Effectiveness of neurodynamic mobilization and MCGILL-type strengthening exercises in patients with piriformis syndrome: study protocol for a randomized controlled trial





piriformis syndrome, sciatica, neurodynamic mobilization, strengthening exercises.



Purpose: Determine the effectiveness of adding a McGill-type strengthening exercise program to neurodynamic mobilization in patients with pyramidal syndrome (PS).

Material and methods: This study has a pre/post experimental design of a randomized single-blind clinical trial that will be carried out in the province of Chimborazo - Ecuador, with a duration of 8 months. The final sample will be formed by 58 patients with a diagnosis of SP who will be randomly assigned to a control group: neurodynamic mobilization and to an experimental group: neurodynamic mobilization plus McGill type strengthening exercises. Both groups will be evaluated before, immediately after and after two months of the intervention phase to determine changes in pain, disability, and range of motion.

Results: The comparison between the evaluations aims to reveal information on the effectiveness of combining neurodynamic mobilization plus McGill-type strengthening exercises, providing valuable information to contribute to the quality assurance of rehabilitation and physical activity behavior throughout rehabilitation patients.

Conclusions: Neurodynamic mobilization plus McGill-type strengthening exercises could reduce pain, improve range of motion and quality of life in patients diagnosed with SP.


Barbado, D., Irles-Vidal, B., Prat-Luri, A., García-Vaquero, M. P., & Vera-Garcia, F. J. (2019). Quantification of Core Stability Exercise Training Intensity using a Smartphone Accelerometer-Exercise Science. Journal of Physical Education. https://g-se.com/cuantificacion-de-la-intensidad-del-entrenamiento-de-ejercicios-de-estabilidad-de-core-mediante-un-acelerometro-de-smartphone-2527-sa-G5cd071a69b9d8

Boudier-Revéret, M., Gilbert, KK., Allégue, DR., Moussadyk, M., Brismée, JM., Sizer, PS., Feipel, V., Dugailly, PM., & Sobczak, S. (2017). Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskeletal Science and Practice, 31, 45-51. https://doi.org/10.1016/j.msksp.2017.07.004.

Boyajian-O'Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. The Journal of the American Osteopathic Association, 108(11), 657. https://doi.org/10.7556/jaoa.2008.108.11.657. https://doi.org/10.7556/jaoa.2008.108.11.657

Coppieters, M. W., & Butler, D. S. (2008). Do "sliders" slide and "tensioners" tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy, 13(3), 213-221. https://doi.org/10.1016/j.math.2006.12.008

Durrani, Z., & Winnie, A. P. (1991). Piriformis muscle syndrome: An underdiagnosed cause of sciatica. Journal of Pain and Symptom Management, 6(6), 374-379. https://doi.org/10.1016/0885-3924(91)90029-4.

Efstathiou, M. A., Stefanakis, M., Savva, C., & Giakas, G. (2015). Effectiveness of neural mobilization in patients with spinal radiculopathy: A critical review. Journal of Bodywork and Movement Therapies, 19(2), 205-212. https://doi.org/10.1016/j.jbmt.2014.08.006.

Ghorbanpour, A., Azghani, M. R., Taghipour, M., Salahzadeh, Z., Ghaderi, F., & Oskouei, A. E. (2018). Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain. Journal of Physical Therapy Science, 30(4), 481-485. https://doi.org/10.1589/jpts.30.481

Haładaj, R., Pingot, M., Polguj, M., Wysiadecki, G., & Topol, M. (2015). Anthropometric Study of the Piriformis Muscle and Sciatic Nerve: A Morphological Analysis in a Polish Population. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 21, 3760-3768. https://doi.org/10.12659/MSM.894353.

Hopayian, K., & Danielyan, A. (2018). Four symptoms define the piriformis syndrome: An updated systematic review of its clinical features. European Journal of Orthopaedic Surgery & Traumatology, 28(2), 155-164. https://doi.org/10.1007/s00590-017-2031-8

Kean Chen, C., & Nizar, A. J. (2013). Prevalence of Piriformis Syndrome in Chronic Low Back Pain Patients. A Clinical Diagnosis with Modified FAIR Test: Diagnosis of Piriformis Syndrome with Modified FAIR. Pain Practice, 13(4), 276-281. https://doi.org/10.1111/j.1533-2500.2012.00585.x

Montenegro, J. A. (n. d.). Effect of two trunk stability trainings on balance quantified by smartphone-integrated accelerometer. 19.

Muñoz Chiamil, S. (2004). Piriform syndrome: A controversial entrapment neuropathy. Rev. Méd. Clín. Condes, 58-60.

Nazlıkul, H., Ural, F. G., Öztürk, G. T., & Öztürk, A. D. T. (2018). Evaluation of neural therapy effect in patients with piriformis syndrome. Journal of Back and Musculoskeletal Rehabilitation, 31(6), 1105-1110. https://doi.org/10.3233/BMR-170980.

Neto, T., Freitas, S. R., Marques, M., Gomes, L., Andrade, R., & Oliveira, R. (2017). Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis. Musculoskeletal Science and Practice, 27, 14-22. https://doi.org/10.1016/j.msksp.2016.11.014.

Papadopoulos, E. C., & Khan, S. N. (2004). Piriformis syndrome and low back pain: A new classification and review of the literature. Orthopedic Clinics of North America, 35(1), 65-71. https://doi.org/10.1016/S0030-5898(03)00105-6

Plaza-Manzano, G., Cancela-Cilleruelo, I., Fernández-de-las-Peñas, C., Cleland, J. A., Arias-Buría, J. L., Thoomes-de-Graaf, M., & Ortega-Santiago, R. (2020). Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients With Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial. American Journal of Physical Medicine & Rehabilitation, 99(2), 124-132. https://doi.org/10.1097/PHM.0000000000001295

Pourahmadi, M., Hesarikia, H., Keshtkar, A., Zamani, H., Bagheri, R., Ghanjal, A., & Shamsoddini, A. (2019). Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis. Pain Medicine, 20(2), 378-396. https://doi.org/10.1093/pm/pny208.

Solheim, L. F., Siewers, P., & Paus, B. (1981). The Piriformis Muscle Syndrome: Sciatic Nerve Entrapment Treated with Section of the Piriformis Muscle. Acta Orthopaedica Scandinavica, 52(1), 73-75. https://doi.org/10.3109/17453678108991762.

Tonley, J. C., Yun, S. M., Kochevar, R. J., Dye, J. A., Farrokhi, S., & Powers, C. M. (2010). Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 103-111. https://doi.org/10.2519/jospt.2010.3108

Uttam, M., & Yadav, H. (2016). Effectiveness of Dry Needling on Release of Myofascial Trigger Points in Acute Piriformis Syndrome: A Case Report. 5.