Comparative effectiveness of muscle energy technique and positional release technique on hip pain, range of motion and function in piriformis syndrome

Introduction

Piriformis syndrome is a painful musculoskeletal condition characterized by buttock or hip pain, often leading to chronic discomfort, restricted hip mobility, and functional limitations.

It can significantly affect daily activities and impose a socioeconomic burden. Manual therapy techniques such as Muscle Energy Technique (MET) and Positional Release Technique (PRT) are frequently used in its management. MET aims to improve muscle length and joint mobility through controlled contractions, whereas PRT reduces muscle spasm by positioning the muscle in a shortened, pain-free state.

Review of Literature-Previous studies have demonstrated positive effects of both techniques on pain, hip range of motion (ROM), and function in piriformis syndrome; however, there is no consensus on which is more effective. Limited comparative research exists, creating a gap in evidence-based practice.

This study aims to compare the effectiveness of MET and PRT on pain, hip internal rotation ROM, and functional ability in individuals with piriformis syndrome.

Objectives and Hypothesis

• Primary Objectives:

To compare the effectiveness of Muscle Energy Technique (MET) and Positional Release Technique (PRT) on pain, hip internal rotation and function in piriformis syndrome.

• Null hypothesis: There is no significant difference in the effectiveness of MET and PRT on pain (VAS), improving hip internal rotation (Universal Goniometer) and in enhancing function (LEFS) in individuals with piriformis syndrome.

• Alternate hypothesis: There is significant difference in the effectiveness of MET and PRT on pain (VAS), improving hip internal rotation (Universal Goniometer) and function in piriformis syndrome.

Materials and Methods

a. Study Design: Randomized Controlled Trial

b. Sample size and method

Sample Size: 22 participants (11 in each group)

Method of Calculation: Based on previous study (Velappanchavadi, 2019) taking VAS (Visual Analog Scale) as the primary outcome, with:

Effect size = 1.11

Alpha = 0.05

Power = 0.80

c. Enrolment period: approximately 5–6 months after RRC and IEC approval

d. Total Study duration: approximately 6 months

e. Inclusion and exclusion criteria:  Participants aged 18–50 years diagnosed with piriformis syndrome with unilateral buttock pain more than or equal to 4 cm on VAS for at least 1 month will be included. Exclusion criteria include spinal pathologies, prior spine/lower limb surgery, neurological disorders, pregnancy, and positive SLR.

f. Study Procedure: After RRC and IEC clearance, participants fulfilling inclusion criteria were enrolled after informed consent. They were randomly allocated into two groups using random allocation software. Baseline assessment of pain (VAS), hip internal rotation (Universal Goniometer), and function (LEFS) was done.

Group A: MET and  Conventional Physiotherapy

Group B: PRT and  Conventional Physiotherapy

Both groups received 6 sessions per week for 2 weeks. Post-intervention assessments were taken at the end of week 1 and week 2 using the same outcome measures. Data collection lasted 5–6 months and analysis will be  performed using SPSS v21.

g. Assessment tools:

Pain is assesses by Visual Analog Scale (VAS)

Hip Internal Rotation Range of Motion assess by  Universal Goniometer

Function assesses by  Lower Extremity Functional Scale (LEFS)

Statistical Analysis Plan (SAP)

Data will be analyzed using SPSS v21.0 with a significance level of  0.05 and power of 0.80 . Descriptive statistics will summarize data as mean and standard deviation or median (IQR) for continuous variables and frequencies for categorical variables. Normality will be tested using the Shapiro–Wilk test. For normal data, between-group changes will be analyzed using Mixed-Model ANOVA and within-group changes using Repeated Measures ANOVA; for non-normal data, the Friedman and Wilcoxon signed-rank tests will be used. Effect sizes, p-values, and 95 percentage confidence intervals will be reported, with missing data handled appropriately.