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EFFECTIVENESS OF DEEP FRICTION MASSAGE & STRETCHING EXERCISES IN

PIRIFORMIS SYNDROME

Article · July 2011

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Waqar Awan Muhammad Naveed Babur

Riphah International University Isra University, Pakistan
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 January-June 2012 International Journal of Rehabilitation Sciences (IJRS) Volume I, Issue I

THE EFFECTIVENESS OF
Introduction
ELECTROTHERAPY WITH MANUAL
Most of the time in sports medicine regular stretching
THERAPY IN THE TREATMENT OF and manual therapy, like techniques of soft tissue
PIRIFORMIS SYNDROME mobilization approaches, tell a greater decrease and
Authors; Waqar Ahmed Awan, Muhammad Naveed elimination of piriformis syndrome.1,2,7 The greatest
Babur, Shaukat Ali, Usman Janjua success occurs when the client commit to a daily home
stretching protocol.3,4 Before stretching the piriformis
Abstract muscle it is important to mobilize the capsule and
Objective: To compare the effectiveness of surrounding muscles of the hip joint to gain effective
electrotherapy with manual therapy in the treatment of stretching of the piriformis muscle.5,6 The two MT
piriformis syndrome. techniques most commonly reported for the
Methods: In this study which was conducted at management of piriformis syndrome are counter-strain
Physical therapy department of Family Health and facilitated positional release. Both techniques are
Hospital Islamabad, National Institute of helpful to reduce the tension from the piriformis
Rehabilitation Medicine Islamabad and DHQ muscle to a great extend.11,12 In an acute exaggeration
Hospital Mansehra for a period of two years, 50 of symptoms, the client must stretch every two to three
patients with piriformis syndrome were divided into hours in a day. This will help in learning to return to a
two groups; a Control group which underwent relaxed state. After symptoms subside, it is necessary
electrotherapy treatment (Ultra sonic Therapy -US, to continue the stretching exercises to reduce the
Short wave Diathermy-SWD & Transcutaneous return of habitual patterns that may have created this
Electrical nerve Stimulation-TENS) and Experimental syndrome 4,8,9,17
. There is also a lack of objective
group which underwent Manual Therapy treatment clinical trial due to which no consensus is found about
(Soft Tissue & Joint Mobilization Techniques and the overall treatment of piriformis syndrome. But
stretching exercises). Both groups had regular mostly manual therapy techniques and stretching are
physical therapy sessions for 3 weeks; all participants considered to be effective treatments.14,15,18
were taught and practiced home care plan. The
progress of the patients was measured on modified Subjects and Methods
Oswestry scale, based on the subjective evaluation of The study was conducted at Physical Therapy
the patients in their activities of daily life. Department of National Institute of rehabilitation

Results; Total disability post-test scores were lower in Medicine Islamabad, Family Health Hospital

experimental group than control group. Islamabad and District Headquarter Hospital

Conclusion; Soft tissue and Joint mobilization Mansehra for a period of two years. Fifty subjects with

Techniques along with stretching exercises are of better piriformis syndrome were participated in the study and

choice when compared with electrotherapy treatment were divided randomly in two groups; a control group

in patients with pain due to piriformis syndrome. which underwent Electrotherapy (Ultra sonic Therapy

Key words; Pocket sciatica, Piriformis syndrome, Ultra -US, Short wave Diathermy-SWD & Transcutaneous

sonoic Therapy, Cross Fiber Friction, Positional Release Electrical nerve Stimulation-TENS) and an

Therapy and TENS experimental group which underwent Manual

16
 January-June 2012 International Journal of Rehabilitation Sciences (IJRS) Volume I, Issue I

Therapy management (Soft Tissue & Joint groups. In particular, the strengthening of the adductor
Mobilization Techniques) and stretching exercises. muscles of the hip has been shown to be beneficial for
Both groups had MRI to rule out lumbosacral patients with piriformis syndrome.22 Application of
involvement in the radiating pain to the leg. All deep transverse friction at tenoperiostial junctions is
subjects were taught about the awareness of habitual helpful and should be focused on softening and
pattern which may precipitate the symptoms of relaxing the piriformis and the other deep lateral
piriformis syndrome. rotators, as well as the gluteal muscles. 23
The progress was measured with modified
Oswestry scale (Appendix). To check the
difference between means of the total disability
score of the two groups, student t-test was used. A
P<0.05 was considered to be statistically
significant. SPSS 17 was used for data analysis.

Results
Total disability score at the start of the study and
post test total disability score in experimental and
control group are shown in figures 1, 2 and 3
respectively. Total disability post-test scores were
lower in experimental group than control group
(p=0.000007).

Discussion
Most of the time in sports medicine regular stretching
and manual therapy, like soft tissue mobilization
approaches, tell a greater decrease and elimination of
piriformis syndrome.18,19 Heat or cold therapy is
usually most effectively applied before the physical
therapy or home therapy sessions because it may
decrease the discomfort associated with direct
treatment applied to an irritated or tense piriformis
muscle.20, 21
Deep friction massage is also helpful for release of
piriformis muscle with passive internal rotation of
hip22. The ultimate goal of physical therapy is
symptom elimination through a systematic program
designed to increase the relaxation by mobilization of
surrounding muscle groups and joints, as well as to
increase the supporting strength of these muscle

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January-June 2012 International Journal of Rehabilitation Sciences (IJRS) Volume I, Issue I

11. Benzon HT, Katz JA, Benzon HA, Iqbal MS.

Conclusion
Piriformis syndrome: anatomic considerations, a
The Soft Tissue and Joint Mobilization techniques
new injection technique, and a review of the
along with stretching exercises provided
literature.Anesthesiology.2003
significantly better results as compared with
12. DiGiovanna EL, Schiowitz S, Dowling DJ, eds.
Electrotherapy management in the patients
An Osteopathic Approach to Diagnosis and
with Piriformis Syndrom. They were safe and
Treatment. 3rd ed. Philadelphia, Pa: Lippincott
easy to perform.
Williams & Wilkins; 2005
Reference 13. Prather H. Sacroiliac joint pain: practical
1. Gary’s Anatomy, The Anatomical Basis of management. Clin J Sport Med.2003; 21
Clinical Practice, 40th edition 2008. 14. Chaitow L. Soft Tissue Manipulation: A
2. Whitney Lowe, LMT, Treating Piriformis Practitioner's Guide to the Diagnosis and
Syndrome, Massage Today March, 2008, Vol. Treatment of Soft-Tissue Dysfunction and
08, Issue 03 Reflex Activity. 3rd ed. 1988
3. Dawson D, Hallett M, Wilbourn A. Entrapment 15. Peggi Honig, Treatment Of Piriformis
Neuropathies, 3rd ed. Philadelphia: Lippincott- Syndrome, Appling Modalities of Therapeutic
Raven, 1999. Bodywork. Massage Manual. 2002
4. Travell J, Simons D. Myofascial Pain and 16. Schultz, Louis B., Feitis, Rosemary: The Endless
Dysfunction: The Trigger Point Manual, Volume Web/Fascial Anatomy and Physical Reality.
2. Baltimore: Williams & Wilkins, 1992 North Atlantic Books 1996,
5. Klein, Milton J. Piriformis syndrome. eMedicine. 17. Douglas, Sara, Sciatic pain and piriformis
Nov 6, 2008. 14:2. syndrome.. Vol. 22, The Nurse Practitioner, 05-
6. New injection technique. Anesthesiology. 2003 01-1997, pp 166(6).
Jun; 98 (6): 1442-8. PMID: 12766656. 18. Hallin RP. Sciatic pain and the piriformis
7. Benson ER, Schutzer SF. Posttraumatic muscle. Postgrad Med 1983; 74:69-72.
piriformis syndrome: diagnosis and results of 19. Lori A. Boyajian-O’Neill, Rance L. McClain,
operative treatment. J Bone Joint Surg (U.S.), Michele K. Coleman and Pamela P. Thomas,
1999 Diagnosis and Management of Piriformis
8. 8. Magee D. Orthopedic Physical Assessment, Syndrome: An Osteopathic Approach,
3rd ed. Philadelphia: W.B. Saunders, 1997. JAOA,108, November 2008 , 659-661
9. Wu, Q. Triple puncture with the bai hu yao tou 20. Beatty RA. The piriformis muscle syndrome: a
maneuver. J Tradit Chin Med. 2003. Sep: 23(3): simple diagnostic maneuver. Neurosurgery.
197-8. PMID: 14535185. 1994; 34:512-514.
10. Fishman LM, Anderson C, Rosner B. BOTOX 21. Fishman LM, Schaefer MP. The piriformis
and physical therapy in the treatment of syndrome is under diagnosed. Muscle Nerve.
piriformis syndrome. Am J Phys Med Rehabil. 2003;28:646-649.
2002

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 January-June 2012 International Journal of Rehabilitation Sciences (IJRS) Volume I, Issue I

22. Fishman LM, Dombi GW, Michaelsen C, Ringel

S, Rozbruch J, Rosner B, et al. Piriformis
syndrome: diagnosis, treatment, and outcome—a
10-year study [review]. Arch Phys Med Rehabil.
2002; 83:295-301.
23. Arthur Hulbert, PT, DPT, and Gail D. Deyle PT,
PhD. Differential Diagnosis and Conservative
Treatment for Piriformis Syndrome: A Review
of the Literature. In Current Orthopaedic
Practice. May/June 2009. Vol. 20. No. 3. Pp.
313-319.

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