MEDICAL HEALTH CAREPRESENTATION

1. Supervisor:
Dr. Laila Niaz Khan
Submitted by:
Rabia Arif
Mohsan Mubarak
Sidra Amjad

2. Department: Doctor of Physical Therapy
Session: 2018-2023

3.  The piriformis is a small muscle deep in the buttock, behind the gluteus
maximus. It runs diagonally from the lower spine to the upper surface of
the femur, with the sciatic nerve running underneath or through the
muscle. The piriformis muscle helps the hip rotate, turning the leg and foot
outward.
 The arterial supply of piriformis muscle is from the inferior gluteal, superior
gluteal, and internal pudendal arteries, all branches of the internal iliac
artery. The nerve supply of piriformis is superior gluteal nerve
 Low back pain is defined as pain and discomfort, localised below the costal
margin and above the inferior gluteal folds, with or without leg pain.
 The most common muscles that are responsible for Low Back Pain are the
Iliopsoas, Quadratus Lumborum, the Gluteals and the Multifidus muscles.
They are the muscles that attach in and around your spine. The Iliopsoas is
actually two muscles that meet at the front of your hip.

4. This study was conducted by Khan et al. conducted a cross-sectional study at Lady
Reading Hospital in Peshawar, Pakistan, to regulate the regularity of piriformis
syndrome in patient role by post decompression lumbar surgical procedure. Study
included 60 patients selected through simple random sampling. The analysis
revealed that the occurrence of piriformis syndrome among affected role with
post-decompression lumbar surgeries was 36.5%. However, no was found between
piriformis syndrome and the surgeries.

5. In a recent study published in the International Journal of Health Science Research,
researchers aimed to recognize the prevalence of piriformis tightness in inactive
people. The study included 200 subjects, who were carefully evaluated and screened
constructed on explicit inclusion, and exclusion criteria. The assessment of piriformis
muscle tightness involved the use of the both the established piriformis stretch
medical test and the piriformis stretch test. The findings revealed that 159 subjects,
accounting for 79.5% of the sample, exhibited piriformis tightness. The study
concluded that there is a high prevalence of piriformis tightness in the inactive
people, particularly among adults, which may rise the danger of emerging piriformis
syndrome and subsequent low back pain. (Othman et al., 2023)

6.  This study set out to ascertain whether people with low back discomfort were more
susceptible to piriformis muscular disorder. The purpose of this study is to increase
knowledge about piriformis muscle disorder as well as low back discomfort in the
research groups along with healthcare professionals.
The purpose of this study is to determine the prevalence of piriformis muscle syndrome
among individuals with low back pain who spend a lot of time sitting down and being
sedentary at work and to generate the frequency of piriformis muscle syndrome among
individuals with low back pain

7. 3.1 Study Design:
It was a cross-sectional study. which an is observational study that analyzes data from a population or a
representative at specific point in time that is cross-sectional data.
3.2 Study Setting:
Data was gathered from Services Hospital, Lahore. Johar institute professional study and bank
3.3 Study Duration:
The study was completed in six months following the ethical committee's approval of the summary.
3.4 Sampling technique:
For this study, nonprobability convenient sampling technique was used.
3.5 Sample Size/collection:
The sample size of my research was 210. The sampling was calculated by the following the formula keeping
the margin of error equal to 0.05 and the level of significance equal to 5%
𝑛 = 𝑍P (1 − 𝑃)
n = Sample size= 210
Z 2 = corresponding to the level of significance
d 2 = margin of error = 0.05%
p = expected prevalence

8. 3.6 Sample Selection:
The following criteria were used to choose the sample.
3.6.1 Inclusion criteria:
Sample within the age group of 30-50 years was a part of this study.
Both gender are included
Other symptoms including sciatic nerve compression, association of low back pain is also
found positive
Low back discomfort, above the age of 30.(A. Chang et al., 2023)
patients included office worker, prolonged bad rest of hospital, and institute
3.6.2 Exclusion Criteria:
The following were among the criteria for exclusion:
Injury to lumber during a traffic accident
Spinal fusion surgery
Disc degenerative disease
Lumbar disc discomfort (Koli & Anap, 2018)
3.7 Data Collection Procedure:
This study was conducted by selecting subjects based on inclusion criteria from different
setting . A questionnaire was used for the collection of demographic data. To diagnose
piriformis syndrome and low back pain FAIR Test and visual analogue scale were used

9. 3.8 Data Collection Tool:
The information was gathered from every participant after taking consent,
after briefing them regarding our study and data collection procedure. During
our testing process we followed social norms. We collected data using the
visual analogue scale questionnaire and an outcome assessment tool that
includes questions about everyday activities to find prevalence of piriformis
muscle syndrome with low back pain.
3.9 Ethical Issues:
The subject was fully informed before the interview and the reason for
conducting the survey. All information gathered by the subject was kept
confidential and was not shared with any outside source for public display.
The subject was free to complete the questionnaire or to withdraw at any
stage.

10. Patients with confirmed 210 cases of low back pain were
added, and musculoskeletal tests (FAIR test) and questions
regarding their pain based on the VAS (visual analog scale) were
administered to the patients. Place the patient side-lying with
the hip being evaluated on top. Move the patient's lower
extremity passively into internal rotation, adduction, and 90-
degree flexion. To internally rotate and adduct the hip and
stretch the piriformis, which compresses the sciatic nerve, the
examiner stabilizes the hip and presses downward on the knee.
The test was considered affirmative when the sciatic/gluteal
region experiences pain. Data was gathered using a self-made
questionnaire.

11. 3.11 Data Analysis:
The Statistical Package for Social Sciences (SPSS) 16 version was used to analyze
the data. To check each factor, the frequency of each item's response was
examined individually

12. Figure 1: Age of participant
This figure shows the age distribution of participants as 66.7% are between the
ages of 30 to 40, and the remaining 33.3% fall within the 41 to 50 age range with
a mean deviation of 1.3333±47253.

13. Figure 2:Gender of Participants
This figure shows the gender distribution of participants, majority of 57.6% are female,
while 42.4% are male with the frequency of 121 and 89 and mean standard deviation1.5762± .49534.
0
20
40
60
80
100
120
140
male female
Frequency

14. Figure 3:Occupation of participant
This figure shows the occupation distribution of participants as 35.7% was an office worker,
29.0% was a housewife, and 35.2% was a teacher, with a mean standard deviation of 1.9952±.84433.
0
10
20
30
40
50
60
70
80
Office worker Housewife Teacher
Frequency

15. Figure 4: FAIR Test of participant
This figure shows the FAIR test values among participants as 49.0% positive and 41.0%
negative with a mean standard deviation of 1.4095±.49292.
0
20
40
60
80
100
120
140
Positive Negative
Frequency
FAIR Test

16. FIGURE 5: Visual Analogue Scale of Participants
This figure shows the participant’s values of the visual analogue scale. A total number of 210 participants
were included in this study. Of the participants who have 27.1% had no pain, 33.3% had moderate pain,
and 39.5% had unbearable pain. The average mean standard deviation of the participant’s VAS was 1.1238±.80898.
0
10
20
30
40
50
60
70
80
90
No Pain Moderate Pain Unbearable Pain
Frequency

17. A disorder known as piriformis syndrome results in pain in the leg and buttocks due
to injury to the piriformis muscle. Although piriformis syndrome can cause low back
pain, doctors tend to underestimate it and ignore it most of the time to assess
individuals with low back pain for piriformis syndrome.

18. our study concluded that the Prevalence of piriformis muscle syndrome with low
back pain is very high among office workers teachers and housewives. Along with
other symptoms including sciatic nerve compression, association of low back pain
is also found positive.

19. Limitation
 Small sample size
 Study was limited to Services Hospital Lahore
 Subject Perception of Fatigue
 Further studies should have large sample sizes, and data should be collected from different
hospitals.
Recommendations
 For study populations, it is recommended that office workers, teachers, and housewives should be
encouraged to include a graded exercise program in their routine with adequate rest intervals.
Sleep management, stress management, a healthy diet, and several relaxation techniques should be
adopted by individuals to prevent piriformis muscle syndrome with low back pain.

20. Khan, M. I., Khalid, Z., Adnan, M., Rashid, F., Ullah, Q. F., & Bangash, S. A. (2022). Frequency of
Piriformis Syndrome in Patients with Post Decompression Lumbar Surgeries. Annals of the
Romanian Society for Cell Biology, 26(01), 2651-2656.
Othman, I. K., Raj, N. B., Siew Kuan, C., Sidek, S., Wong, L. S., Djearamane, S., . . . Selvaraj, S.
(2023). Association of Piriformis Thickness, Hip Muscle Strength, and Low Back Pain Patients with
and without Piriformis Syndrome in Malaysia. Life, 13(5), 1208.
Chang, A., Ly, N., & Varacallo, M. (2023). Piriformis injection StatPearls [Internet]: StatPearls
Publishing.
Koli, B. K., & Anap, D. B. (2018). Prevalence and severity of hamstring tightness among college
student: A cross sectional study. International Journal of Clinical and Biomedical Research, 65-
68.