Pace Maneuver | Piriformis Syndrome | Deep Gluteal Syndrome of the Hip
Deep gluteal syndrome, abbreviated as DGS is defined as pain in the buttock area caused by a non-discogenic entrapment of the sciatic nerve in the subgluteal space.
The structures that can be involved in sciatic nerve entrapment are not only the piriformis but also fibrous bands containing blood vessels, gluteal muscles, hamstring muscles, the gemelli-obturator internus complex, vascular abnormalities and space-occupying lesions. For this reason, the term “deep gluteal syndrome” instead of “pirformis syndrome” is now preferred.
Commonly reported symptoms include hip or buttock pain and tenderness in the gluteal and retro-trochanteric region. The pain is often described to be sciatica-like, often unilateral and exacerbated with rotation of the hip in flexion and knee extension. Other symptoms include intolerance of sitting for more than 20 to 30 minutes, limping, disturbed or loss of sensation in the affected extremity and pain at night getting better during the day.
No diagnostic studies have been done on the Pace maneuver yet, which is why we give it a questionable clinical value in practice.
Before you conduct the test, make sure you have examined and excluded more prevalent pathologies in the lumbar spine and SI joint that could explain the patient’s symptoms.
To perform the test as shown in the study of Fishman, have the patient lie on the unaffected side with his upper hip flexed to 90 degrees, maximal adduction and the upper knee flexed to 90 degrees. While both acetabula are kept vertical apply upward and lateral pressure to the shin while passively rotating the hip internally to 45 degrees or as near as the patient can tolerate.
This test is positive if the patient reports pain at the intersection of the sciatic nerve and the piriformis.
Other common tests to assess for deep gluteal syndrome are:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.