Comparative Effects of Post-Isometric Relaxation and Reciprocal Inhibition Techniques inPiriformis Syndrome

Comparative Effects of Post-Isometric Relaxation and Reciprocal Inhibition Muscle Energy Techniques on Pain, ROM and Function in Piriformis Syndrome

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Piriformis Syndrome
• Intervention / Treatment: Other: Post isometrics Relaxation Techniques (PIR); Other: Reciprocal Inhibition Technique

Detailed Description

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

• Study Type: Interventional
• Enrollment (Estimated): 42
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad; Phone Number: 03324390125; Email: Imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Ghurki Hospital Lahore
      • Contact: Hira Shaukat, TDPT; Phone Number: 03360405480; Email: hira.shaukat@riphah.edu.pk
      • Principal Investigator: Hafiza Mahnoor Anwar, MSOMPT

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

- Piriformis syndrome clinically confirmed via special tests (e.g., FAIR test, Freiberg sign, Pace test)

• Both gender male and female.
• Age between 25 and 40 years.
• Presence of antalgic gait due to pain.
• Moderate to severe pain (e.g., NPRS score ≥ 4)
• Voluntary consent to participate in the study.
• Medically stable, no acute or unstable medical conditions that would interfere with participation.

Exclusion Criteria:

• Lumber disc herniation or radiculopathy confirmed by imaging or neurological signs

  • History of hip or pelvis surgery.
  • Other neuromuscular or musculoskeletal disorders e.g., stroke, multiple sclerosis, or rheumatoid arthritis
  • Recent lower limb fracture or injury within the last 6 months.
  • Pregnancy due to potential risks and altered biomechanics.
  • Inability to follow instruction
  • Ongoing physiotherapy or alternative treatments

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: Post isometrics Relaxation Techniques (PIR); 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.	Other: Post isometrics Relaxation Techniques (PIR); 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.
Active Comparator: Reciprocal Inhibition Technique; This group will receive Hot Pack and TENS (for 15 minutes) and Sonics (for 5 minutes) Followed by METs.	Other: Reciprocal Inhibition Technique; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Hira Shaukat, Mphill, 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.
• 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.
• 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).
• 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.

Study record dates

Study Major Dates

• Study Start (Estimated): June 17, 2026
• Primary Completion (Estimated): October 10, 2026
• Study Completion (Estimated): November 20, 2026

Study Registration Dates

• First Submitted: June 8, 2026
• First Submitted That Met QC Criteria: June 8, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Pain; Disability; Manual Therapy; Piriformis
• 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: REC/RCR&AHS/25/0120

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