Volume 15, Issue 2 (Spring 2026)
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Rezazade F, Aali S, Imani F, Moradzade N, Sheikhalizadeh H. Comparison of the effectiveness of shockwave and guided injections on pain in patients with piriformis syndrome: a systematic review. aumj 2026; 15 (2) : 6
URL: http://aums.abzums.ac.ir/article-1-1950-en.html
URL: http://aums.abzums.ac.ir/article-1-1950-en.html
1- Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran , rezazadeh.farhad@uma.ac.ir
2- Department of Physical Education, Farhangian University, Tehran, Iran
3- Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
2- Department of Physical Education, Farhangian University, Tehran, Iran
3- Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
Abstract: (219 Views)
Introduction: Piriformis syndrome is a neuromuscular condition characterized by compression or irritation of the sciatic nerve by the piriformis muscle or adjacent structures. Various conservative treatment modalities have been proposed, including extracorporeal shockwave therapy (ESWT) and image-guided corticosteroid injections. This systematic review aimed to compare the effectiveness of ESWT and guided corticosteroid injections in improving pain and functional outcomes in patients with piriformis syndrome.
Methods: A systematic review was conducted by searching English- and Persian-language studies published up to 2025 in PubMed/MEDLINE, Web of Science, Scopus, SID, Magiran, Noormags, and Google Scholar. Studies evaluating the effectiveness of ESWT and guided corticosteroid injections in patients with piriformis syndrome were screened according to predefined inclusion and exclusion criteria. Eleven eligible studies involving a total of 576 participants were included in the review. The review protocol was registered in PROSPERO (CRD420251242461).
Results: The findings demonstrated that both ESWT and guided corticosteroid injections were effective in reducing pain intensity and improving functional outcomes and quality of life in patients with piriformis syndrome. Across the included studies, the two treatment modalities showed comparable clinical effectiveness, with no substantial differences in short-term outcomes. Improvements were generally maintained for up to three months following treatment.
Conclusion: Current evidence supports the clinical equivalence of ESWT and guided corticosteroid injections for the management of piriformis syndrome. Both interventions effectively reduce pain and improve quality of life. However, ESWT offers the advantages of being noninvasive and having a favorable safety profile, making it an attractive first-line treatment option, particularly for patients with contraindications to corticosteroid injections or concerns regarding invasive procedures.
Methods: A systematic review was conducted by searching English- and Persian-language studies published up to 2025 in PubMed/MEDLINE, Web of Science, Scopus, SID, Magiran, Noormags, and Google Scholar. Studies evaluating the effectiveness of ESWT and guided corticosteroid injections in patients with piriformis syndrome were screened according to predefined inclusion and exclusion criteria. Eleven eligible studies involving a total of 576 participants were included in the review. The review protocol was registered in PROSPERO (CRD420251242461).
Results: The findings demonstrated that both ESWT and guided corticosteroid injections were effective in reducing pain intensity and improving functional outcomes and quality of life in patients with piriformis syndrome. Across the included studies, the two treatment modalities showed comparable clinical effectiveness, with no substantial differences in short-term outcomes. Improvements were generally maintained for up to three months following treatment.
Conclusion: Current evidence supports the clinical equivalence of ESWT and guided corticosteroid injections for the management of piriformis syndrome. Both interventions effectively reduce pain and improve quality of life. However, ESWT offers the advantages of being noninvasive and having a favorable safety profile, making it an attractive first-line treatment option, particularly for patients with contraindications to corticosteroid injections or concerns regarding invasive procedures.
Article number: 6
Keywords: Piriformis Muscle Syndrome, Extracorporeal Shockwave Therapy, Injections, Intralesional, Sciatic Neuropathy, Pain Management, Quality of Life
Type of Study: Original |
Subject:
General
Received: 2025/10/08 | Accepted: 2026/02/24 | Published: 2026/06/06
Received: 2025/10/08 | Accepted: 2026/02/24 | Published: 2026/06/06
References
1. Barbosa ABM, Santos PVd, Targino VA, Silva NdA, Silva YCdM, Gomes FB, et al. Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome? Arquivos de Neuro-Psiquiatria. 2019;77(9):646-53. [DOI:10.1590/0004-282x20190093]
2. Lam C, Francio VT, Gustafson K, Carroll M, York A, Chadwick AL. Myofascial pain-A major player in musculoskeletal pain. Best Practice & Research Clinical Rheumatology. 2024;38(1):101944. [DOI:10.1016/j.berh.2024.101944]
3. Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Current sports medicine reports. 2015;14(1):41-4. [DOI:10.1249/JSR.0000000000000110]
4. Chang C, Jeno SH, Varacallo MA. Anatomy, bony pelvis and lower limb: piriformis muscle. StatPearls [Internet]: StatPearls Publishing; 2023.
5. Giuffre BA, Black AC, Jeanmonod R. Anatomy, sciatic nerve. StatPearls [Internet]: StatPearls Publishing; 2023.
6. Aali S, Rezazadeh F, Ardigò LP, Badicu G. Altered lower extremity muscle activity patterns due to Iliopsoas tightness during single-leg landing. Scientific Reports. 2025;15(1):9477. [DOI:10.1038/s41598-025-93905-6]
7. Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. Journal of Osteopathic Medicine. 2008;108(11):657-64. [DOI:10.7556/jaoa.2008.108.11.657]
8. Doosti Irani R, Golpayegani M, Faraji F. The effect of core stability exercises on pain and inflammation of patients with piriformis syndrome. Journal of Arak University of Medical Sciences. 2022;25(2):310-23. [DOI:10.32598/jams.25.2.6890.1]
9. Reus M, de Dios Berná J, Vázquez V, Redondo MV, Alonso J. Piriformis syndrome: a simple technique for US-guided infiltration of the perisciatic nerve. Preliminary results. European radiology. 2008;18(3):616-20. [DOI:10.1007/s00330-007-0799-3]
10. Wiewelhove T, Döweling A, Schneider C, Hottenrott L, Meyer T, Kellmann M, et al. A meta-analysis of the effects of foam rolling on performance and recovery. Frontiers in physiology. 2019;10:449926. [DOI:10.3389/fphys.2019.00376]
11. Jaiswal A, Saxena A, Sandhu YK, Jangra MK. Joint Effectiveness of Dry Needling and Neurodynamic Mobilisation in Patients Suffering from Piriformis Syndrome: A Case Series. Journal of Clinical & Diagnostic Research. 2024;18.
12. Khakneshin A, Javaherian M, Attarbashi Moghadam B. The efficacy of physiotherapy interventions for recovery of patients suffering from piriformis syndrome: a literature review. Journal of Rafsanjan University of Medical Sciences. 2021;19(12):1304-18. [DOI:10.29252/jrums.19.12.1304]
13. Cassidy L, Walters A, Bubb K, Shoja MM, Shane Tubbs R, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surgical and radiologic anatomy. 2012;34(6):479-86. [DOI:10.1007/s00276-012-0940-0]
14. Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle & nerve. 2009;40(1):10-8. [DOI:10.1002/mus.21318]
15. Misirlioglu TO, Akgun K, Palamar D, Erden MG, Erbilir T. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain physician. 2015;18(2):163. [DOI:10.36076/ppj/2015.18.163]
16. Tabatabaei A, Takamjani IE, Sarrafzadeh J, Salehi R. Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial. Journal of Bodywork and Movement Therapies. 2024;37:323-7. [DOI:10.1016/j.jbmt.2023.11.058]
17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021;372.
18. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of epidemiology & community health. 1998;52(6):377-84. [DOI:10.1136/jech.52.6.377]
19. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj. 2019;366.
20. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. bmj. 2016;355.
21. Fu Y-S, Shih K-S, Lin Y-T, Hsieh L-F, Liu Y-F, Chen Y-R. Efficacy of ultrasound-guided piriformis muscle corticosteroid injection versus extracorporeal shockwave therapy in patients with piriformis syndrome: A randomized controlled trial. Journal of the Formosan Medical Association. 2025.
22. Ahadi T, Yousefi A, Sajadi S, Yousefi N, Babaei-Ghazani A. Comparing radial extracorporeal shockwave therapy and corticosteroid injection in the treatment of piriformis syndrome: A randomized clinical trial. Journal of bodywork and movement therapies. 2023;33:182-8. [DOI:10.1016/j.jbmt.2022.09.020]
23. Elsawy AGS, Ameer AH, Gazar YA, Allam AE-S, Chan S-M, Chen S-Y, et al., editors. Efficacy of ultrasound-guided injection of botulinum toxin, ozone, and lidocaine in piriformis syndrome. Healthcare; 2022: MDPI.
24. Yan K, Xi Y, Hlis R, Chhabra A. Piriformis syndrome: pain response outcomes following CT-guided injection and incremental value of botulinum toxin injection. Diagnostic and Interventional Radiology. 2020;27(1):126. [DOI:10.5152/dir.2020.19444]
25. Ahmed MAA. Dexamethasone versus magnesium sulfate as an adjuvant to local anesthetics in the ultra-sound guided injection of piriformis muscle for the treatment of piriformis syndrome. The Open Anesthesia Journal. 2020;14(1).
26. Tabatabaiee A, Takamjani IE, Sarrafzadeh J, Salehi R, Ahmadi M. Ultrasound‐guided dry needling decreases pain in patients with piriformis syndrome. Muscle & nerve. 2019;60(5):558-65. [DOI:10.1002/mus.26671]
27. Huang C-F, Chen T-W, Li C-F, Hsiao Y-H, Chen C-H, Huang M-H. The preliminary results of extracorporeal shockwave therapy in patients with piriformis syndrome. Rehabilitation Practice and Science. 2018;46(1):37-45.
28. Jeong HS, Lee GY, Lee EG, Joe EG, Lee JW, Kang HS. Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome. Ultrasonography. 2015;34(3):206-10. [DOI:10.14366/usg.14039]
29. Fabregat G, Rosello M, Asensio-Samper JM, Villaneuva-Perez VL, Martinez-Sanjuan V, De Andres J, et al. Computer-tomographic verification of ultrasound-guided piriformis muscle injection: a feasibility study. Pain physician. 2014;17(6):507. [DOI:10.36076/ppj.2014/17/507]
30. Masala S, Crusco S, Meschini A, Taglieri A, Calabria E, Simonetti G. Piriformis syndrome: long-term follow-up in patients treated with percutaneous injection of anesthetic and corticosteroid under CT guidance. Cardiovascular and interventional radiology. 2012;35(2):375-82. [DOI:10.1007/s00270-011-0185-z]
31. Şenlikci HB, Yücealp Ö, Borman P, Ince Keskin Z, Gümüş Atalay S, Yaşar E. Comparison of the efficacy of radial and focused extracorporeal shock-wave therapy (ESWT) in myofascial pain syndrome: a randomized, sham-controlled study. Lasers in medical science. 2025;40(1):404. [DOI:10.1007/s10103-025-04676-5]
32. Wang Y-C, Chen S-J, Huang P-J, Huang H-T, Cheng Y-M, Shih C-L. Efficacy of different energy levels used in focused and radial extracorporeal shockwave therapy in the treatment of plantar fasciitis: a meta-analysis of randomized placebo-controlled trials. Journal of clinical medicine. 2019;8(9):1497. [DOI:10.3390/jcm8091497]
33. Şah V, Kaplan Ş, Özkan S, Adanaş C, Toprak M. Comparison between radial and focused types of extracorporeal shock-wave therapy in plantar calcaneal spur: A randomized sham-controlled trial. Phys Sportsmed. 2023;51(1):82-7. [DOI:10.1080/00913847.2022.2091413]
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