Comparison Of INIT Versus NMR in Patients With Deep Gluteal Syndrome

Comparison Of Integrated Neuromuscular Inhibition Technique Versus Neuromuscular Reeducation in Patients With Deep Gluteal Syndrome

Rationale of this research is to evaluate the outcome of Comparison of Integrated Neuromuscular Inhibition technique versus Neuromuscular reeducation on pain in patients with Deep Gluteal Syndrome. The significance of this study is to identify which technique is superior in alleviating the symptoms of deep gluteal syndrome. This study will help gather evidence on the practice of incorporating trigger point therapy in the treatment of deep gluteal syndrome.

Study Overview

• Status: Completed
• Conditions: Deep Gluteal Syndrome
• Intervention / Treatment: Other: Integrated Neuromuscular Inhibition Technique; Other: Neuromuscular Reeducation Technique

Detailed Description

Deep gluteal syndrome is a common buttock and posterior hip pain caused by entrapment of the sciatic nerve in the posterior hip region. Nonoperative therapy involves treating the entrapment location, using rest, anti-inflammatories, musclerelaxants, and physical therapy to relieve compression. The purpose of the study was to evaluate the effects of Integrated Neuromuscular Inhibition Technique versus Neuromuscular Reeducation Technique on pain in subject with deep gluteal syndrome. It was a randomized, controlled trial, conducted among deep gluteal syndrome patients. Sample size was 54 by using G Power Tool software. Participantswere randomly assigned to the intervention or control group after a baseline assessment with a lottery ticket and an opaque envelope. All participants in both groups were evaluated on baseline and 12 th Session.

• Study Type: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Islamabad, Punjab, Pakistan, 44000
      • Gulberg green campus of Riphah International University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Both genders Age: 30-50 years Pain due to a non-discogenic sciatic nerve entrapment in the sub gluteal space Pain, tightness and dysesthesias in the buttock area, posterior thigh Buttock pain aggravated with prolong sitting (>20-30 min) Buttock pain aggravated when sitting with limited straight leg raising ability (seated piriformis test) Pain with the passive internal rotation of hip (Freiberg sign) Pain increase in Flexion, Adduction and internal rotation (Positive FAIR test)

Exclusion Criteria:

• Patient with any Intrinsic Etiology such as hemarthrosis, rheumatoid arthritis, infection or gout Patient with any severe trauma, fractures dislocation, subluxation or ligament injury Any pathology or recent injury around the hip, sacroiliac joint, or lumbar spine Limb length discrepancy Recent buttock trauma and bladder/bowel dysfunction

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Integrated Neuromuscular Inhibition Technique; Individuals in Group A, After palpating the trigger point ischemic compression were applied for 20-60 sec while strain counterstain for 60-90 sec and MET is for 7-10 sec. This technique was repeat 3-4 time per session Conventional treatment include Hot Pack for 5mins, AROM exercises ,Home plans include stretching exercise of glutes,hamstring and calf (5-7 reps x 10 sec hold, each).	Other: Integrated Neuromuscular Inhibition Technique; After palpating the trigger point ischemic compression were applied for 20-60 sec while strain Counterstain for 60-90 sec and MET is for 7-10 sec.
Active Comparator: Neuromuscular Reeducation Technique; Deep pressure were applied along origin and insertion of Piriformis and hamstring muscle combined with active movement of patient for 5 -15 time as per required (depend upon thickness of scar) per session, 10 sec rest b/w pressure. This technique given 5 time per session. Conventional treatment include Hot Pack for 5mins, AROM exercises ,Home plans include stretching exercise of glutes,hamstring and calf (5-7 reps x 10 sec hold, each).	Other: Neuromuscular Reeducation Technique; Deep pressure were applied along origin and insertion of Piriformis and hamstring muscle combined with active movement of patient for 5 -15 time as per required

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NPRS	Numeric Pain Rate Scale used to assess pain intensity	4th week
Goniometer	used to assess lower limb ranges	4th week
Lower Extremity Functional scale	LEFS questionnaire have 20 questions will assess the impairment of a patient with lower extremity musculoskeletal condition or disorders	4th week
Sciatica Bothersomeness Index	used to measure the participants' level of sciatica. The scale's ratings range from 0 to 24, with higher levels indicating severe sciatica discomfort.	4th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Ramsha Tariq, MS-OMPT, Riphah International University

Publications and helpful links

General Publications

• 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.
• Aguilera-Bohorquez B, Cardozo O, Brugiatti M, Cantor E, Valdivia N. Endoscopic treatment of sciatic nerve entrapment in deep gluteal syndrome: Clinical results. Rev Esp Cir Ortop Traumatol (Engl Ed). 2018 Sep-Oct;62(5):322-327. doi: 10.1016/j.recot.2018.03.004. Epub 2018 May 26. English, Spanish.
• Frank RM, Slabaugh MA, Grumet RC, Virkus WW, Bush-Joseph CA, Nho SJ. Posterior hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010 May;2(3):237-46. doi: 10.1177/1941738110366000.

Study record dates

Study Major Dates

• Study Start (Actual): April 10, 2023
• Primary Completion (Actual): November 15, 2023
• Study Completion (Actual): November 15, 2023

Study Registration Dates

• First Submitted: December 26, 2023
• First Submitted That Met QC Criteria: December 26, 2023
• First Posted (Actual): January 9, 2024

Study Record Updates

• Last Update Posted (Actual): January 9, 2024
• Last Update Submitted That Met QC Criteria: December 26, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: NMR; Trigger point; INIT; Deep Gluteal Syndrome
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Pain; Neurologic Manifestations; Disease; Neuromuscular Diseases; Sciatic Neuropathy; Mononeuropathies; Peripheral Nervous System Diseases; Neuralgia; Nerve Compression Syndromes; Pelvic Pain; Syndrome; Sciatica; Piriformis Muscle Syndrome
• Other Study ID Numbers: RCRAHS-ISB/REC/MS-PT/01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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