DOI: 10.7860/JCDR/2025/76341.

21035
Case Report

Effect of Class IV LASER Therapy

Physiotherapy Section
as an Adjunct to Conventional
Physical Therapy on Piriformis
Syndrome: A Case Report
Tushar Sharma1, Pooja Mehra2, Nitesh Verma3, Aksh Chahal4, Nikita Rathore5

ABSTRACT
Piriformis syndrome is a clinical condition characterised by the entrapment of sciatic nerve beneath the piriformis muscle, resulting
in non discogenic sciatica. This syndrome is often neglected despite its capacity to induce considerable pain and functional
impairments. Physical therapy plays a crucial role in the management of such conditions, providing customised interventions aimed
at symptom alleviation and functional restoration. Class IV Light Amplification by Stimulated Emission of Radiation (LASER) therapy
has surfaced as a promising therapeutic approach for a variety of musculoskeletal conditions. LASER therapy possesses the
potential to effectively mitigate pain associated with piriformis syndrome while enhancing patient outcomes. Hereby, the authors
present a case study involving a 27-year-old male patient who reported experiencing pain in the right hip region. He exhibited an
antalgic gait and faced difficulties with daily activities due to the intensity of pain. The outcome measures comprised evaluations
of hip Range of Motion (ROM), the Numeric Pain Rating Scale (NPRS) and the Oswestry Low Back Disability Questionnaire (ODI).
Following two weeks of consistent physiotherapy interventions and one week of subsequent follow-up, the patient demonstrated
a notable reduction in pain, allowing him to return to normal activities. The present findings substantiate the efficacy and safety
of Class IV LASER therapy as a non invasive intervention for the treatment of patients with piriformis syndrome, with no adverse
effects observed in both the short and long-term.

Keywords: Light amplification by stimulated emission of radiation, Musculoskeletal disorders,

­Numeric pain rating scale, Pain, Range of motion, Sciatic nerve

CASE REPORT the supero-lateral quadrant of the right buttock. Limb length
A 27-year-old male patient visited the Orthopaedic Department measurement was done using measuring tape, and it shows right
expressing complaints of pain in his right buttock. Due to the acute limb was 1.2 cm shorter then left one.
nature of his pain and notable tenderness in the superolateral Specific diagnostic tests, such as Freiberg test [2,3], Flexion
quadrant of the right buttock, he was referred to the Department of Adduction Internal Rotation Test (FAIR) [4], Beatty test [5], and Pace
Physiotherapy. Patient is a businessman and typically maintained a sign [6], shown in [Table/Fig-1-3], were employed in physiotherapy
seated posture for 5-6 hours daily as part of his professional routine. for provisional and differential diagnosis. Straight Leg Raise Test
He had no history of smoking or drinking, and no pertinent medical (SLRT) [7] on the right leg elicited increased buttock pain at 50°,
or family history was reported. while the slump test yielded positive for right-side. Based on the
The onset of the pain occurred 3-4 months prior and has patient signs and symptoms, some above mentioned special tests
progressively exacerbated over preceding 3-4 days. The patient has were conducted to make a diagnosis. Beatty sign was negative,
resorted to self-medication with Non-steroidal Anti-inflammatory while other tests were found positive [Table/Fig-4].
Drugs (NSAIDs) at intervals of 6-7 hours over the last three days
to alleviate the discomfort, yet has not sought formal treatment.
During the present visit, the pain was described as shooting in
nature inspite of attempts to engage in prolonged periods of rest,
activities such as sitting, climbing stairs, and walking for more
than 5-6 minutes remain arduous, accompanied by a sensation of
numbness extending into leg and foot.
The patient presented with an antalgic gait, along with Hand on
Hip Sign (HHS), and was instructed to minimise clothing for
further evaluation in a cabin to maintain the privacy. The patient’s
physique was ectomorphic, with a postural assessment conducted
in standing position revealing no deformities, misalignments, or
muscular imbalances when assessed in anterior, posterior, and [Table/Fig-1]: FAIR test performed on the patient [4].
lateral views. In prone position, the patient exhibited a poor general
condition, with muscular atrophy and mild swelling at the site of On the basis of these findings and HHS, the patient was diagnosed
pain (right buttock). Palpation revealed grade-3 tenderness [1], with with piriformis syndrome. Because of this syndrome, symptoms of
no significant temperature difference compared to the unaffected Prolapsed Intervertebral Disc (PIVD) and radiculopathy may persist
side. Direct palpation over the right sciatic notch precisely in patient. A lumbar spine X-ray, in anteroposterior and lateral
reproduced the patient’s pain, which intensified with palpation over views, was advised to rule out other possible causes of pain. The
6 Journal of Clinical and Diagnostic Research. 2025 May, Vol-19(5): YD06-YD09
[Link] Tushar Sharma et al., LASER Therapy Effect on Piriformis Syndrome

imaging results displayed a normal lordotic curvature of lumbar

spine, characterised by 28° lumbo-sacral angle, and without any
degenerative changes were observed.

Physiotherapy Intervention
A two-week regimen of physical therapy, along with one week of a
home exercise protocol, was devised to alleviate pain. Cryotherapy
[8], Transcutaneous Electrical Nerve Stimulation (TENS) [9], and
Class IV LASER therapy were employed during the first week,
after which, commencing on the second week, onwards Positional
Release Technique (PRT) was added alongside the ongoing
treatment, and is shown in [Table/Fig-5]. Before treatment, all
the procedures were explained to patient, and a written informed
consent was taken.
[Table/Fig-2]: PACE sign performed on the patient [6].
Treatment started with 10 minutes of cryotherapy over the affected
area, followed by 10 minutes of rest to minimise its effect. After that,
2-pole TENS was used in continuous mode for 25 minutes. Class IV
LASER therapy was used at last over the taut and painful area using
non contact and continuous grid scanning mode for five minutes.
This treatment was repeated daily. Detailed description is shown in
[Table/Fig-6].
From 2nd week, the PRT was integrated into the treatment along with
ongoing therapy, which included five repetitions per session with
three sets, each lasting 90 seconds [10]. Following each repetition,
an active rest of one minute was given, with two minutes of active
rest provided after each set.
Home exercises were recommended to the patient for the following
week, and he was instructed to perform them daily, twice per
day, along with ergonomic advice (to avoid prolonged sitting and
[Table/Fig-3]: Beatty test performed by the patient [5]. maintain good posture). One week after completion of therapy, the

Tests Patient position Description Result

Freiberg test [2,3] Supine Therapist passively performed internal rotation at hip. Movement caused pain at the buttock indicated positive result. Positive
Patient lied on the left-side with right leg on top. Therapist stabilised the hip with one hand and brought knee towards
FAIR test [4] Side lying Positive
chest while internally rotating the leg. Increase in discomfort over buttock area, indicated positive result.
Patient was asked to abduct and externally rotate the hip, while the therapist applied resistance over the thigh. Increase
Pace sign [6] Sitting Positive
in pain resulted in positive outcome.
Beatty test [5] Side lying Patient lied on left-side with right leg on top and performed abduction. Patient complaint no pain, hence test was negative. Negative
[Table/Fig-4]: Diagnostic tests for piriformis syndrome.
FAIR: Flexion adduction internal rotation

Right Left
After 1 week of After 2 weeks of 1 week after After 1 week of After 2 weeks of 1 week after
AROM ­initiating therapy initiating therapy ­completion of therapy ­initiating therapy initiating therapy ­completion of therapy
Flexion 0°-95° 0°-100° 0°-105° 0°-110° 0°-110° 0°-110°
Extension 0°-15° 0°-20° 0°-30° 0°-25° 0°-25° 0°-25°
Internal rotation 0°-20° 0°-30° 0°-30° 0°-40° 0°-40° 0°-40°
External rotation 0°-25° 0°-40° 0°-45° 0°-45° 0°-45° 0°-45°
Abduction 0°-40° 0°-45° 0°-45° 0°-45° 0°-45° 0°-45°
Adduction 0°-25° 0°-30° 0°-30° 0°-35° 0°-35° 0°-35°
[Table/Fig-5]: Hip Range of Motion (ROM).
AROM: Active range of motion

Intervention Patient position Description

1st and 2nd week
Cryotherapy [10] Prone lying A cold pack was placed over right gluteal and mid-thigh region for 10 minutes.
2-Pole Transcutaneous Electrical Electrodes were placed over right gluteal region (ischial tuberosity and medial to sacrum), continuous mode for
Prone lying
Nerve Stimulation (TENS) [11] 25 minutes with frequency of 80 Hz were used.
Head of LASER was placed over taut muscle fibre in right gluteal region. Parameters used were continuous scanning
Class IV LASER Therapy Prone lying mode with non-contact application and wavelength 810-910 nm, energy density 216 J/cm2 with peak power 12.0 W
for 5-minute treatment.
2nd week onwards
Patient was asked to bend right knee (90°) and palpate muscle to identify taut band. Muscle was shortened in
Positional Release Technique position (passive hip extension) and adequate pressure was applied over trigger point for 90 seconds then back to
Prone lying
(PRT) [12] starting position. He was advised to perform no active movement during the procedure. Five repetitions, three sets
with two minutes rest given in-between.

Journal of Clinical and Diagnostic Research. 2025 May, Vol-19(5): YD06-YD09 7

 Tushar Sharma et al., LASER Therapy Effect on Piriformis Syndrome [Link]

Home exercise program

Patient was asked to cross his right leg over left leg. Then, pull the left knee towards right shoulder until stretch is felt.
Piriformis muscle stretching [12] Supine lying
3 repetitions with 30-seconds hold, 2 sets and 1 minute rest in-between.
Patient was asked to stand near wall and bend right knee (90°). Then, perform hip extension and return to starting position.
Hip extension Standing
5 repetitions with 5-seconds hold, 2 sets and 1 minute rest in-between.
[Table/Fig-6]: Description of treatment program.

patient’s gait was observed to be normal, with no HHS, indicating concluded that seven sessions of Class IV LASER therapy were
substantial recovery across all dimensions. No adverse effects, effective in reducing pain in patients with knee osteoarthritis [17].
harms, or allergic reaction over the skin were reported at the end of In a similar study by Haladaj R et al., high-intensity LASER therapy
two-weeks of physical therapy. was shown to be more efficacious for cervical spondylosis than the
Outcome measures, such as NPRS and ODI, were used to asses, Saunders traction device [18]. Fiore P et al., conducted a study on
patients with low back pain, revealing that fifteen sessions of high-
pain intensity and lower back disability [8,9]. NPRS is a subjective
intensity LASER therapy showed significant improvement compared
pain assessment tool in which patient is asked to score their
to therapeutic ultrasound [19].
intensity of pain on a scale of 0 to 10 [8]. ODI, which offers a
subjective percentage score of disability in activities of daily life, is The current report highlights the significant clinical importance of
the gold standard tool for low back pain. Each of the ten sections Class IV LASER therapy as a crucial electrotherapeutic modality for
of this questionnaire has six questions, with a score ranging from 0 treating piriformis syndrome, thereby facilitating patient recovery and
to 5. The percentage of disability is determined by taking the total overall health status. The synergistic application of these therapeutic
score, dividing it by the total possible score, and then multiplying modalities expedited the recovery process within a reduced time
the result by 100. The interpretation of ODI is as follows: 0%-20%: frame and prevented extraneous screening tests, time saving and
minimal disability, 21-40%: moderate disability, 41-60%: severe cost-effective.
disability, 61-80%: crippled, and 81-100%: bed-bound/ridden [11]. Nevertheless, it is important to note that this investigation is based
All outcome measures were assessed at day 1 (pre-assessment), on a single case study, and simultaneous administration of LASER
as well as on 1st and 2nd weeks (post-assessment), and one week therapy in conjunction with other therapeutic approaches may
after completion of therapy and are documented in assessment obscure the isolated effect attributable solely to LASER therapy, this
proforma. represents a limitation of our research. Future randomised controlled
trails should be conducted on a larger cohort to assess the efficacy
The hip AROM was assessed at baseline for right limb. The ROM for
of LASER therapy in isolation.
hip flexion, extension, internal and external rotation, abduction, and
adduction was 0-30°, 0°-10°, 0°-10°, 0°-10°, 0°-20°, and 0°-20°,
CONCLUSION(S)
respectively. There was significant improvement in right hip ROM In present study, authors concluded that two weeks of LASER
after completion of treatment, as shown in [Table/Fig-5]. therapy shows significant improvement in patients with piriformis
Pre- and post-outcome measures showed improvement in NPRS syndrome along with conventional physical therapy.
and ODI as shown in [Table/Fig-7]. Pain significantly decreased from
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PARTICULARS OF CONTRIBUTORS:
1. BPT Student, Department of Physiotherapy, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India.
2. Assistant Professor, Department of Physiotherapy, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India.
3. Assistant Professor, Department of Physiotherapy, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India.
4. Professor and Research Professor, Department of Physiotherapy and Galgotias Multi-Disciplinary Research and Development Cell, Galgotias University, Greater Noida,
Uttar Pradesh, India.
5. Chief Physiotherapist, Pain and Strains Rehabilitation Clinic, Jaipur, Rajasthan, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: PLAGIARISM CHECKING METHODS: [Jain H et al.] Etymology: Author Origin
Dr. Pooja Mehra, • Plagiarism X-checker: Oct 17, 2024
Assistant Professor, Department of Physiotherapy, Maharishi Markandeshwar Medical • Manual Googling: Feb 08, 2025 Emendations: 7
College and Hospital, Kumarhatti, Solan-173229, Himachal Pradesh, India. • iThenticate Software: Feb 10, 2025 (5%)
E-mail: [Link]@[Link]

Author declaration: Date of Submission: Oct 16, 2024

• Financial or Other Competing Interests: None Date of Peer Review: Nov 27, 2024
• Was informed consent obtained from the subjects involved in the study? Yes Date of Acceptance: Feb 15, 2025
• For any images presented appropriate consent has been obtained from the subjects. Yes Date of Publishing: May 01, 2025

Journal of Clinical and Diagnostic Research. 2025 May, Vol-19(5): YD06-YD09 9