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Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional Study

Authors:
  • 1.46
  • National Institute For Locomotor Disabilities (Divyangjan)
  • 9.03
  • National Institute for Locomotor Disabilities (Divyangjan), Kolkata formerly NIOH
  • 2.57
  • GOODHAB Advanced Physiotherapy Centre
  • 2.06
  • National institute for locomotor disability,India ,kolkata

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Original Research Article Year: 2017 | Month: July | Volume: 7 | Issue: 7 | Pages: 134-142 Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional Study Malika Mondal1, Bibhuti Sarkar2, Sarfaraz Alam3, Shriya Das1, Komal Malik3, Pravin Kumar4, Pallavi Sahays5 1Professional Trainee, 2Demonstrator (PT), 3Senior Professional Trainee, 4Assistant Professor (PT), 5Physiotherapist, Department of Physiotherapy, National Institute for Locomotor Disabilities (Divynagjan), B.T. Road, Bonhoogly, Kolkata-700090, West Bengal, India. Corresponding Author: Malika Mondal ABSTRACT Background: Pain in the lower back region is a common concern, affecting up to 90% of population at some point in their lifetime, up to 50% have more than one episode. Prolonged sitting position is the foremost cause of piriformis tightness in sedentary population that may eventually leads to piriformis syndrome and low back pain. Therefore, the present study was designed to identify the prevalence of piriformis tightness in sedentary individuals. Methods: 200 subjects enrolled in this study were evaluated and screened on the basis of the inclusion and exclusion criteria. Tightness of piriformis muscle was assessed using piriformis stretch test and seated piriformis stretch clinical test. Results: Data was analyzed using SPSS version 23. Piriformis tightness was found to be present in 159 subjects (79.5%). Prevalence of piriformis tightness was highest in third decade. However the prevalence of piriformis tightness in males and females was statistically insignificant. Conclusion: In sedentary population the prevalence of piriformis tightness is very high and adult population has more chances to get affected with piriformis muscle tightness that can lead to development of piriformis syndrome and later on low back pain. Key words: Piriformis muscle tightness, piriformis syndrome, sedentary individuals, piriformis stretch test.
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International Journal of Health Sciences & Research (www.ijhsr.org) 134
Vol.7; Issue: 7; July 2017
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article
Prevalence of Piriformis Tightness in Healthy Sedentary Individuals:
A Cross-Sectional Study
Malika Mondal1, Bibhuti Sarkar2, Sarfaraz Alam3, Shriya Das1, Komal Malik3, Pravin Kumar4, Pallavi Sahay5
1Professional Trainee, 2Demonstrator (PT), 3Senior Professional Trainee, 4Assistant Professor (PT),
5Physiotherapist,
Department of Physiotherapy, National Institute for Locomotor Disabilities (Divynagjan), B.T. Road,
Bonhoogly, Kolkata-700090, West Bengal, India.
Corresponding Author: Malika Mondal
ABSTRACT
Background: Pain in the lower back region is a common concern, affecting up to 90% of population
at some point in their lifetime, up to 50% have more than one episode. Prolonged sitting position is
the foremost cause of piriformis tightness in sedentary population that may eventually leads to
piriformis syndrome and low back pain. Therefore, the present study was designed to identify the
prevalence of piriformis tightness in sedentary individuals.
Methods: 200 subjects enrolled in this study were evaluated and screened on the basis of the
inclusion and exclusion criteria. Tightness of piriformis muscle was assessed using piriformis stretch
test and seated piriformis stretch clinical test.
Results: Data was analyzed using SPSS version 23. Piriformis tightness was found to be present in
159 subjects (79.5%). Prevalence of piriformis tightness was highest in third decade. However the
prevalence of piriformis tightness in males and females was statistically insignificant.
Conclusion: In sedentary population the prevalence of piriformis tightness is very high and adult
population has more chances to get affected with piriformis muscle tightness that can lead to
development of piriformis syndrome and later on low back pain.
Key Words: Piriformis muscle tightness, piriformis syndrome, sedentary individuals, piriformis
stretch test.
INTRODUCTION
Low back pain (LBP) is the most
disabling condition worldwide and one of
the most common causes of LBP is
piriformis syndrome that results from
tightness of piriformis muscle. Reported
incidence rates for piriformis syndrome
among patients with low back pain vary
widely from 5% to 36%. [1] Piriformis
muscle originates from pelvic surface of the
sacrum between (and lateral to) the first
through fourth pelvic sacral foramina,
margin of the greater sciatic foramen and
pelvic surface of the sacrotuberous ligament
and inserted to the superior border of the
greater trochanter of the femur via a round
tendon that, in many individuals, is merged
with the tendons of the obturator internus
and gemelli muscles& it is supplied by
sciatic nerve. [2] The piriformis muscle acts
as an external rotator, weak abductor and
weak flexor of the hip, providing postural
stability during ambulation and standing. [1]
Piriformis muscle acts as an external rotator
when angle of hip flexion is 60º or less and
the function changes when angle of hip
flexion is greater than 60°, so that it
becomes an internal rotator of the hip. [3]
From this it could be stated that piriformis
remains active during any type of sitting
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 135
Vol.7; Issue: 7; July 2017
position whether high sitting or cross sitting
although its function changes in different
styles of sitting. Previous literature showed
that sitting in a chair for eight hours or more
may develop tightness of back muscle and
create strain on joints which remains so long
in a constant position, especially when the
muscles are under constant low-grade
contraction in order to hold and maintain the
sitting position. [4] The sedentary individuals
frequently complain of low back pain
caused by muscular imbalance and if it is
left unchecked, this imbalance may create a
chronic pain condition in the lower back.
Sedentary healthy individual are those who
perform sedentary job. Jobs are sedentary if
walking and standing are required
occasionally and other sedentary criteria
like any walking behavior characterized by
an energy expenditure of 1.5 METs or less
while in a sitting or reclining posture are
met. [5] "Occasionally" means occurring
from very little up to one- third of the time,
and would generally total no more than
about 2 hours of an 8-hour workday. [5]
Occupation which demands prolonged
sitting in a chair include computer
professionals, call center workers, piano
players / music instrument players, office
based work, motor vehicle drivers etc. are
more prone to develop piriformis tightness.
[6] Piriformis muscle has a predominance of
type-I fibers which has a tendency to
develop shortness or tightness when the
muscle is abnormally stressed. When the
piriformis is shortened its diameter
increases and because of its location it
creates pressure to the sciatic nerve which
passes under it in 80% of population. [3] The
perpetual loading of the piriformis muscle
through over lengthening and eccentric
demand during functional activities
secondary to weak agonist muscles may
result in sciatic nerve compression or
irritation. For example, if the hip
excessively adducts and internally rotates
during weight-bearing tasks due to
weakness of the gluteus maximus and/or
gluteus medius, a greater eccentric load may
be shifted to the piriformis muscle. [7] The
piriformis muscle is under strain during the
entire gait cycle and it is postulated that it
may be more prone to hypertrophy than
other muscles in the region. Gait
abnormalities may accentuate this,
especially if the result is increased internal
rotation or adduction such as with a leg
length discrepancy. [8] When the piriformis
becomes tight it can put pressure on the
sciatic nerve causing irritation and sending
pain down the back of the leg (sciatica). [9]
Peripheral neuritis of the sciatic nerve
caused by pressure of an injured or irritated
piriformis muscle or an abnormal condition
of the piriformis muscle lead to piriformis
syndrome. In most cases of piriformis
syndrome due to contracted piriformis
muscle, the sacrum anteriorly rotated toward
the ipsilateral side on a contralateral oblique
axis, resulting in compensatory rotation of
the lower lumbar vertebrae in the opposite
direction, this facilitation and compensatory
somatic dysfunctions may lead to low back
pain, thoracic and cervical pain. [1]
Delayed diagnosis of piriformis
syndrome may lead to pathologic conditions
of the sciatic nerve, chronic somatic
dysfunction and compensatory changes and
it may cause pain, paresthesia, hyperesthesia
and muscle weakness. In extreme cases,
misdiagnosis of piriformis syndrome-related
back pain with ‘‘sciatica’’ as prolapsed
intervertebral disc may lead to unnecessary
surgery. [10,11] The prevalence of piriformis
tightness in sedentary normal individuals is
scarce in the literatures. Therefore, the
present study was designed to identify
prevalence of piriformis tightness in
sedentary individuals so that appropriate
preventive and corrective measures can be
taken in time which may reduce the rate of
development of Low back pain because of
piriformis tightness.
MATERIALS AND METHODS
Subjects: This prospective cross sectional
study evaluated the prevalence of piriformis
tightness in healthy sedentary individuals.
The subjects included were the students,
staff and caregiver of patients coming to
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 136
Vol.7; Issue: 7; July 2017
NILD, (Divyangjan) OPD, and nearby
locality of NILD, Kolkata, India from April,
2016 to December, 2016. Scientific and
Ethical approval was taken from Institute
Ethical Committee (IEC) before
commencement of the study. The subjects
included were the healthy males and
females from 18yrs to 60yrs of age with
Physical Component Summary (PCS) and
Mental Component Summary (MCS) score
of SF36 scale above 50 by using convenient
sample design.
The subjects were excluded if they
had history of back surgery or lower limb
surgery, trauma to back or lower extremity,
low back pain within the last six months,
diagnosed cases of rheumatoid arthritis or
osteoarthritis of the spine or hips, spinal
deformity, tightness of tensor fascia latae
and neurological disease, any history of
cardiovascular diseases such as
hypertension, stroke or other cardiac
disorders, females with pregnancy and
uncooperative subjects. Total 230 healthy
individuals were approached with the
proposal of study, 16 individuals refused to
participate. The individuals agreed to
participate and signed the consent form
were 214. 14 subjects were excluded,
amongst them 03 were having spinal
deformity, 11 had gone through a period of
low back pain in last 6 months. Finally data
was collected from 200 healthy individuals.
Procedures: Aim and procedure of the
study were explained to all subjects in their
preferred language before data collection.
Informed consent form (which also includes
permission to use their data and photograph.
for presentation and publication purpose)
written in their preferred language (English/
Hindi/ Bengali) was taken from all the
subjects who agreed to participate.
Demographic data including age, sex
and occupation was collected. Short Form-
36 scale (SF-36) (English/Bengali Version)
was filled by therapist (M.M) by asking the
questions from subjects. Prior to the test, all
the subjects underwent warm up with 10
minutes comfortable walk at self-
determined pace around the research venue
under therapist supervision (M.M).
Piriformis tightness was checked
through piriformis stretch & seated
piriformis stretch test. Piriformis Stretch
Test [3] was done with the subjects
positioned in supine, the tested leg was
placed in flexion at the hip & knee so that
the foot rests on the table lateral to the
contralateral knee (the tested leg was
crossed over the straight non-tested leg, as
shown in figure 2) The angle of hip flexion
was maintained at 60º. It was ensured by
measuring universal goniometer (Fig-4.2).
Therapist was standing beside the plinth at
the tested side to stabilize the non-tested
side ASIS by one hand and to prevent pelvic
motion during the test. The knee of the
tested side was pushed into adduction, to
place a stretch on the piriformis muscle. If
the adduction ROM was limited & the
patient reported discomfort posterior to the
tested greater trochanter tested side
piriformis was considered tight (positive).
Figure 2: Hip flexion ensured by universal goniometer
Seated Piriformis Stretch Test [12]
was done with the subject in high seating
position over the edge of treatment couch,
the tested leg placed into flexion at the hip
approximately 90° & knee extended (as
shown in figure 3). Therapist was sitting in
front and beside the plinth at the tested side.
The weight of the trunk provides some
stabilization. The subject grasped the edge
of the plinth to stabilize the pelvis. By
palpating the sciatic notch, therapist
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 137
Vol.7; Issue: 7; July 2017
adducted and internally rotated the tested
limb, to place a stretch on piriformis and
created dural tension of the sciatic nerve.
Test was considered positive if recurrence
of the subject’s (familiar complaints) of
gluteal pain and / or paraesthesia, radiating
into posterior aspect of the lower extremity.
Figure 2a: Starting Position of piriformis stretch test Figure 2b: End Position of piriformis stretch test
Figure 3:Starting Position of seated piriformisstretch test Figure 3a: End Position of seated piriformis stretch test
Figure1: Flow chart
Statistical Analysis
Data were analyzed using SPSS
version 23 software. Descriptive statistics
was used to determine the frequency of
piriformis tightness in male and female
subjects and among all ages. Two sample
proportion z-tests were used to test the
significance of piriformis muscle tightness
with respect to clinical test in male and
female population. The tests were applied at
95% confidence interval and level of test
was set at 0.05.
RESULTS
Prevalence of piriformis muscle
tightness was checked among 200 healthy
sedentary subjects with an age range of 18-
60 years (mean age of 32.3 ± 11.4), out of
which 105 were males & 95 were females.
Out of 200 subjects, 159 subjects were
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 138
Vol.7; Issue: 7; July 2017
clinically diagnosed with piriformis
tightness & 41 subjects had no tightness.
This overall prevalence of the piriformis
tightness was found to be statistically
significant (at 5% level of significance)
which is shown in table 1.
Table 1: Comparison between with and without piriformis muscle tightness
Total number of subjects (n=200)
With piriformis muscle tightness
(n=159)
Without piriformis muscle tightness
(n=41)
Percentage
z-value
p-value
Percentage
p-value
79.5
1.96
0.05
20.5
0.05
The prevalence of piriformis muscle
tightness in male and female was
statistically insignificant [|Z| <1.96 and at
5% level p-value >0.05. 0.025= 1.96)].
Therefore males were affected as much as
the females. This prevalence of piriformis
muscle tightness between genders was
shown in table 2.
Table 2: Difference of piriformis tightness prevalence between genders
Total no of subjects included (n=200)
Total no of subjects affected (n=159)
no of male affected (n=80)
no of female affected (n=73)
no of male affected(n=80)
no of female affected(n=73)
Percentage of involvement
Percentage of involvement
40%
36.5%
54.1%
45.9%
The prevalence of piriformis muscle
tightness among different ages is shown
through the histogram (H1). Red and blue
curve indicates the fitted density line of total
subjects included in that class and total
subject affected with piriformis tightness in
that class respectively. From descriptive
statistics of histogram (H1) class 20-25
years was found to be modal class as most
of the subjects included in the sample
dataset belong to this class and most of the
subjects affected from piriformis muscle
tightness also belongs from this class i.e.
20-25 years.
Graph 1: H3 - Difference between the age distribution of
subjects affected with piriformis muscle tightness and overall
age distribution
DISCUSSION
Sedentary population frequently
complain of low back pain caused by
muscular imbalance because they usually
involved with prolonged sitting job with
certain amount of walking and standing
occasionally to carry out job duties which
require energy expenditure of 1.5 METs or
less. [5] Sitting in a chair for eight hours or
more may develop tightness of back and hip
muscles such as hamstrings, iliopsoas,
piriformis etc and create strain on joints
which remains in a constant position for
long time, especially when the muscles are
under constant low-grade contraction in
order to hold and maintain the sitting
position. [4] When the piriformis becomes
tight it can put pressure on the sciatic nerve
causing irritation and pain down the back of
the leg (sciatica). [9] Peripheral neuritis of
the sciatic nerve caused by pressure of an
injured or irritated piriformis muscle or an
abnormal condition of the piriformis muscle
lead to piriformis syndrome. [13,14]
In most cases of piriformis
syndrome due to contracted piriformis
muscle, the sacrum anteriorly rotated toward
the ipsilateral side on a contralateral oblique
axis, resulting in compensatory rotation of
the lower lumbar vertebrae in the opposite
direction, this facilitation and compensatory
somatic dysfunctions may lead to low back
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 139
Vol.7; Issue: 7; July 2017
pain, thoracic and cervical pain. [10] Janda
suggested that spasm of the piriformis pulls
on the sacrotuberous ligament, causing SI
joint pain. [15] Previous studies have stated
that the prevalence of piriformis syndrome
among the cases of low back/buttock pain
with sciatica but there is lack literatures that
can state the prevalence of piriformis
tightness in healthy sedentary population.
So the present study was designed and
conducted with a goal to find out the
prevalence of piriformis tightness in healthy
sedentary individuals.
In this study, total 200 sedentary
healthy individuals subjects were included,
among them 159 subjects were identified as
having piriformis muscles tightness, the
prevalence of piriformis tightness thus was
79.5%. It was difficult to find any previous
study which was directly showing the
prevalence of piriformis muscle tightness
but one study by Singh US et al (2013)
could be cited in previous literature which
showed the prevalence of piriformis
syndrome as 6.25% in low back pain
patients which is mainly caused by the
piriformis tightness as mentioned above. [8]
The piriformis muscle is considered
as a postural muscle and the postural
muscles has the tendency to become
overactive, hypertonic, weak and shortened
in length. The piriformis muscle gets
overactive and hypertonic during prolonged
sitting and walking. When there is a
weakness of the primary muscle which is
responsible for specific joint movement
causes the synergistic muscle to overcome
and behave as a primary muscle. Primary
work of piriformis is external rotation of the
hip and it work as a synergistic muscle to
gluteus muscle during hip abduction. [16]
Currently, people spend more time sitting
than standing due to the development of
science and technology and automation.
Dependence on automobiles, even for
traveling short distances and long periods
spent working on computers; contribute to
today’s sedentary lifestyles. According to
Nicholson S the gluteus muscles are the
most neglected group of muscle in whole
body as individuals spend their most of the
time in sitting and walking very little on the
track. So, this may leads to the weakness of
gluteal muscle group and synergistic
activation of piriformis muscle. This over
activation may cause the hypertonicity as
well as the tightness of piriformis muscle.
Another reason for the over activation of
piriformis muscle during a maintained
posture is the small size of its muscle fibers.
According to Hennemans size principle, the
smaller the fiber the easier it activates, the
larger the fiber the faster it conducts. [17]
That’s why postural muscles have abundant
red fibers. The neurons are smaller and
easier to activate, constantly sending
impulses with correction messages to the
postural muscles to maintain body position.
Prolonged activation of muscle may lead to
localized muscle tension, muscle strains,
muscle fatigue, and other soft-tissue
damage. These reasons clearly explain the
high prevalence of piriformis muscle
tightness in sedentary population.
The subjects who participated in this
study were healthy adults from 18 to 60
years of age. Most of subjects (n=86)
affected with piriformis tightness were
found in third decade. In this group subject
included were college student and spend
most of the time in sitting position. Others
profession in third decade which may lead
to piriformis tightness include computer
professional, teachers, businessman, bus
driver, housewife, police etc. all were
spending sedentary lifestyle in their job area
as well as at home. Now a days, individuals
spend their leisure time in recreational
activities that also include sitting posture
such as watching T.V, playing video game
and indoor games such as playing cards,
carom, chess etc.
In this study, the number of male
subject (n=105) was slightly more than the
females (n=95) with male to female ratio as
21:19. Out of total affected subjects
(n=159), 86 subjects were male and 73
subjects were female who were presented
with piriformis tightness which was
clinically diagnosed by piriformis stretch
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 140
Vol.7; Issue: 7; July 2017
test & seated piriformis stretch test. There
was no statistically significant difference of
piriformis tightness found between male and
female. But the reasons of piriformis
tightness in both the genders are different.
Males have the tendency to sit in a more
open leg position, so their piriformis or
outer thigh muscle serve as external hip
rotator and get tighten. [18] Apart from this, it
is opposite in case of females, they use to sit
with leg crossed. [18,19] Previous studies have
indicated that people prefer sitting with the
legs crossed because it change the weight or
load on soft tissues and muscles; and
provides stability to the lower extremities or
because of social situations or for aesthetic
reasons. [18,19] If an individual habitually
adopts such postures, part of the body will
deviate from proper alignment and
deformation will be aggravated, to
compensate for the unstable state causing
problems in the musculoskeletal system.
Park Y et al 2014 concluded the subjects
with the habit of sitting with their legs
crossed for at least three hours per day had
statistically significant differences in the
heights of the acromion processes and the
ASISs between the two sides. [18] If an
individual works for an extended period of
time in a sitting position, maintaining a
proper posture may become difficult and
muscle fatigue increases. So, the reason of
piriformis tightness in females during cross
sitting could be
a) Inhibition and weakness of gluteal group
of muscle over a time can further leads to
over activation of piriformis muscle.
Dieterich et al (2015) reported that
maximal-effort internal rotation torque in
healthy persons increased by about 50%
with the hip flexed as a compared to extend.
This increased internal rotation torque with
flexion may be due to the increased leverage
of some of the internal rotator muscles such
as the anterior fibers of the gluteus medius,
as depicted in , but also to a reversal of
rotary action of some of the traditional
external rotators, such as the piriformis, or
posterior fibers of the gluteus medius. [20]
b) In crossed leg position piriformis muscle
was is excessive lengthening position as the
hip is flexed and externally rotated position.
Because the piriformis is actually an internal
rotator in a position of marked hip flexion,
incorporating external rotation into the
stretch appears to be a rational approach.
Snijders et al (2006) in their study have
shown that cross-legged sitting, which
combines flexion and external rotation of
the hip, increases the length of the
piriformis by 21% as compared to its length
in upright standing. [21] This may leads to
cumulative injury and tissue trauma which
results in development of piriformis spasm.
After a prolonged time, this spasm leads to
muscle imbalance and tightness of
piriformis muscle in females.
Limitations of the study: Strength of
gluteus medius was not measured which
may leads to piriformis tightness. Sample
size was small and data was collected from
a single center.
Suggestions: Further studies are
recommended with large sample size and
data collected from multiple centers. Risk
factors that lead to development of
piriformis muscle tightness need to be
studied.
CONCLUSION
Prevalence of piriformis muscle
tightness in sedentary individuals was found
to be 79.5% in this study which concludes
that person who have long hour of sitting
and certain period of standing and walking
are affected mostly with piriformis
tightness. Young adults mostly in third
decade were found to be most affected with
piriformis muscle tightness than any other
age group. So, the preventive measures such
as proper sitting posture, strengthening of
abductor muscles and change in walking
habits etc. could be explained to sedentary
population to prevent piriformis tightness
which further prevent the piriformis
syndrome and the episodes of low back
pain.
Malika Mondal et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional
Study
International Journal of Health Sciences & Research (www.ijhsr.org) 141
Vol.7; Issue: 7; July 2017
ACKNOWLEDGEMENT
We are indebted to Dr. Abhishek
Biswas (Director (Offg), NILD (Divyangjan)
Kolkata for his kind consent/permission to carry
out the project at NILD.
Contributions of authors:
MM: Evaluation of subjects and data collection.
KM: Evaluation of subjects and supervision of
warm-up exercise.
SA: Statistical analysis
BS: Designing the methodology section and
Manuscript preparation
P.K: Recruitment of subjects and suggestions in
Manuscript preparation
Conflict Of Interest: Authors report no conflicts
of interest for this study. The authors alone are
responsible for content and writing of this
article.
Funding:
No funds were received from any organization
or person to carry out this project.
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How to cite this article: Mondal M, Sarkar B, Alam S et al. Prevalence of piriformis tightness in
healthy sedentary individuals: a cross-sectional study. Int J Health Sci Res. 2017; 7(7):134-142.
... In serious cases, misdiagnosis lead to unnecessary surgery in prolapsed intervertebral disc. 4 The biggest problem of clinical diagnosis of piriformis syndrome is the absence of a specific and consistent test in diagnosing piriformis syndrome. Confirmation of the diagnosis is also as a treatment of piriformis syndrome is imaging guided block injections done by a skilled clinician. ...
... While the most average duration of sitting is 6-8 hours a day (47.7%). Long duration of sitting might be as a predisposing factor for piriformis syndrome, supported by the study of Carro et al and Mondal et al (2017). 4,11 However, both studies did not correctly state the duration of sitting a day which could be considered as a predisposing factor. ...
... Long duration of sitting might be as a predisposing factor for piriformis syndrome, supported by the study of Carro et al and Mondal et al (2017). 4,11 However, both studies did not correctly state the duration of sitting a day which could be considered as a predisposing factor. Park et al concluded that inactive populations who sit more frequently for long periods (duration ≥8 hours) have a tendency to experience lower back pain than other populations. ...
... 5 In several articles, PS is defined as a peripheral neuritis of the branches of the sciatic nerve caused by an abnormal condition of the piriformis muscle, such as a shortened muscle. 6,7 The piriformis muscle has a tendency to shorten when the muscle is abnormally stressed. 6 In addition, repetitive and persistent external hip rotation of the piriformis muscle may increase the stiffness of the posterior hip structures. ...
... 6,7 The piriformis muscle has a tendency to shorten when the muscle is abnormally stressed. 6 In addition, repetitive and persistent external hip rotation of the piriformis muscle may increase the stiffness of the posterior hip structures. 8 Flexion and internal rotation movements of the hip joint are reduced through insufficient posterior gliding of the femur, and restricted hip motion can cause compensatory movements of adjacent joints. ...
... 8,9 Treatment for PS has traditionally included physical therapy, focused on muscle stretching, extracorporeal shock wave therapy and a combination of local anaesthetic and corticosteroids into the piriformis muscle belly. 6,10,11 Stretching exercises in particular have been proposed as a mainstay for intervention. 12 These techniques are generally identified as "piriformis muscle stretching". ...
... Mitra et al., (2014) also stated that at least 6% of patients who have been diagnosed with low back pain actually have piriformis syndrome. In a study by Mondal et al., (2017) on prevalence of piriformis syndrome among 200 sedentary healthy individuals, 159 (79.5%) were identified as having piriformis syndrome. Bell (2008) stated that massage therapy helps reduce pain and elevate range of motion, in addition to assisting in healing patients with low back pain and sciatica symptoms. ...
Article
Title: The Effectiveness of Myofascial Release over Stretching on Pain and Range of Motion among Female College Students with Piriformis Syndrome.Background & Aim: Piriformis syndrome is a painful neuromuscular disorder that occurs when the piriformis muscle irritates and/or compresses the proximal sciatic nerve. Prolonged sitting position is the foremost cause of piriformis tightness in sedentary population that may eventually leads to piriformis syndrome. The incidence of piriformis has been reported to be six times more prevalent in female than in males. Piriformis tightness will cause reduced in range of motion as well as limitations in walking, sitting and even running. Moreover, individuals will also feel pain at their butt muscles which could be frustrating. Thus, the aim of this study is to determine the effectiveness of myofascial release over stretching on pain and range of motion among female college students with piriformis syndrome.Methods: twenty subjects aged between 19 to 25 years old with tight piriformis muscle for 4 weeks will make a part of the study based on the inclusion and exclusion criteria. Subjects are divided and will undergo myofascial release and stretching treatment for 4 weeks twice in a week. At the beginning before the session the pain score and goniometer measurements will be recorded.Conclusion: Group 1 and Group 2 are beneficial in reducing pain and range of motion. Therefore, there are no significant effect of myofascial release over stretching between the two groups.Keywords: Myofascial release, college students, piriformis syndrome, stretching, goniometer, pain score.
... patients was 32,3 years. 7 Characteristic respondents based on gender show that female and male ratio was 1:4. This result with a review by Chahal, A et al., who mentioned piriformis syndrome synonyms is fat wallet syndrome and wallet neuritis, which often occurs in men. ...
Article
Full-text available
Objective: the purpose of this study was to find out the prevalence and risk factors of Piriformis syndrome in online motorcycle taxis in Denpasar Methods: This study was an observational study with cross-sectional study design. The total sample was 87 respondents, and the sampling method used a purposive sampling technique. Results: research result showed prevalence and risk factor of piriformis syndrome based on risk factors for work duration: the prevalence of Piriformis syndrome in respondents with a duration of work of more than 8 hours was 48 (55.2%) respondents while 39 respondents (44.8%) in respondents with a duration of work of fewer than 8 hours. Based on the habit of putting a wallet in the back pocket, there were 33 (37.9%) respondents who had that habit while respondents without that habit had 54 respondents (62.1%). Conclusion: in a conclusion work duration, the habit of putting a wallet in the back pocket becomes a risk factor for piriformis syndrome in an online taxi driver.
... The yearly prevalence of low back pain ranges from 5% to as high as 65%. Lifetime prevalence can range up to 84% and the monthly prevalence has been placed between 35% and 37% 2,3 . Nachem son in 1976 defined low back pain as an acute, sub-acute or chronic episode, which is characterized either by a slowly or a suddenly occurring rather sharp pain with or without radiation over the buttocks or slightly down the leg, with concomitant restriction of motion, when subsiding to the chronic type, the pain will be a little less severe and continue for more than two months. ...
Article
Full-text available
Efficacy of K-Tape in Chronic Mechanical Low Back Pain. Randomized Control Trial. A total of 30 patients were included as per pre define inclusion and exclusion criteria and randomly assigned into two groups, consisting of 15 patients in each group. Group A was given K-Tape along with standardized exercise program. Group B was given standardized exercise program along with moist hot pack for 4 weeks, 3 sessions per week one session per day. The patient's outcome measures were assessed by visual analog scale, ODI and Goniometry for Lumbar Range of Motion. Measurements were recorded before and after the end of the treatment period. Results revealed that means and S.D of both group were significant (p=0.000) statically but clinically the Group of patients treated with K-Tape along with standardized exercise program managed pain (pre=7.50±1.21,post=0.71±0.37),ODI(pre=41±18.16,post= 8±4.49) and range of motion (flexion pre=31±5.04,post=50±10.12,extension pre=17±2.13,post=29±4.20 Rt side flexion pre=10±2.55,post=22±4.75 and Lt. side flexion pre=10±2.35, post=22±4.63, Rt side rotation pre= 8±1.27,post=19±2.65) Lt. side rotation pre=8±2.15, post=18±2.46 better than group of patients treated with standardized exercise program along with Moist hot pack in terms of pain (pre=7.81±1.16,post=2.35±1.27), ODI (pre=44±21.32,post=22±10.6) and range of motion (flexion pre=25±5.65,post=37±10.16, extension pre=15±2.55,post=21±5.32, Rt side flexion pre=10±2.35 post=15±2.28, Lt Side flexion pre=11±2.35, post=19±2.36, Rt side rotation pre=9±1.90 post=16.±2.71, Lt Side rotation pre=8±1.63, post=15±3.15. The result of study suggests that both K-Tape and exercises improves the symptoms of chronic low back pain. Better improvement was shown by K-Tape group when compared with exercise group. Based on these results K-Tape and Exercise should be the treatment of choice for chronic mechanical low back pain rather than Exercise with HP.
... If the patient's piriformis is shortened, then it can be an effective method to promote posterior glide of the femoral head and extending the piriformis. [10][11][12][13] In the patient in the present case, the external rotators including the piriformis were very weak. Thus, backward rocking exercise in quadruped position was performed for a short period compared to other exercises, and abductor- strengthening exercise was subsequently conducted (Table 4). ...
... The yearly prevalence of low back pain ranges from 5% to as high as 65%. Lifetime prevalence can range up to 84% and the monthly prevalence has been placed between 35% and 37% 2,3 . Nachem son in 1976 defined low back pain as an acute, sub-acute or chronic episode, which is characterized either by a slowly or a suddenly occurring rather sharp pain with or without radiation over the buttocks or slightly down the leg, with concomitant restriction of motion, when subsiding to the chronic type, the pain will be a little less severe and continue for more than two months. ...
Article
Full-text available
ABSTRACT Efficacy of K-Tape in Chronic Mechanical Low Back Pain. Randomized Control Trial. A total of 30 patients were included as per pre define inclusion and exclusion criteria and randomly assigned into two groups, consisting of 15 patients in each group. Group A was given K-Tape along with standardized exercise program. Group B was given standardized exercise program along with moist hot pack for 4 weeks, 3 sessions per week one session per day. The patient’s outcome measures were assessed by visual analog scale, ODI and Goniometry for Lumbar Range of Motion. Measurements were recorded before and after the end of the treatment period. Results revealed that means and S.D of both group were significant (p=0.000 ) statically but clinically the Group of patients treated with K-Tape along with standardized exercise program managed pain (pre=7.50±1.21,post=0.71±0.37),ODI(pre=41±18.16,post= 8±4.49) and range of motion (flexion pre=31±5.04,post=50±10.12,extension pre=17±2.13,post=29±4.20 Rt side flexion pre=10±2.55,post=22±4.75 and Lt. side flexion pre=10±2.35, post=22±4.63, Rt side rotation pre= 8±1.27,post=19±2.65) Lt. side rotation pre=8±2.15, post=18±2.46 better than group of patients treated with standardized exercise program along with Moist hot pack in terms of pain (pre=7.81±1.16,post=2.35±1.27), ODI (pre=44±21.32,post=22±10.6) and range of motion (flexion pre=25±5.65,post=37±10.16, extension pre=15±2.55,post=21±5.32, Rt side flexion pre=10±2.35 post=15±2.28, Lt Side flexion pre=11±2.35, post=19±2.36, Rt side rotation pre=9±1.90 post=16.±2.71, Lt Side rotation pre=8±1.63, post=15±3.15. The result of study suggests that both K-Tape and exercises improves the symptoms of chronic low back pain. Better improvement was shown by K-Tape group when compared with exercise group. Based on these results K-Tape and Exercise should be the treatment of choice for chronic mechanical low back pain rather than Exercise with HP. Keywords: K-Tape, Chronic Low Back Pain, Moist hot Pack, Exercise.
... [2] The yearly prevalence of low back pain ranges from 5% to as high as 65%, the lifetime prevalence can range up to 84% and the monthly prevalence has been placed between 35% and 37%. [3,4] Nachemson (1976) defined low back pain as an acute, sub-acute or chronic episode, which is characterised either by a slowly or a suddenly occurring rather sharp pain with or without radiation over the buttocks or slightly down the leg, with concomitant restriction of motion, when subsiding to the chronic type, the pain will be a little less severe and continue for more than two months. 80-90% of low back pain is of mechanical origin and the source of the pain is the spine or its supporting structures. ...
Research
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ABSTRACT Background and purpose: Chronic Mechanical low back pain is one of the most common health problems. Core stabilization exercise has an important role in Chronic low back pain treatment as well as prevention. Extensive literature review revealed little evidence on Kinesio taping with standardized exercise program and standardized exercise program alone for the management of chronic mechanical low back pain. So, the purpose of this study was to compare the effectiveness of Kinesio taping with standardized exercise program Vs standardized exercise program alone and find out the efficacy of Kinesio Taping in subjects with Chronic Mechanical Low Back Pain. Study design: Randomised clinical trial. Subjects and methods: Thirty (30) subjects with Chronic Mechanical low back pain were randomly assigned into two groups. Group –A (n=15, 14 Male, 1 Female) received Kinesio Taping (2 session/week for 4 weeks) with standardized exercise program (3sittings per week for 4 weeks) and Group-B (n=15, 9 Male, 6 Female) received standardized exercise program alone (3sittings per week for 4 weeks). Pain intensity was measured by Visual Analogue Scale (VAS), lumbar spine range of motion was evaluated by Modified Schober‟s test (MST) and Functional disability was evaluated by Oswestry Disability Index (ODI) at Baseline, after second week and after 4th week of intervention. Results: Both groups showed statistical significant improvement after 4 weeks of intervention in respect to pain intensity, range of motion and functional disability. Group-A showed significant improvement than Group-B in respect to Pain intensity (p value <0.05) and functional disability (p value <0.05), however, there was insignificant changes found between the groups for lumbar spine range of motion (p value >0.05) after 4 weeks of treatment. Conclusion: The results of this study suggested that Kinesio taping with standardized exercise has a significant effect in improving pain and function in subjects with Chronic Mechanical low back pain. Keywords: Chronic Mechanical low back pain, Kinesio taping, Visual analogue scale, Oswestry disability index.
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[Purpose] To investigate the effects of erect sitting, slouched posture with cross-legged sitting, and erect posture with cross-legged sitting on the lumbar and pelvic angles, and gluteal pressure. [Subjects] For the experiments, 17 healthy women were recruited. [Methods] All subjects were asked to perform three sitting postures: erect sitting, slouched posture with cross-legged sitting, and erect posture with cross-legged sitting. Lumbar and pelvic angles were measured using a three-dimensional motion-capture system, and gluteal pressure was measured using a pressure mat. [Results] Compared to erector sitting, slouched posture with cross-legged sitting showed significantly greater lumbar flexion, posterior pelvic tilt, and left pelvic tilt. Compared to erect sitting, erect posture with cross-legged sitting showed significantly greater lumbar flexion and posterior pelvic tilt. Compared to erect posture with cross-legged sitting, slouched posture with cross-legged sitting showed significantly greater lumbar flexion and posterior pelvic tilt. Compared to erect sitting and erect posture with cross-legged sitting, slouched posture with cross-legged sitting showed significantly greater left gluteal pressure; there was no significant difference in right gluteal pressure. [Conclusion] An erect posture can reduce changes in lumbar and pelvic angles, and gluteal pressure compared to a slouched posture during cross-legged sitting.
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[Purpose] The purpose of this study was to identify postural changes in adults who have adopted the habit of sitting with their legs crossed. [Subjects and Methods] The subjects were 232 adults in their 20s and 30s (84 males and 148 females). They were divided into 0-, 1-, 2-, and 3-hour or more groups by observing how much time per day they sat with their legs crossed while sitting on a chair. We measured the postural alignment of all the subjects in the sagittal plane and coronal plane. In the sagittal plane, distances from the line of gravity to the external auditory meatus, the shoulder joints, the knee joints, and the calcaneocuboid joint were measured. In the coronal plane, the shoulder inclination and the pelvic tilt were measured. [Results] The shoulder joints, the knee joints, and the calcaneocuboid joint did not show any significant differences, but the head was aligned further forward in the 3-hour group compared to the other groups. In the coronal plane, the acromion processes and the anterior superior iliac spines of the 3-hour group showed statistically significant differences than those of all of the other groups. [Conclusion] The results indicate that sitting with the legs crossed for longer than three hours per day may cause shoulder inclination, lateral pelvic tilt and forward head posture.
Article
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Purpose: Piriformis syndrome is a collection of symptoms and signs of pain from piriformis muscle and is characterized by pain in buttock with variable involvement of sciatic nerve. This syndrome is often overlooked in clinical practice because its presentation has similarities with other spine pathologies. A major problem with the clinical diagnosis of piriformis syndrome is the lack of consistent objective findings and an absence of single test that is specific for piriformis syndrome. Therefore, a precise and reliable clinical method of diagnosing piriformis syndrome should be developed by clinicians. Methods: This is a prospective observational study involving 93 consecutive patients who attended the pain management unit for chronic low back pain. The diagnosis of piriformis syndrome was made using the modified flexion adduction internal rotation (FAIR) test, which is a combination of Lasègue sign and FAIR test. Prevalence of piriformis syndrome based on this technique was compared with the previous data using other techniques. Chi square (χ2) analysis was performed to detect the relationship between piriformis syndrome and the potential risk factors. Results: On the basics of our diagnostic criteria, the prevalence of piriformis syndrome was 17.2% among low back pain patients. All the patients diagnosed with piriformis syndrome responded well with piriformis muscle injections. No significant associations were detected between piriformis syndrome and spine disorders. Conclusions: Piriformis syndrome is a painful condition that is often overlooked in the differential diagnosis of chronic buttock or low back pain. The modified FAIR test together with piriformis muscle injection is potentially a reliable method for the clinical diagnosis of piriformis syndrome.
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Since its translation to Thai in 2000, the SF-36 Health Survey has been used extensively in many different clinical settings in Thailand. Its popularity has increased despite the absence of published evidence that the translated instrument satisfies scoring assumptions, the psychometric properties required for valid interpretation of the SF-36 summated ratings scales. The purpose of this paper was to examine these properties and to report on the reliability and validity of the Thai SF-36 in a non-clinical general population. 1345 distance-education university students who live in all areas of Thailand completed a questionnaire comprising the Thai SF-36 (Version 1). Median age was 31 years. Psychometric tests recommended by the International Quality of Life Assessment Project were used. Data quality was satisfactory: questionnaire completion rate was high (97.5%) and missing data rates were low (< 1.5% for all items). The ordering of item means within scales generally were clustered as hypothesized and scaling assumptions were satisfied. Known groups analysis showed good discriminant validity between subgroups of healthy persons with differing health states. However, some areas of concern were revealed. Possible translation problems of the Physical Functioning (PF) items were indicated by the comparatively low ceiling effects. High ceiling and floor effects were seen in both role functioning scales, possibly due to the dichotomous format of their response choices. The Social Functioning scale had a low reliability of 0.55, which may be due to cultural differences in the concept of social functioning. The Vitality scale correlated better with the Mental Health scale than with itself, possibly because a healthy mental state is central to the concept of vitality in Thailand. The summated ratings method can be used for scoring the Thai SF-36. The instrument was found to be reliable and valid for use in a general non-clinical population. Version 2 of the SF-36 could improve ceiling and floor effects in the role functioning scales. Further work is warranted to refine items that measure the concepts of social functioning, vitality and mental health to improve the reliability and discriminant validity of these scales.
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Results of construct validity and reliability of the SF-36 are described, based on data from a multi-centre study on asthmatics and a population based survey. Questionnaire refinement was carried out between the two studies. Quality of data was good, with all items having less than 0.5% missing values. Floor and/or ceiling effects were observed for REE, REP, PF and SF. For scaling assumptions, correlations between each items and its hypothesized scale were all above 0.50, except for one item in PF. and for both items in SF. Item discriminant validity was an issue for items in VT, SF and MH scales. Cronbach's as for all scales exceeded the recommended 0.70 level, except for SF. Only one latent dimension was identified in principal component analysis, and only 52-53% of variance accounted for. As expected, PF shows high correlations with the physical component while MH was highly correlated with the mental component. Contrasting findings in the loadings of other scales were observed in the asthma data. Age, disease severity and presence of self-reported handicap/disability significantly affect PF, while MH demonstrates no obvious pattern with declining age. In essence, the Malay version of SF-36 could be used in Malaysia, with its generally acceptable internal consistency and validity. The caveat is in the call for additional domains of importance to Malaysians that is not covered by the instrument, and in the caution to be employed when using and construing the instrument.
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Hip extension and abduction movements involve coordinated muscular contractions occurring in a specific sequence. When a change occurs in the sequence of muscular contractions, a new movement pattern will develop called an 'altered movement pattern.' Understanding muscle function during hip extension and hip abduction allows muscle imbalance and altered movement patterns to be recognized. Treatment to correct the muscular imbalance causing an altered movement pattern is part of the treatment plan.
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Knowledge on task-specific activity of the deep hip abductor muscles is limited and is required for determining appropriate hip abductor exercises. To assess the temporal differentiation of activity of gluteus minimus and the deep and the superficial regions of gluteus medius during weight bearing and non-weight bearing exercises. Repeated measures design on a single recording occasion. M-mode ultrasound was used to capture activity-related muscle motion of the gluteus minimus and medius muscles in 20 healthy volunteers during weight shift, hip hitch, side-lying abduction and active leg lengthening exercises. M-mode traces were computer-processed for detecting muscle motion onsets. Mean onset differences between muscle regions and their intra-individual variability were assessed. In contrast to side-lying abduction, the weight shift and hip hitch exercises resulted in larger onset variability between the gluteus minimus and deep gluteus medius (P < 0.001) and also between the deep and superficial regions of the gluteus medius (P < 0.05). Weight bearing exercises promoted a greater functional differentiation between deep and superficial hip abductor muscles. Copyright © 2015 Elsevier Ltd. All rights reserved.