Comparative Effects of Post Facilitation Stretch and Active Release Technique in Female Patients With Piriformis Syndrome.

Comparative Effects of Post Facilitation Stretch and Active Release Technique on Pain, Disability, Quality of Life and Range of Motion in Female Patients With Piriformis Syndrome.

This clinical study aimed to compare the effectiveness of Post-Facilitation Stretch (PFS) and Active Release Technique (ART) on pain, disability, quality of life, and range of motion of hip internal and external rotation in female patients with piriformis syndrome. After recruitment, participants were randomly allocated into two groups using the chit-box method, either in group A Post-Facilitation Stretch, and group B Active Release Technique. Clinical outcomes including pain, disability, quality of life, and hip range of motion (abduction and internal rotation) were assessed at baseline, during the third week of treatment, and at the sixth-week follow-up from the National Institute of Rehabilitation and Medicine (NIRM) Hospital.

Study Overview

• Status: Completed
• Conditions: Piriformis Syndrome
• Intervention / Treatment: Other: Post Facilitation Stretch; Other: Active Release Technique

Detailed Description

Background: Piriformis syndrome (PS) is a neuromuscular condition in which the piriformis muscle irritates the sciatic nerve, causing pain, numbness, and tingling in the buttock, hip, and posterior thigh, sometimes radiating to the low back or sacroiliac joint. Women are more commonly affected, comprising 35-79% of cases (Hopayian et al., 2010). Conservative physiotherapy interventions are effective in improving pain, function, and quality of life.

Literature / Rationale: Post-Facilitation Stretch (PFS) involves isometric contraction followed by stretching of the piriformis to enhance hip range of motion (ROM) and reduce pain. Active Release Technique (ART) targets soft tissue adhesions to improve mobility and function. Prior studies indicate benefits of these techniques individually, but direct comparisons in female patients are limited.

Methods: Forty female patients with PS at NIRM Islamabad were randomly allocated via chit-box into PFS and ART groups. Interventions were administered twice weekly for 3 weeks.

PFS: Supine, hip >60° flexion, slight adduction/external rotation; 10-sec isometric external rotation contraction + 30-sec relaxation; stretch into internal rotation/adduction 15 sec; repeat 5× per session(Shahzad et al., 2020).

ART: Targeted soft tissue release of the piriformis muscle.

Outcomes included pain (measured by NPRS), hip IR and abduction ROM (measured by goniometer), functional disability (measured by LEFS-U), and quality of life (measured by SF-36), assessed at baseline, week 3, and week 6.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan
    • Faculty of Allied Health & Biological Sciences

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• 25 to 45-year-old women.
• Clinically diagnosed with piriformis syndrome by Orthopaedic Surgeon.
• Unilateral pain.
• Sitting exacerbates buttock pain.
• External soreness in the vicinity of the greater sciatic notch.
• Positive findings on standard piriformis syndrome clinical tests (FAIR, Beatty, Freiberg, and Pace).
• Limited SLR ability

Exclusion Criteria:

• History of trauma and malignancies.
• Hip dislocation, osteoporosis, and femur fractures.
• Any postural abnormality, including disc pathology.
• Patients with neurological symptom, metabolic disease (RA) and diagnosed psychological problem.
• Pregnancy.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Post Facilitation Stretch; Following a 10-minute application of a moist hot pack, participants were positioned supine with the hip flexed beyond 60° and gentle resistance was applied to facilitate an isometric external rotation contraction. This was followed by a passive stretch held for 15 seconds, performed for 5 repetitions per session.	Other: Post Facilitation Stretch; Following a 10-minute application of a moist hot pack, participants were positioned supine with the hip flexed beyond 60° and gentle resistance was applied to facilitate an isometric external rotation contraction. This was followed by a passive stretch held for 15 seconds, performed for 5 repetitions per session.
Experimental: Active Release Technique; Following a 10-minute application of a moist hot pack, participants were positioned prone, and deep manual pressure was applied over the piriformis muscle for approximately 90 seconds while the patient actively moved the hip from internal to external rotation. This procedure was repeated for 10 repetitions per session.	Other: Active Release Technique; Following a 10-minute application of a moist hot pack, participants were positioned prone, and deep manual pressure was applied over the piriformis muscle for approximately 90 seconds while the patient actively moved the hip from internal to external rotation. This procedure was repeated for 10 repetitions per session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain was measured by Numerical Pain Rating Scale. On this scale, ten values range from 0 to 10, with 0 representing "no pain" and 10 representing "worst possible pain."	Assessment was done at baseline, 3rd week and 6th week
Disability	Disability was measured by the Urdu version of the Lower Extremity Functional Scale. It is a 20-item self-report questionnaire assessing functional difficulty in daily, work, and recreational activities for adults with lower limb musculoskeletal conditions. Ranging from 0 (extreme difficulty) to 80 (high function).	Assessment was done at baseline, 3rd week and 6th week
Quality of life of Patients	Quality of life was measured by the Short Form Health Survey (SF-36) questionnaire. The overall score goes from 0 to 100. Higher scores indicate a higher quality of life, while lower numbers indicate a lower quality of life.	Assessment was done at baseline, 3rd week and 6th week
Hip abduction and internal rotation range of motion	Hip abduction and internal rotation range of motion was measured by goniometer	Assessment was done at baseline, 3rd week and 6th week

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad
• Investigators: Principal Investigator: Muhammad Nazim Farooq, PhD-PT, Ibadat International University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Actual): December 15, 2025
• Study Completion (Actual): December 15, 2025

Study Registration Dates

• First Submitted: April 5, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Quality of Life; Pain; Female; Range of Motion; Disability; Piriformis Syndrome; Active Release Technique; Post-Facilitation Stretch
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Neuralgia; Pelvic Pain; Mononeuropathies; Nerve Compression Syndromes; Sciatic Neuropathy; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Piriformis Muscle Syndrome
• Other Study ID Numbers: IIUI/RERC/ADT/2025/04/74

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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