Strain-Counterstrain Treatment of Piriformis Pain

Study Overview
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Brief Summary
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The purpose of this investigator-initiated study is to provide an efficient and non-invasive treatment option for pain caused by the piriformis muscle.

Detailed Description
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There are two arms to the study: treatment and sham. The treatment group will receive strain-counterstrain for the piriformis muscle. The sham group will receive strain-counterstrain treatment for the hamstring muscle. There will be two treatments, 1-2 weeks apart ideally. Participants will fill out the Oswestry Disability Index Questionnaire before the first treatment and after the second treatment (which is 1-2 weeks after the first treatment). Participants will also identify pain using the Visual Analog Scale (VAS) before and after each treatment. Participants will identify pain at rest prior to treatment using VAS. Participant will then identify pain at the start of treatment while pressure is applied to the piriformis muscle (4.5kg/cm2) and post treatment while pressure is applied to the piriformis muscle (4.5 kg/cm2). An algometer will be used pre and post each treatment (2 treatments that are 1-2 weeks apart) to objectively measure any change in pain pressure threshold.

Official Title
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Strain-Counterstrain Treatment of Piriformis Pain

Conditions
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Low Back Pain, Mechanical, Piriformis Syndrome, Somatic Dysfunction of Sacral Region (Finding)

Intervention / Treatment
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* Other: Strain-Counterstrain treatment of piriformis muscle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 to 65 years of age Tender point (or trigger point) in piriformis muscle determined by physical exam Exclusion criteria: Less than 45 degrees of active hip flexion, less than 5 degrees of active hip internal rotation or less than 30 degrees of active hip external rotation, on side of affected piriformis Unable to lay prone Non-English speaker Inability to attend 2 sessions within the same month Active cancer Pregnant Diagnosis of lumbar radiculopathy Greater than grade 1 lumbar spondylolisthesis Presence of lumbar region Pars Defect Receiving massage, acupuncture, chiropractic treatments, osteopathic treatments during study period.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There are two arms to the study: treatment and sham. The treatment group will receive strain-counterstrain for the piriformis muscle. The sham group will receive strain-counterstrain treatment for the hamstring muscle.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Piriformis Strain-Counterstrain<br>The treatment group will receive strain-counterstrain for the piriformis muscle. | Other: Strain-Counterstrain treatment of piriformis muscle<br>* Participant will lay prone on table with affected leg close to edge of table. Piriformis muscle tender point is identified and palpated. Then patient leg is passively moved off table and passive hip flexion, abduction, and possible internal/external rotation is added to reduce tender point by 70% or more. This is done passively. This position is held for 90 seconds and then participant is passively returned back to neutral prone position with leg on table. Tender point is palpated again to reassess for change in pain (using subjective visual analog scale). An algometer is also used pre and post to assess objective change in pressure pain threshold.<br>|
| Sham Comparator: Hamstring Strain-Counterstrain<br>The sham group will receive strain-counterstrain treatment for the hamstring muscle. | Other: Strain-Counterstrain treatment of piriformis muscle<br>* Participant will lay prone on table with affected leg close to edge of table. Piriformis muscle tender point is identified and palpated. Then patient leg is passively moved off table and passive hip flexion, abduction, and possible internal/external rotation is added to reduce tender point by 70% or more. This is done passively. This position is held for 90 seconds and then participant is passively returned back to neutral prone position with leg on table. Tender point is palpated again to reassess for change in pain (using subjective visual analog scale). An algometer is also used pre and post to assess objective change in pressure pain threshold.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Algometer - Change in pressure pain threshold | Objective improvement in pressure/pain threshold | Pre and post each treatment. There are 2 treatments, 1-2 weeks apart from one another. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Visual Analog Scale | Subjective improvement in low back/leg pain | Pre and post each treatment. There are 2 treatments, 1-2 weeks apart from one another. | 
| Change in Oswestry Disability Index | Assesses pain with doing different activities (sleeping, walking, sitting, etc), assesses ability to do activities of daily living | Before first treatment and after second treatment. Each treatment is 1-2 weeks apart (anticipated). |