Ms L presented to the clinic complaining pain mainly over her right buttock with sharp shooting pain radiating down on the side of her leg and foot. She was walking with limping gait, difficulty bending forward and reported severe sharp shooting pain when she first get up in the morning. On examination at initial session, there was pain over the piriformis muscle on palpation and reduced passive hip internal rotation compared to the left which was consistent with the clinical findings of piriformis syndrome. Treatments such as soft tissue massage, electrotherapy and piriformis stretching exercises were introduced in the first session. Upon the second session, the patient reported the pain was only getting slightly better and very mild low back pain was reported. Neurological examination was conducted which showed reduced sensation and reflex while the muscle function was intact. Since the neurological examination was positive with her severe leg pain that impacts her physical function, she was advised for a CT scan which demonstrates lumbar spondylosis with impingement on the descending S1 nerve root. On reassessment, the patient showed improvement in flexion after repeated lumbar flexion. The treatment approaches were adjusted according to the reassessment with a main focus on symptom-free and core stability exercises along with mobilisations. The patient is showing gradual improvement with reduced pain on walking and getting easier to bend forward. The following exercises were prescribed to reduce her symptoms and improve her physical function:

Sustained lumbar rotation in left side-lying
Straight leg raise nerve gliding exercise
Posterior pelvic tilting exercise in supine
Knee to chest repeated flexion in supine
Postural correction to reduce excessive lumbar lordosis