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Piriformis Syndrome (PS) is a condition which is characterized by pain, numbness, and limited range of motion (ROM) due to compression or irritation of the sciatic nerve by the piriformis muscle. It often leads to discomfort in the buttock region, radiating pain along the posterior thigh, and functional limitations in daily activities. Manual therapy techniques, particularly Muscle Energy Techniques (METs), have been widely used for the management of musculoskeletal dysfunctions, including piriformis syndrome.
This study will highlight the clinical relevance of METs in piriformis syndrome management and supports the integration of these techniques into routine physiotherapy practice to optimize patient outcomes.This study will be a randomized controlled trial involving -- patients diagnosed with piriformis syndrome. 40 participants will be randomly assigned into two groups. Both groups will receive conservative treatment, including a 10-15minutes cold pack and TENS and 5 minutes of ultrasound therapy application along with stretching (gluets and hamstrings) and strengthening exercises of core and hip stabilizers (gluteus medius, gluteus maximus). Group A will receive an additional 10-minute session of post isometrics relaxation technique of muscle inhibition techniques (METs). In contrast, Group B will receive reciprocal inhibition techniques of muscle energy techniques (METs) for 10 minutes. The intervention will be administered daily for four weeks. Pain intensity, ROM, and functional disability will be measured at baseline and post-intervention using standardized assessment tools
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Post isometrics Relaxation Techniques (PIR) | Experimental | In this group First conventional treatment will be applied for 20 minutes including Hot Pack and TENS (for 15 minutes) and sonics (for 5 minutes) Followed by PIR. |
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| Reciprocal Inhibition Technique | Active Comparator | This group will receive Hot Pack and TENS (for 15 minutes) and Sonics (for 5 minutes) Followed by METs. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Post isometrics Relaxation Techniques (PIR) | Other | Post-Isometric Relaxation is a type of MET in which the target muscle is gently contracted isometrically (without movement) against resistance, followed by a passive stretch during the post-contraction relaxation phase. To reduce muscle tension, increase flexibility, and lengthen tight muscles (like the piriformis in Piriformis Syndrome). Position the patient in a stretch position for the tight muscle just before the point of resistance. Then ask the patient to perform a gentle isometric contraction of the tight muscle (e.g., piriformis) for about 5-10 seconds against minimal resistance. After contraction, the patient relaxes for a few seconds. During this relaxation, the therapist passively stretches the muscle to a new barrier and holds for 15-30 seconds. Repeat 3-5 times. So, the whole treatment session will be of 50 minutes. This technique will be applied twice a week for 4 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| NPRS for assessment of pain | To determine the degree of pain that the patient will report, the Numeric Pain Rating Scale (NPRS) will be utilized. | 4 weeks |
| Lower Extremity Function Test (LEFT) | The LEFT protocol includes a timed sequence of agility-based tasks, typically performed in a zigzag pattern or shuttle-based layout over a 120-foot course | 4 weeks |
| GONIOMETERY | Goniometry is the measurement of joint angles in the human body using a tool called a goniometer. It is a standard and essential part of physical therapy and rehabilitation for assessing range of motion (ROM) in various joints | 4 weeks |
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Inclusion Criteria:
- Piriformis syndrome clinically confirmed via special tests (e.g., FAIR test, Freiberg sign, Pace test)
Exclusion Criteria:
Lumber disc herniation or radiculopathy confirmed by imaging or neurological signs
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Imran Amjad | Contact | 03324390125 | Imran.amjad@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Hira Shaukat, Mphill | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ghurki Hospital Lahore | Lahore | Punjab Province | 54000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19011229 | Background | Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008 Nov;108(11):657-64. doi: 10.7556/jaoa.2008.108.11.657. | |
| 22863240 | Background | Kean Chen C, Nizar AJ. Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test. Pain Pract. 2013 Apr;13(4):276-81. doi: 10.1111/j.1533-2500.2012.00585.x. Epub 2012 Aug 2. |
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| ID | Term |
|---|---|
| D055958 | Piriformis Muscle Syndrome |
| D010146 | Pain |
| ID | Term |
|---|---|
| D020426 | Sciatic Neuropathy |
| D020422 | Mononeuropathies |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
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| Reciprocal Inhibition Technique | Other | Reciprocal Inhibition is another MET technique where the antagonist of the tight muscle is contracted, which reflexively causes the tight (agonist) muscle to relax. To inhibit the overactive muscle by activating its opposing muscle group, allowing for greater stretch and flexibility. Place the muscle (e.g., piriformis) into a gentle stretch. Ask the patient to contract the antagonist muscle (e.g., hip adductors/internal rotators) for about 5-10 seconds. Therapist then passively stretches the target muscle (e.g., piriformis) further. Repeat 3-5 times. So, the whole treatment session will be of 50 minutes. This technique will be applied twice a week for 4 weeks. |
|
| Background | Kutty NN, Siddeeque S, Tamphaibema H, Othayoth N, Bineesh C. Effect of Muscle Energy Technique with Deep Friction Massage on Pain, Disability and Internal Rotation Range of Motion of Hip Joint in Individuals with Piriformis Syndrome. Indian Journal of Physiotherapy & Occupational Therapy. 2020;14(1). |
| 20118521 | Background | Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. J Orthop Sports Phys Ther. 2010 Feb;40(2):103-11. doi: 10.2519/jospt.2010.3108. |
| D009422 | Nervous System Diseases |
| D009408 | Nerve Compression Syndromes |
| D009437 | Neuralgia |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D017699 | Pelvic Pain |