Sacroiliac joint manipulation helps to improve pain pressure threshold in chronic piriformis syndrome: a 6-week randomized controlled trial US

Background: Piriformis syndrome (PS) has negative impact on the daily activities of the patients and lead to disability. There is an anatomical association of piriformis muscle with sacroiliac joint (SIJ). So manual therapy including manipulation of SI joint may be the option for relieving the symptoms of PS Objective: To investigate the effectiveness of Sacroiliac joint manipulation in improving pain pressure threshold in patients with chronic piriformis syndrome. Materials and Methods: A randomized clinical trial (NCT04603703) was conducted at Max Rehab and Physical Therapy Centre G8-Markaz, Islamabad, Pakistan. A total of n=30 patients were randomly divided into Experimental group (n=15) and control group (n=15). Both groups received conventional physical therapy including therapeutic ultrasound, moist hot pack, piriformis muscle stretching, myofascial release of paraspinal muscles, gluteal strengthening, sciatic neurodynamics. The experimental group additionally received sacroiliac joint manipulation. The outcome measures were pain, straight leg raise (SLR), pain pressure threshold and piriformis muscle length. The total time frame of the treatment was 3 days per week for 6 weeks and pre and post intervention assessment was done. Result: The mean age of participants was 40.46 ±10.513 years. Pain, SLR, pain pressure threshold and piriformis length was significantly improved (p<0.001) in both the experimental and control group after 6th week intervention. Between group comparison there was no significant difference between the groups after 6-week intervention regarding the pain, SLR and piriformis muscle length, except pain pressure threshold which was significantly improved in experimental group as compared to control group (67.7±18.42 vs 52.51±15.26, p=0.020) . Conclusion: Addition of the sacroiliac joint thrust manipulation technique and conventional physical therapy alone were equally effective in decreasing pain intensity and normalizing length of Piriformis and Straight leg raise. But SIJ manipulation showed promising results on pain pressure threshold. Keywords: Articular, physical therapy modalities, piriformis muscle syndrome, pain threshold, range of motion, sacroiliac joint.