Comparison of Active Release Technique and Post Isometric Relaxation in Patients With Piriformis Syndrome
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Visual Analogue Scale
研究概览
简要总结
The purpose of the study is to compare the effects of active release technique and post isometric relaxation in patients with piriformis syndrome on pain, hip internal rotation range of motion and functional disability. A randomized clinical trial was conducted at Shifa Intl. Hospital, Islamabad. The sample size was 26 calculated through open-epi tool but were recruited 30. The participants were divided into two interventional groups each having 15 participants. The study duration was six months. Sampling technique applied was purposive sampling for recruitment and group randomization using sealed envelope method. Only 35 to 55 years participants with diagnosed piriformis syndrome were included in this study. Tools used in this study are Goniometer, Visual Analogue Scale and lower extremity functional scale. Data was collected at baseline, 3 weeks after sessions and after one month follow up. Data was analyzed through SPSS version 20.
详细描述
Piriformis syndrome is caused by prolonged or excessive contraction of the piriformis muscle. Because of the close proximity to the sciatic nerve, piriformis syndrome is associated with pain in the buttocks, hips, and lower limbs. Yeoman was the first to describe pain in the sciatic distribution to piriformis syndrome. Many synonyms for the condition are used in the literature, such as ''deep gluteal syndrome'' and ''pelvic outlet syndrome''. It has been suggested that piriformis syndrome is responsible for 5-6% of cases of sciatica. In the majority of cases, piriformis syndrome occurs in middle-aged patients (mean age 38 year). The ratio of female to male patients with piriformis syndrome has been reported as 6:1.
Three specific conditions may contribute to piriformis syndrome:
- myofascial referred pain from trigger points in the piriformis muscle
- adjacent muscles, nerve and vascular entrapment by the piriformis muscle at the greater sciatic foramen
- dysfunction of the sacroiliac joint. Myofascial pain syndrome in the piriformis muscle is well recognized. Gluteal pain is reported to be observed in 97.9% of cases, pain (and paresthesias) in the back, groin, perineum, buttocks, hip, back of the thigh (81.9%),calf (59%),foot, in the rectum (during defecation), and in the area of the coccyx. Low back pain is reported to be observed in 18.1% of cases. Intense pain will occur when the patient sits or squats. Nevertheless, true neurologic findings are not usually present in piriformis syndrome and sensory deficits may be completely absent.
There is no gold standard in diagnosing piriformis syndrome. The physical examination may reveal several of the following well-described signs:
- The piriformis sign, (which presents as tonic external rotation of the affected lower extremity) is reported to be observed in 38.5% of the patients.
- Freiberg's sign involves pain on passive forced internal rotation of the hip in the supine position, thought to result from passive stretching of the piriformis muscle and pressure on the sciatic nerve at the sacrospinous ligament. This test is positive in 56.2% of the patients.
- Pace's sign consists of pain and weakness on resisted abduction and external rotation of the thigh in a sitting position . A positive test is reported to occur in 46.5% of the patient.
- Lasegue's sign involves pain on the affected side on voluntary adduction, flexion, and internal rotation.
- Beatty's maneuver is an active test that involves elevation of the flexed leg on the painful side while the patient lies on the asymptomatic side. Abducting the thigh to raise the knee off the table elicits deep buttock pain in patients with piriformis muscle but back and leg pain in those with lumbar disk disease.
- The Hughes Test (external isometric rotation of the affected lower extremity following maximal internal rotation) may also be positive in piriformis syndrome.
- Gluteal atrophy may be present.Sacroiliac tenderness is reported to be observed in 38.5% of the patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 35 Years 至 55 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Chronic pain in the buttock and hip area
- •Tenderness to palpation over the sciatic notch
- •Positive FABER (flexion, abduction, external rotation),FAIR (flexion, adduction, internal rotation) maneuvers.
排除标准
- •Malignancies
- •History of steroid therapy
- •Rheumatoid arthritis/ Osteoarthritis
- •Pain medications/ muscle relaxants
- •Osteoporosis
- •Fracture of femur and hip joint dislocation
研究组 & 干预措施
Active release technique alongwith conventional treatment
Patients in Group A will receive active release technique. ART will be applied with patient in prone lying, knee flexed at 90. The therapist will place his elbow tip on taut band of piriformis and direct pressure is applied, patient is then asked to do internal rotation of hip, in order to achieve lengthening of the muscle. This will be repeated 5-7 times(22).
干预措施: Active release technique alongwith conventional treatment (Other)
Post isometric relaxation alongwith conventional treatment
Patients in group B will receive post isometric relaxation technique. Patient lying in supine position, with the treated leg is placed into flexion at the hip and knee, so that the foot rests on the table lateral to the contra lateral knee (the leg on the side to be treated is crossed over the other). Therapist places one hand on the contra lateral ASIS to prevent pelvic motion, while the other hand is placed against the lateral flexed knee as this is pushed into resisted abduction to contract piriformis (PIR MET). The starting position will be the 1st sign of resistance towards end range. Therapist Force will be same as patient's force. Initial effort is approximately 20% of patient's strength. Duration of contraction is 7-10 seconds with three repetitions(32)
干预措施: Post isometric relaxation (Other)
结局指标
主要结局
Visual Analogue Scale
时间窗: 6 months
It is used to measure the intensity or frequency of pain. It ranges on a scale from 0 to 10.
Goniometer
时间窗: 6 months
Goniometer is an efficient tool to measure hip range of motion. It measures an angle from 0 to 180.
Lower Extremity Functional Scale
时间窗: 6 months
It is a questionnaire containing 20 questions about a persons ability to perform everyday tasks. It minimum score is 0 and maximum score is 80
次要结局
未报告次要终点