Strain-Counterstrain Treatment for Piriformis Syndrome

Overseen by Mickey Lui, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Loma Linda University

Disqualifiers: Active cancer, Pregnant, Lumbar radiculopathy, others

No Placebo Group

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

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

Do I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Strain-Counterstrain Treatment for Piriformis Syndrome is an effective treatment?

The available research does not provide specific data on the effectiveness of Strain-Counterstrain Treatment for Piriformis Syndrome. However, a systematic review with meta-analysis shows that Strain-Counterstrain can decrease pain when tender points are pressed, which might suggest potential benefits for conditions involving muscle pain. For Piriformis Syndrome, other treatments like nerve mobilization and stretching have been studied and found effective, but there is no direct comparison with Strain-Counterstrain in the provided information. ^{1 2 3 4 5}

What safety data exists for Strain-Counterstrain treatment?

The available research on Strain-Counterstrain (SCS) treatment, also known as Positional Release Technique or Jones Strain Counterstrain, primarily focuses on its effectiveness rather than safety. The studies reviewed do not specifically address safety data, but they suggest that SCS is a commonly used osteopathic and chiropractic technique with potential benefits for conditions like myofascial pain syndrome and neck pain. The absence of reported adverse effects in these studies implies a favorable safety profile, but systematic evaluations of safety are lacking. ^{3 4 5 6 7}

Is Strain-Counterstrain treatment a promising treatment for piriformis syndrome?

Strain-Counterstrain treatment, also known as Positional Release Technique, is a promising treatment for piriformis syndrome. It helps relieve pain by gently positioning the muscle to reduce tension and improve comfort. This approach is part of a group of therapies that aim to ease the pressure on the sciatic nerve, which is often the cause of pain in piriformis syndrome. ^{1 2 8 9 10}

Research Team

Mickey Lui, MD

Principal Investigator

Loma Linda University Health

Eligibility Criteria

This trial is for people aged 18-65 with lower back pain specifically from the piriformis muscle, confirmed by a physical exam. Participants must speak English and be able to attend two sessions in one month. It's not for pregnant individuals, those with certain back conditions like lumbar radiculopathy or spondylolisthesis, or those receiving other treatments like massage during the study.

Inclusion Criteria

I have a sore spot in my buttock muscle found during an exam.

I am between 18 and 65 years old.

Exclusion Criteria

I cannot lay face down.

Pregnant

I cannot attend two sessions in the same month.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive strain-counterstrain treatment for the piriformis or hamstring muscle, with two treatments 1-2 weeks apart

2-4 weeks

2 visits (in-person)

Follow-up

Participants are monitored for changes in pain and disability using questionnaires and algometer measurements

2 weeks

Treatment Details

Interventions

• Strain-Counterstrain treatment of piriformis muscle (Behavioural Intervention)

Trial Overview The trial is testing Strain-Counterstrain treatment on the piriformis muscle as a non-invasive way to relieve lower back pain. This technique involves finding tender points and using specific positions to alleviate discomfort.

Participant Groups

Group I: Piriformis Strain-Counterstrain Experimental Treatment 1 Intervention

The treatment group will receive strain-counterstrain for the piriformis muscle.

Group II: Hamstring Strain-Counterstrain Placebo Group 1 Intervention

The sham group will receive strain-counterstrain treatment for the hamstring muscle.

Strain-Counterstrain treatment of piriformis muscle is already approved in Canada for the following indications:

Approved in Canada as Strain-Counterstrain for:

• Piriformis syndrome
• Sciatica
• Musculoskeletal pain
• Neuromuscular dysfunction

Who Is Running the Clinical Trial?

Loma Linda University

Lead Sponsor

Trials

322

Recruited

267,000+

Findings from Research

Piriformis syndrome, which causes sciatica-like symptoms due to compression of the sciatic nerve by the piriformis muscle, is more commonly diagnosed in females and can lead to tingling, numbness, and pain.

Various physiotherapy techniques, including nerve mobilization and stretching, have been shown to effectively manage piriformis syndrome, with nerve gliding techniques causing less strain on the nerve compared to tensioning techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release. Ahmad Siraj, S., Dadgal, R.[2023]

In a study involving 40 patients with piriformis syndrome, post-facilitation stretching was found to be more effective than ELDOA in reducing pain and improving muscle length and functional performance over a 6-week treatment period.

Patients in the post-facilitation group showed significant improvements in pain levels, piriformis muscle length, straight leg raise ability, and lower extremity function compared to those receiving ELDOA treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of ELDOA and post-facilitation stretching technique on pain and functional performance in patients with piriformis syndrome: A randomized controlled trial. Shahzad, M., Rafique, N., Shakil-Ur-Rehman, S., et al.[2021]

Strain counterstrain is a developing osteopathic technique, and recent research is beginning to explore its physiological mechanisms and clinical effects.

The master class provides clinical application guidelines and specific treatment strategies for various key clinical scenarios, indicating its practical relevance in patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strain counterstrain: current concepts and clinical evidence. Wong, CK.[2022]

Strain counterstrain (SCS) technique shows a statistically significant reduction in tender point palpation pain compared to control conditions, based on a meta-analysis of five randomized control trials.

The overall quality of evidence for SCS's effectiveness is low, indicating a need for higher-quality studies with larger sample sizes to better assess long-term outcomes related to pain and dysfunction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: a systematic review with meta-analysis. Wong, CK., Abraham, T., Karimi, P., et al.[2022]

A single strain-counterstrain intervention did not significantly improve cervical range of motion compared to a sham treatment in 61 patients with neck pain, with only a 1.5% difference in mobility restriction after treatment.

Both groups showed improvement after receiving full individualized osteopathic treatment, suggesting that the overall osteopathic approach may be more effective than strain-counterstrain alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial. Klein, R., Bareis, A., Schneider, A., et al.[2022]

In a study involving 60 patients with mechanical neck pain, the addition of the Strain-counterstrain technique (SCS) to standard therapy significantly improved pain levels, pressure pain thresholds, and disability scores compared to standard therapy alone.

The results suggest that SCS is an effective treatment method for enhancing recovery in patients with mechanical neck pain, supporting its use in clinical practice to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial. El-Khateeb, YS., Mahmoud, AG., Mohamed, MH., et al.[2023]

The strain and counterstrain (SCS) technique showed promising results in reducing pain and improving function in 19 out of 20 patients with chronic myofascial pain who had not responded to standard treatments, with improvements ranging from 50% to 100%.

After SCS therapy, 11 of the 20 patients maintained partial improvement for 6 months, and 4 patients reported being pain-free, suggesting that SCS could be a valuable adjunctive therapy for chronic pain disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy. Dardzinski, JA., Ostrov, BE., Hamann, LS.[2019]

A case study of a man in his late 40s with piriformis syndrome showed that a botulinum toxin (BoNT) injection significantly relieved his pain, lasting for 2 years after the second injection.

The study suggests that increasing the dilution volume of the BoNT injection may enhance its therapeutic effectiveness for treating piriformis syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Botulinum toxin injection strategy of intractable and relapsed piriformis syndrome: A case report. Kwon, SY., Jun, EH., Park, SJ., et al.[2022]

Ultrasound-guided dry needling is proposed as a novel treatment approach for piriformis syndrome, which is caused by the compression of the sciatic nerve under the piriformis muscle.

This method offers a different perspective compared to traditional treatments like physical therapy, stretching, and injections, potentially providing effective relief for patients suffering from this painful condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment. Bağcıer, F., Tufanoğlu, FH.[2021]

The study identified optimal injection sites for botulinum neurotoxin in the piriformis muscle, based on nerve distribution patterns observed in 15 specimens, which can enhance treatment efficacy.

Clinicians can use these guidelines to improve the effectiveness of various injection treatments (like steroids and anesthetics) while minimizing the risk of adverse outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidelines for botulinum neurotoxin injections in piriformis syndrome. Yi, KH., Lee, KL., Lee, JH., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release. [2023]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Effects of ELDOA and post-facilitation stretching technique on pain and functional performance in patients with piriformis syndrome: A randomized controlled trial. [2021]

3. Scotland pubmed.ncbi.nlm.nih.gov

Strain counterstrain: current concepts and clinical evidence. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: a systematic review with meta-analysis. [2022]

5. Scotland pubmed.ncbi.nlm.nih.gov

Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial. [2022]

6. Italy pubmed.ncbi.nlm.nih.gov

Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Botulinum toxin injection strategy of intractable and relapsed piriformis syndrome: A case report. [2022]

9. Turkey pubmed.ncbi.nlm.nih.gov

A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Guidelines for botulinum neurotoxin injections in piriformis syndrome. [2021]