The Piriformis muscle is a pyramidal shape muscle that lies in the gluteal region. The main function of the piriformis muscle is it helps lateral rotation of the hip, and in hip abduction when the hip is flexed, it maintains the stability of the head of the femur in the acetabulum1.
Piriformis syndrome is a non-discogenic cause of sciatica from compression of the sciatic nerve through or around the piriformis muscle2. Most experts agree that previous gluteal trauma and posttraumatic scarring are important causes of Piriformis syndrome3. In posttraumatic Piriformis syndrome is due to the formation of a hematoma between the sciatic nerve and external rotators. 4 The FAIR position maximizes vertical adduction and internal rotation of the flexed thigh. This position is important in treating piriformis syndrome as well5.
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Pathophysiology and etiology of piriformis syndrome, two components somatic and neuropathic add to clinical presentation. The somatic component is a myofascial pain syndrome of the Piriformis muscle. Symptoms of Piriformis Syndrome can also occur from small external rotators of the hip and hamstring muscles through activation of the trigger point. As the neuropathic component sciatic nerve passes through infra piriformis foramen it gets compressed and irritated along with neighboring nerves and vessels.
Kinesiological Taping:-
It is a time-tested therapeutic taping method that makes use of uniquely designed elastic tape that Enhances muscular, joint, and circulatory function. It is cotton-based cloth tape with acrylic glue that allows for ventilation, and good adhesion with minimal negative skin reactions. It can be applied for 24 hrs a day and 3-5 days. It is based on the science of kinesiology with belief that body muscles are responsible for the movement of and in the body as well as being in control of other elements such as circulation of blood and body temperature. It has the potential skin-lifting effect of kinesiological tape Creates convulsions, Sub dermal vacuum, Tissue decomposition and Promotes fluid flow 6.
Soft Tissue Mobilization:
Soft tissue mobilization is useful to break down adhesions, improve the range of motion, lengthen muscles and tendons, reduce swelling and edema reduce pain to restore muscle functions. Various techniques such as direct oscillations and friction massage can be used.
Hot Water Fomentation:-On basis of the principle of thermodynamics heat is transferred from one area to the other area. It vasodilates the area, which subsides the metabolites that in turn reduce spasm which in turn reduces pain and increases the flexibility of the muscle fibers.8
Weight cuffs are used for resistance training. Strength training is associated with the production of lactate which limits exercise performance. Regular endurance exercise leads to adaptation in muscles which prevents lactate levels from rising during strength training9. All the above-mentioned treatments are used for piriformis syndrome.
This study was conducted to compare the effect of kinesiological taping and soft tissue mobilization and conventional physiotherapy in piriformis syndrome.
Materials and Methods
A cross-sectional comparative study was conducted on 30 individuals with Piriformis syndrome. 30 patients with piriformis syndrome from the department of orthopedics at Pravara Rural Hospital and Orthopedics physiotherapy Dr.APJ Abdul Kalam college of physiotherapy were undertaken for the study.
They were grouped into two groups, group 1 (n=15) and group 2 (n=15) by Simple Random Sampling.
Group 1 was given kinesiological taping and soft tissue mobilization for 4 days/week for 2 weeks. Group 2 was given conventional physiotherapy including. The range of motion of the hip is seen to be restricted in piriformis syndrome. Range of motion was assessed by a universal goniometer for flexion, abduction, and lateral rotation of the hip joint. Piriformis muscle has the chief action of the external rotator along with hip flexion and abduction. Thus the effect can be measured on these three ranges of the hip.11 Pain intensity was measured by Numerical Pain Rating Scale. It is a subjective type of pain assessment with 10 point scale demonstrating endpoints are of no pain and pain as bad or worst as it could be. The NPRS was graphically and verbally delivered.10
Medically stable Patient’s with piriformis syndrome between the ages of 30 to 50 years were included. Both male and female patients who are willing to participate were considered. Patients having Low back pain with any neurological, surgical, or congenital history were excluded. Also, patients having Low back pain with pathological diseases, and muscular and bony atrophy were excluded.
FAIR test and hip range of motion were assessed for both groups prior to starting the treatment. For group 1 the intervention was kinesiological taping along with soft tissue mobilization kinesiological taping was given for 4 days each week and the tape was changed after 48 hours and simultaneously the new tape was applied along with that soft tissue mobilization was given for 4 days with follow upto 2 weeks the same protocol was given. For group 2 the intervention was conventional physiotherapy which included a hot pack, piriformis stretching, and strengthing with the help of a weight cuff. The total duration was with follow-up of 2 weeks
Previous studies done for taping on shoulder range of motion and pain have shown that there is a significant improvement in pain intensity.12 Taping works by offering constant proprioceptive feedback or providing alignment correction during movements. In their study, however, pain intensity improvement was significantly different between the two groups immediately after Kinesiological Taping without a concurrent significant difference in change in shoulder active ROM. Similar proprioceptive feedback changes may have occurred in the present study.
More skillfully applied Kinesio Tape may promote a greater proprioceptive effect, joint mechanical correction, and enhancement of muscle function. Moreover, the four taping techniques were applied in a study done to assess the clinical effectiveness of kinesiological taping on pain and pain‐free shoulder range of motion in shoulder impingement syndrome. The study suggests that to provide facilitation of the lower trapezius muscle, inhibition of the deltoid and upper trapezius muscles, and mechanical correction affecting the subacromial space12. Kinesiological taping, irrespective of type, shows reduced pain and disability with sustained short-term effects after the treatment. Also, a study done with Kinesio taping on chronic non-specific low back pain, suggested that Kinesio Tape ensures reduction in pain and disability, irrespective of technique, with sustainable effects in short term at the end and after the treatment13. Studies have shown that elastic tape positively changes scapular motion and the performance of muscles, suggesting the therapeutic use of Kinesio taping. Also prophylactically it can assist in rehabilitation clinic as well as on field14
In another study comparing Kinesio taping and physical therapy modalities on shoulder impingement, it has been suggested that increased space is believed to reduce pressure by lifting the skin. By technique of lymphatic correction, Kinesio Tape decreases pressure under the Kinesio Tape strip which acts as a channel to direct exudates to the nearest lymph duct. Kinesio taping can improve musculoskeletal conditions such as strengthening of weakened muscles, controlling joint instability, assisting the postural alignment, and relaxing overused muscles. Kinesiological Tape is more elastic as compared with conventional tape forms. Kinesiological Tape provides an immediate effect on the limitation of the active ROM. The sensorimotor and proprioceptive feedback mechanisms help to get the effect of taping. The immediate effect of taping is characterized as sensorimotor feedback and patients often report symptom relief, improved comfort level, or stability of the involved joint. The elasticity of Kinesio Taping conforms to the body and allows free movement. Taping is an adjunct treatment option of the rehabilitation program and helps to improve functional recovery.
Some studies proposed that the immediate effect of Kinesio Tape may be considered a very important advantage as compared with local physical therapy modalities. This is also a favorable result that may increase performance during exercise. Kinesio Tape may be preferred as an alternative treatment option when an immediate effect by shorter application durations is needed15.
The result obtained in the current study may be due to proprioceptive feedback offered by kinesiological taping. Also, it provides correct alignment during the movement o the hip joint. Kinesiological taping may increase space and may reduce pressure by lifting skin14. Similarly, sudden effects may have been potentially due to Kinesio tape, which reduces mechanical irritation of involved soft tissue structures and reorients hip movements. In various studies, kinesiological taping has been shown to improve weak musculature control joint instability and postural correction.
Hence combined effects may be seen in our study as a result of proprioceptive and sensorimotor feedback systems and improvement of the muscular system along with the postural correction. The piriformis syndrome may have increased soft tissue irritation and limited ranges of the hip joint. Kinesiological tape may assist in reducing mechanical irritation of muscles, thereby reducing pain.
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