Co esponding au ho : Be cy Biju
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Acu e e ec o con inuous 10 second passi e s e ching on pi i o mis lexibili y
Be cy Biju * and Va adha ajulu Go indha Mandi i
Depa men o Neu osciences, K ishna College o Physio he apy, K ishna Ins i u e o medical Science Deemed o be
Uni e si y, Ka ad, Maha ash a, India-415539.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 413-420
Publica ion his o y: Recei ed on 17 Augus 2025; e ised on 23 Sep embe 2025; accep ed on 26 Sep embe 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.23.3.0870
Abs ac
Backg ound: Pi i o mis synd ome (PS) is a neu omuscula condi ion cha ac e ized by bu ock pain and scia ic ne e
i i a ion, o en exace ba ed by si ing o lowe limb ac i i y. Conse a i e in e en ions, including s e ching, a e
commonly used o manage symp oms, bu e idence on he acu e e ec i eness o sho -du a ion passi e s e ching is
limi ed.
Objec i e: This s udy aimed o e alua e he immedia e e ec s o a 10-second passi e s e ching in e en ion on
pi i o mis muscle lexibili y and associa ed pain in adul s aged 20–45 yea s.
Me hods: A o al o 20 pa icipan s (13 males, 7 emales) wi h pi i o mis igh ness and lowe back discom o we e
ec ui ed. P e- and pos -in e en ion assessmen s o pain we e pe o med using he Visual Analogue Scale (VAS).
Pa icipan s we e s a i ied by age (20–35 and 35–45 yea s) and gende o examine subg oup esponses. Da a we e
analysed o o e all pain educ ion, age- and gende -speci ic e ec s, and imp o emen s in muscle lexibili y.
Resul s: The in e en ion signi ican ly educed pain, wi h mean VAS sco es dec easing om 5.45 p e-in e en ion o
2.80 pos -in e en ion (mean educ ion: 2.65). Bo h age g oups demons a ed compa able imp o emen s (20–35 yea s:
2.62; 35–45 yea s: 2.67), and bo h gende s bene i ed, wi h sligh ly highe educ ions in males (2.69) compa ed o
emales (2.57). Pa icipan s wi h highe baseline pain also expe ienced meaning ul imp o emen s. Ad anced
isualiza ion echniques, including KDE and iolin plo s, highligh ed pain dis ibu ion and in e en ion e icacy.
Conclusion: A 10-second passi e s e ching in e en ion e ec i ely educes pain and imp o es pi i o mis muscle
lexibili y ac oss age and gende g oups. These indings suppo i s po en ial clinical applica ion o acu e managemen
o pi i o mis synd ome. Howe e , small sample size and gende imbalance sugges ha la ge , mo e balanced s udies
a e needed o con i m and gene alize hese esul s.
Keywo ds: Pi i o mis Synd ome; Passi e S e ching; Visual Analogue Scale; Pain Reduc ion; Muscle Flexibili y; Acu e
In e en ion
1. In oduc ion
Pi i o mis synd ome is a condi ion cha ac e ized by in lamma ion o he scia ic ne e caused by abno mal condi ions
in he pi i o mis muscle (Adiya ma e al, 2022). I is cha ac e ized by bu ock pain, po en ially adia ing o he leg,
wo sened by si ing o lowe limb ac i i y. Symp oms may include ende ness o he pi i o mis muscle, leg leng h
disc epancy, and pain du ing esis ed hip abduc ion, wi hou low back issues (Ag awal e al., 2023). I is causing
symp oms like bu ock pain and ende ness. I is o en diagnosed as a myo ascial condi ion, wi h conse a i e
managemen being he ini ial ea men app oach (Lo e al., 2024). Pi i o mis synd ome is an en apmen neu opa hy
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 413-420
414
caused by he comp ession o he scia ic ne e by he pi i o mis muscle, leading o pain, numbness, and weakness in
he scia ic ne e dis ibu ion, o en ollowing auma o epe i i e hip mo ions (Waldman e al., 2024). Pi i o mis
synd ome (PS) is a condi ion causing deep glu eal pain, o en con used wi h spinal scia ica. I a ec s 0.3% o 36% o
pa ien s wi h low back pain, wi h ea men op ions including analgesics, he apeu ic exe cises, and, in se e e cases,
su ge y (Siddiq e al., 2023). I occu s due o excessi e con ac ion o he pi i o mis muscle, causing in lamma ion o
he scia ic ne e and a ec ing app oxima ely 2.4 million indi iduals annually, p edominan ly women in hei 4 h and
5 h decades o li e (Adiya ma e al, 2022). Diagnosis o pi i o mis synd ome is challenging, o en elying on clinical signs
and excluding o he condi ions and ea men includes physical he apy and injec ions. (Lo e al., 2024; Biggi e al.,
2011). Pi i o mis synd ome (PS) diagnosis is complex due o i s o e lapping symp oms wi h o he condi ions. Se e al
diagnos ic es s ha e been p oposed, each wi h a ying deg ees o eliabili y and speci ici y. The ollowing sec ions
ou line he p ima y diagnos ic me hods o PS (Chen and Niza , 2013; Geb egio igis and Amha, 2024). The diagnosis o
pi i o mis synd ome p ima ily aims o exclude o he causes o scia ica, as he e a e no p ecisely con i med diagnos ic
c i e ia. Va ious diagnos ic es s and imaging s udies a e a ailable, bu hei e ec i eness can a y based on indi idual
cases (Cholewa e la., 2024). The modi ied Flexion Adduc ion In e nal Ro a ion (FAIR) es , which combines he Lasegue
sign and FAIR es , is used o diagnosing pi i o mis synd ome. Con i ma ion is achie ed h ough pi i o mis muscle
injec ion, which se es bo h diagnos ic and he apeu ic pu poses (Chen and Niza , 2013). Diagnos ic musculoskele al
ul asound (MSK US) is a non-in asi e, cos -e ec i e es o e alua ing pi i o mis synd ome, p o iding dynamic, eal-
ime imaging o he pi i o mis muscle and adjacen s uc u es, aiding in accu a e diagnosis when co ela ed wi h clinical
symp oms and o he es s (Manske e al, 2024). The F eibe g es is a p edic i e diagnos ic es o pi i o mis synd ome
(PS). Howe e , diagnosis should be con i med by ende ness o he pi i o mis muscle and a local injec ion, as many
o he pa hologies can be inciden ally de ec ed adiog aphically (Yü ük e al., 2024). The Numbe Ra ing Pain Scale
(NRPS) and he Func ional Pe o mance Lowe Ex emi y Scale (FPLES) a e essen ial ools in pain assessmen and
unc ional e alua ion. The NRPS is a unidimensional scale ha quan i ies pain in ensi y on a 0-10 scale, widely
ecognized o i s eliabili y and alidi y ac oss a ious popula ions, including hose wi h spinal co d inju ies (B yce e
al., 2007). In con as , he FPLES is a mul idimensional ool ha assesses unc ional pe o mance, pa icula ly in lowe
ex emi ies, p o iding a b oade unde s anding o how pain impac s daily ac i i ies, and i allows o a comp ehensi e
e alua ion o pain's impac on unc ional ac i i ies, which is c ucial o ea men planning (Sa an e al., 2024). The
scia ic ne e, implica ed in Pi i o mis synd ome, o igina es om he L4 o S3 ne e oo s, which con e ge an e io o
he la e al sac um a loca ion ha can in luence i s suscep ibili y o en apmen a he pi i o mis muscle (Waldman e
al., 2024). This ne e eme ges om he lumbosac al plexus and ca ies ibe s p ima ily om L4 o S1, con ibu ing o
he a ied symp oma ology o he synd ome. The pi i o mis muscle i sel ecei es inne a ion mainly om he S1 and
S2 spinal segmen s, wi h occasional inpu om L5 (Mi a e al., 2024). The p ima y aim o his s udy is o de e mine he
acu e e ec o con inuous 10-second passi e s e ching on he lexibili y o he pi i o mis muscle. This esea ch ocuses
on e alua ing whe he a sho -du a ion passi e s e ch can p oduce immedia e imp o emen s in muscle lexibili y and
a educ ion in associa ed pain o discom o . The objec i es include assessing he baseline lexibili y o he pi i o mis
muscle, implemen ing a s anda dized 10-second passi e s e ching in e en ion, and measu ing any changes in muscle
lexibili y and pain sco e ollowing he in e en ion. By compa ing p e- and pos -in e en ion ou comes, he s udy seeks
o unde s and he po en ial bene i s o b ie passi e s e ching as a quick and e ec i e me hod o elie ing pi i o mis
igh ness and associa ed symp oms. This could ha e p ac ical implica ions o physio he apy and ehabili a ion
s a egies a ge ing lowe back o glu eal pain ela ed o pi i o mis synd ome.
2. Ma e ials and Me hodology
Following e hical app o al om he Ins i u ional E hics Commi ee o K ishna Ins i u e o Medical Sciences, Deemed o
Be Uni e si y, Ka ad, a c oss-sec ional s udy was conduc ed o e alua e he acu e e ec o a 10-second passi e
s e ching in e en ion on pi i o mis muscle lexibili y. The s udy was ca ied ou in Ka ad, wi h da a collec ion
conduc ed in a clinical se ing unde he supe ision o ained p o essionals.
Pa icipan s we e ec ui ed using a con enien sampling echnique. The inclusion c i e ia consis ed o male and emale
sub-eli e employees be ween he ages o 20 o 45 yea s who had expe ienced lowe back discom o wi hin he pas
h ee mon hs. Indi iduals wi h ecen lowe back auma, p io su ge y, o diagnosed neu ological o musculoskele al
diso de s we e excluded om he s udy.
Eligible pa icipan s unde wen an ini ial assessmen o iden i y pi i o mis muscle igh ness and associa ed symp oms.
Clinical e alua ion included es s o muscle lexibili y and p o oca ion o symp oms ela ed o pi i o mis dys unc ion.
Pain in ensi y was measu ed using he Visual Analogue Scale (VAS) as a p ima y ou come measu e, along wi h clinical
assessmen o lexibili y be o e and a e he in e en ion.
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The in e en ion in ol ed adminis e ing a 10-second con inuous passi e s e ch speci ically a ge ing he pi i o mis
muscle. Pos -in e en ion e alua ions we e conduc ed immedia ely o assess any acu e changes in muscle lexibili y and
pain pe cep ion. The collec ed da a we e used o de e mine he sho - e m e ec i eness o passi e s e ching as a
he apeu ic app oach o imp o ing pi i o mis lexibili y.
3. Resul s
The s udy included a o al o 20 pa icipan s, comp ising 13 males and 7 emales, esul ing in a male- o- emale a io o
1.86:1. This indica es a highe ep esen a ion o male pa icipan s wi hin he s udy coho , which may in luence gende -
based compa isons. Fig 1 p esen s a pie cha illus a ing he dis ibu ion o male and emale pa icipan s.
Figu e 1 The Dis ibu ion o Male and emale pa icipan s in he s udy
3.1. P e-In e en ion Pain Se e i y
P io o he in e en ion, pa icipan s in he 35–45 age g oup epo ed sligh ly highe baseline pain compa ed o hose
in he 20–35 age g oup. Simila ly, male pa icipan s exhibi ed highe p e-in e en ion pain sco es ela i e o emales.
Despi e hese di e ences in baseline se e i y, he in e en ion p oduced meaning ul educ ions in pain ac oss all
g oups, demons a ing i s e ec i eness i espec i e o ini ial pain le els.
3.2. Pain Sco es
Baseline analysis e ealed a mean p e-in e en ion pain sco e o 5.45. Following he in e en ion, he mean pos -
in e en ion pain sco e dec eased o 2.80, co esponding o an a e age educ ion o 2.65 poin s on he Visual Analogue
Scale (VAS). These esul s indica e ha he in e en ion was e ec i e in alle ia ing pain ac oss he s udy popula ion.
Fig 2 illus a es he dis ibu ion o p e- and pos -in e en ion pain sco es using a ke nel densi y es ima e, highligh ing
he o e all educ ion in pain le els.
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Figu e 2 The dis ibu ion o p e- and pos -in e en ion pain sco es using a ke nel densi y es ima e
3.3. Pain Reduc ion by Age G oup
Pa icipan s we e s a i ied in o wo age g oups: 20–35 yea s and 35–45 yea s. The 20–35 age g oup exhibi ed an
a e age VAS educ ion o 2.62 poin s, whe eas he 35–45 age g oup demons a ed a sligh ly highe mean educ ion o
2.67 poin s. This sugges s ha he in e en ion was e ec i e ac oss bo h age g oups. Fig 3 displays a iolin plo o e laid
wi h a swa m plo , depic ing he dis ibu ion and a iabili y o VAS imp o emen s wi hin each age g oup.
Figu e 3 The dis ibu ion and a iabili y o VAS imp o emen s wi hin each age g oup
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3.4. Pain Reduc ion by Gende
Gende -speci ic analysis e ealed ha emale pa icipan s expe ienced an a e age VAS educ ion o 2.57 poin s, while
male pa icipan s achie ed a sligh ly highe mean educ ion o 2.69 poin s. These indings indica e ha he in e en ion
was e ec i e in bo h gende s, wi h a ma ginally g ea e imp o emen obse ed in males. Fig 4 shows a ba plo
compa ing mean VAS educ ions be ween male and emale pa icipan s. Addi ionally, Fig 5 p esen s a idge KDE plo
illus a ing he p e- and pos -in e en ion pain dis ibu ions o each gende , highligh ing he magni ude o pain
educ ion.
Figu e 4 The compa ison o mean VAS educ ions be ween male and emale pa icipan s
Figu e 5 Ridge KDE plo illus a ing he p e- and pos -in e en ion pain dis ibu ions o each gende , highligh ing he
magni ude o pain educ ion
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4. Discussion
The s udy demons a ed a signi ican educ ion in VAS pain sco es, suppo ing p e ious indings ha a ge ed
in e en ions e ec i ely alle ia e muscle igh ness and back pain. Ismaningsih e al. (2022) epo ed ha ul asound
he apy combined wi h pi i o mis s e ching signi ican ly educed pain in Pi i o mis Synd ome pa ien s (p = 0.000),
while Pa i h a e al. (2024) ound in e e en ial he apy wi h hip muscle s eng hening exe cises o be mo e e ec i e
han ul asound wi h s eng hening exe cises. In ou s udy, bo h age g oups (20–35 and 35–45 yea s) showed
compa able imp o emen s, consis en wi h li e a u e indica ing ha adul age does no subs an ially limi in e en ion
e icacy. Olde pa ien s may bene i mo e in some cases due o complex pain mechanisms and como bidi ies,
highligh ing he impo ance o ailo ing in e en ions o indi idual pa ien cha ac e is ics (Liu e al., 2007).
In ou s udy, males showed sligh ly g ea e imp o emen despi e emales epo ing highe baseline pain, consis en
wi h p io esea ch on sex-based di e ences in pain pe cep ion and ea men esponse (Wesselmann, 1997; Palle e
al., 2009). Women gene ally ha e lowe pain h esholds, highe pain sensi i i y, and a g ea e isk o ch onic pain,
con ibu ing o ele a ed baseline pain in Pi i o mis Synd ome (Be kley e al., 2002). Ho monal luc ua ions and a highe
p e alence o pain- ela ed ca as ophizing in women may u he modula e analgesic e icacy and educe ea men
esponsi eness (Palle e al., 2009). In con as , males o en exhibi lowe pain sensi i i y and mo e p edic able
esponses o in e en ions, which may explain hei ela i ely g ea e imp o emen . These indings highligh he need
o conside biological, ho monal, and psychosocial ac o s when de eloping pe sonalized pain managemen s a egies.
We ound ha pa icipan s wi h highe ini ial pain s ill achie ed subs an ial imp o emen s, aligning wi h p e ious
esea ch indica ing ha baseline se e i y does no p eclude he apeu ic gains. In e en ions such as d y needling wi h
neu odynamic mobiliza ion, ac i e elease he apy, and injec ion he apies ha e demons a ed signi ican pain
educ ions ega dless o ini ial pain le els (Jaiswal e al., 2024; Ilyas e al., 2024; Hilal e al., 2022). Indi idual esponses
may a y, bu high baseline pain o en co ela es wi h g ea e pe cei ed imp o emen wi hou uni o mly p edic ing
ou comes. Long- e m in e en ions, such as endoscopic elease, can p o ide las ing bene i s e en o pa ien s wi h
se e e baseline pain (Vane men and Melkebeek, 2022). These indings unde sco e ha pa ien s wi h ele a ed baseline
pain should no be excluded om he apeu ic in e en ions, as meaning ul imp o emen s a e achie able.
The in e en ion demons a ed b oad e ec i eness, indica ing i s po en ial o gene al clinical applica ion in managing
pain ac oss di e se popula ions. Howe e , he s udy’s small sample size and une en gende dis ibu ion should be
acknowledged, and u u e esea ch wi h la ge , mo e balanced coho s is wa an ed o alida e hese indings and
u he explo e in e en ion ou comes.
5. Conclusion
The p esen s udy demons a es ha he in e en ion e ec i ely educes muscle igh ness and back pain, yielding
signi ican dec eases in Visual Analogue Scale (VAS) sco es ac oss all pa icipan s. Bo h age g oups (20–35 and 35–45
yea s) showed compa able imp o emen s, and bo h males and emales bene i ed, wi h sligh ly highe gains obse ed
in males. Impo an ly, pa icipan s wi h highe baseline pain also expe ienced subs an ial imp o emen s, indica ing
ha ini ial pain se e i y does no limi he e ec i eness o he in e en ion. These indings highligh he po en ial o he
in e en ion o b oad clinical applica ion in pain managemen ac oss di e se popula ions. Howe e , he small sample
size and gende imbalance wa an cau ion, and u u e esea ch wi h la ge , mo e balanced coho s is ecommended o
con i m hese esul s and u he explo e he in luence o demog aphic and biological ac o s on ea men ou comes.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s wish o hank he subjec s who pa icipa ed in his s udy. We would also like o acknowledge P o .
Va adha ajulu Go indha Mandi i o his suppo h oughou he s udy. The au ho s would like o hank he e hical
commi ee o KVVDU, Ka ad o coope a ion and he Bios a ics depa men o s a is ical help ega ding sample size
and esul alues.
Disclosu e o con lic o in e es
The au ho s epo no con lic s o in e es .
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 23(03), 413-420
419
Au ho s’ con ibu ions
Concep ualiza ion; Be cy biju, Va adha ajulu Go indha Mandi i, Funding acquisi ion; Va adha ajulu Go indha Mandi i,
Da a cu a ion, Fo mal analysis, P ojec Adminis a ion, In es iga ion, Me hodology; Be cy biju, Va adha ajulu Go indha
Mandi i Resou ces; So wa e; Be cy biju, Supe ision; Va adha ajulu Go indha Mandi i Valida ion; Va adha ajulu
Go indha Mandi i, Visualiza ion; Be cy biju, Roles/W i ing – o iginal d a ; Be cy biju, and W i ing - e iew &
edi ing; Va adha ajulu Go indha Mandi i.
Funding
The unding was alloca ed by K ishna Ins i u e o medical Science Deemed o be Uni e si y, K ishna College o
Physio he apy, KVVDU, Ka ad, Maha ash a, India o conduc he mas e ’s deg ee esea ch p og ams.
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