. J Musculoskelet Pain. 1996; 4(1–2): 93–122.



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©


This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.