Graston vs Manual Myofascial Release Technique in Piriformis Syndrome.

Study Overview
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Brief Summary
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The objective of our study is to compare the effects of Graston and manual myofascial release technique on pain, muscle length and functional status in patients with Piriformis syndrome.

Detailed Description
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In 2019, a study was conducted to conclude the effectiveness of Passive stretching v/s Myofascial release in improving Piriformis flexibility in females. They reported that myofascial release was more valuable than passive stretching exercises in enhancing piriformis flexibility in patients with piriformis tightness. According to another study in 2018, after a single treatment, compressive myofascial release showed more improvement in ankle dorsiflexion than Graston technique, in participants with decrease dorsiflexion range. In 2016, a study reported the effects of the Graston technique and general exercise in patients with chronic low back pain. Graston group showed greater improvement in pain and range of motion in patients with chronic low back pain. According to a study conducted in 2014, self-myofascial release was more effective than Graston technique in improving knee joint flexibility, hamstring, and quadriceps strength. In 2011, a study evaluated the effectiveness of deep soft tissue mobilization techniques and stretching exercises in piriformis syndrome and found that the deep soft tissue mobilization techniques along with stretching exercises significantly improved the piriformis syndrome.

Official Title
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Comparison of Graston and Manual Myofacial Release Technique in Patients With Piriformis Syndrome.

Conditions
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Piriformis Syndrome

Intervention / Treatment
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* Other: Graston
* Other: Manual myofascial release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria:• Pain more than 1 month. Piriformis syndrome diagnosed through screening test (FAIR test, Beatty test, Freiberg test, Sign of Pace) Exclusion Criteria: Leg pain due to causes other than piriformis syndrome. Congenital spinal deformity. History of fracture. History of back or hip surgery. Any systemic illness like metastatic or infective disorders.

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

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: Both groups were treated simultaneously with their specified treatment techniques within given duration.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Graston<br>Ultrasound, Graston technique, piriformis stretching, home plan (hip abductor and extensor strengthening) | Other: Graston<br>* Ultrasound for 10 mins/1 set/ (3 sessions/week), Graston for 5 mins/1 set/ (3 sessions/week), Piriformis stretching exercises/ 10 reps with 30 sec hold/ 1 set/(3 sessions/week), Hip abductor strengthening/10 reps/1 set/(3 weeks), Hip extensor strengthening/10 reps/1 set/(3 weeks), A total of 9 sessions for 3 weeks (3 sessions/week) were given each consisting of 20 mins.<br>|
| Active Comparator: Manual myofascial release<br>Ultrasound, Manual myofascial release, piriformis stretching, home plan (hip abductor and extensor strengthening) | Other: Manual myofascial release<br>* Ultrasound for 10 mins/1 set/ (3 sessions/week), Manual myofascial release for 5 mins/1 set/ (3 sessions/week), Piriformis stretching exercises/ 10 reps with 30 sec hold/ 1 set/(3 sessions/week), Hip abductor strengthening/10 reps/1 set/(3 weeks), Hip extensor strengthening/10 reps/1 set/(3 weeks), A total of 9 sessions for 3 weeks (3 sessions/week) were given each consisting of 20 mins.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale | Changes from baseline and after 1st session, Numeric pain rating scale is a scale from 0 to 10. 0 indicating no pain and 10 indicating worse pain. | 9th day | 
| Piriformis muscle length | Changes from baseline and after 1st session, in prone lying range of internal rotation is measured for piriformis muscle length | 9th day | 
| Lower extremity functional scale | Changes from baseline and after 1st session, lower extremity functional scale is used to measure the functional status of patients with piriformis syndrome. | 9th day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Straight leg raise | Changes from baseline and after 1st session, goniometer is used to measure the straight leg raise range. | 9th day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Graston technique, Myofascial release, Lower extremity functional scale, Piriformis syndrome