Additional Effects of Piriformis Stretch in the Management of Sacroiliac Joint Dysfunction

Sacroiliac joint (SIJ) dysfunction is known as an important contributing factor in lower back pain. Pain and stiffness experienced from the sacroiliac joint in the SI region (hips/groins or may spread to lower extremity) is referred as SIJ dysfunction.Physiotherapists have a wide range of options in managing SIJD including Manipulation, Kinesiotaping, Muscle Energy Technique (MET), McKenzie, Maitland's mobilization, and Mulligan's mobilization. So far studies have shown the efficacy of different treatment tools in combination or in isolation. Likewise, researchers have also studied the effect of piriformis stretch in combination with other exercises on sacroiliac joint pain. However, there is very limited literature available on the cumulative effect of piriformis stretch along with mobilization maneuvers on pain and disability in patient with SIJ dysfunction.Since piriformis is one of the most important muscles involved in stabilization of SI joint and a major source of SI dysfunction, hence the current study is designed to investigate the additional effects of piriformis stretch with manual therapy in the management of sacroiliac joint dysfunction.

Study Overview

• Status: Recruiting
• Conditions: Sacroiliac Joint
• Intervention / Treatment: Procedure: Maitland mobilization; Procedure: Electrotherapy; Procedure: Piriformis stretch

Detailed Description

SIJ dysfunction is a prominent source of pain in low back pain patients. It is reported that 10-30% of individuals suffering from lower back pain is due to SIJ dysfunction.There are different risk factors for developing SIJ dysfunction including leg length discrepancies, a history of lumbar fusion, scoliosis, sustained athletic activity, pregnancy, spondyloarthropathies, or gait abnormalities.Muscles that are commonly found to be shortened (or tightened) in SIJ dysfunction include the rectus femoris, tensor fascia Lata, hip adductors, quadratus lumborum, piriformis, obturator internus, and latissimus dorsi. Particular attentions should be directed to the piriformis muscle. t alters the SIJ motion by rotating the sacrum to the opposite side.Continued inflexibility of this muscle is often thought to be part of the source of recurrent pain Over time several treatment aporaches have been developd to treat SIJ dysfunction.Clinicians also use different electrotherapy modalities, biomechanical correction techniques, and exercises for addressing SI joint pain. Many therapeutic exercises including piriformis stretch, muscle activation exercises and exercise therapy have the potential of improving sacroiliac joint dysfunction , however evidence is deficient. This research presents additional effects of piriformis stretch in the management of sacroiliac joint dysfunction.It will expand current understanding of effects of piriformis stretch on disability and pain in patients with SIJ dysfunction and help in providig treatment protocols for improving pain in patients with sacroiliac joint dysfunction.

Main objective of thi study is to determine and compare the effect of piriformis stretch along with mobilization as compared to SIJ mobilization alone on pain and disability in patients with SIJ dysfunction.

The participants meeting the eligibility citeria will be recruited, followed by random allocation to 2 groups. Both groups will recive standard treatment protocol which consists of Hot pack TENs, mobalization.Three sessions will be provided on alternative days. Pre and Post assessment of pain and disability will be noted

• Study Type: Interventional
• Enrollment (Estimated): 34
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anum Sadiq, DPT,MS-MSKPT*; Phone Number: +923095628050; Email: anumsadiq1995@gmail.com

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46000
      • Recruiting
      • Foundation University College of Physical Therapy
      • Contact: Zara Khalid, MS-CPPT,PHD*; Phone Number: +923335415822; Email: zara.khalid@fui.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults (both male and female) aged 18-45 years experiencing sacroiliac joint pain
• Patients fulfilling the diagnostic criteria, recommended by the International Association for the Study of Pain (IASP).(13)
• Those with > 4 score on Numeric pain rating scale for the sacroiliac pain
• Using no other pain killers or non steroidal anti-inflammatory drugs during the therapy

Exclusion Criteria:

• Individuals suffering from pain due to other conditions (low back pain, hip pathology, hip osteoarthritis, cognitive disorders, radicular pain, ankylosing spondylitis, coccydynia)
• Patients with piriformis syndrome.
• SIJ pain due to other causes such as fractures, tumors and trauma.
• Pregnant females
• Those patients who have received any surgical treatment for SIJ dysfunction

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A (Maitland mobalizations ); Patients in this group will receive Maitland mobilizations along with hot pack and TENS for pain and disability. A total of 3 sessions would be conducted over a period of 1 week.	Procedure: Maitland mobilization; Participants in this group will be first given hot pack and TENS for 10 min. Then they will be given Maitland Mobilizations (10 oscillations total of 3 sets )with 10 sec rest in between. Mobilization will be Unilateral or central based on the patient condition and Intensity of Mobilizations increases as per patient tolerance in 2nd and 3rd session.; Procedure: Electrotherapy; Hot pack and TENS for 10 min
Experimental: Group B (Maitland Moblizations along with piriformis stretch); Patients will receive Maitland mobilizations along with hot pack and TENs and additional stretch of piriformis muscle is given. A total of 3 sessions would be conducted over a period of 1 week.	Procedure: Maitland mobilization; Participants in this group will be first given hot pack and TENS for 10 min. Then they will be given Maitland Mobilizations (10 oscillations total of 3 sets )with 10 sec rest in between. Mobilization will be Unilateral or central based on the patient condition and Intensity of Mobilizations increases as per patient tolerance in 2nd and 3rd session.; Procedure: Electrotherapy; Hot pack and TENS for 10 min; Procedure: Piriformis stretch; Piriformis stretch will be given to this group. In first session piriformis stretch will be given for 10 sec with 10-second resting time in between with, 7 rep total of 1 set. For the 2nd and 3rd session repetitions will be increase to 8 and 10 respectively.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain will be measured using the Numeric Pain Rating Scale, which is an 11-item scale	1 week
Disability level of participant	Disability will be assessed using Oswestry low back disability Index. A higher score indicates more disability	1 week

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): August 30, 2023
• Primary Completion (Estimated): January 1, 2024
• Study Completion (Estimated): February 1, 2024

Study Registration Dates

• First Submitted: September 13, 2023
• First Submitted That Met QC Criteria: September 13, 2023
• First Posted (Actual): September 21, 2023

Study Record Updates

• Last Update Posted (Actual): September 21, 2023
• Last Update Submitted That Met QC Criteria: September 13, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases
• Other Study ID Numbers: FUI/CTR/2023/16

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No