The Effectiveness of Shoe Lift Insertion and High-Intensity Laser Therapy on Reducing Pain Intensity in Piriformis Myofascial Pain with Functional Leg Length Disparity

Introduction: Myofascial pain in the piriformis muscle associated with functional leg length disparities (LLD) in patients with non-specific low back pain (NSLBP) is often undetected, resulting in inappropriate management. High-intensity laser therapy (HILT) is a noninvasive modality for treating piriformis syndrome. However, correction of leg length with the insertion of a shoe lift is also necessary as an adjunctive treatment. This study aims to assess the effectiveness of HILT with and without the use of shoe-lift inserts in reducing myofascial pain in NSLBP patients with LLD. Methods: This single-blind, randomized clinical trial was conducted at the Medical Rehabilitation Clinic of Pasar Minggu General Hospital, Jakarta, from December 2022 to August 2023. Inclusion criteria were adult age, who endured NSLBP for 3-6 months, have LLD, and have myofascial pain in the piriformis muscle with a numerical rating scale (NRS). The Pelvic tilt was measured using an inclinometer. NRS scores in the treatment and control groups were calculated from week 1 to week 4.Results: This study involved 26 subjects assigned to intervention and control groups. The average age was 49.8 years, and 69% of them were female. There was no significant difference in pelvic tilt between groups (p=0.39). The decreasing NRS scores were lower in the intervention than in the control group during the first and second weeks (p=0.015 and p less than 0.001). There was no significant difference in NRS scores between the second and third weeks in intervention and control groups (p=0.157 and p=0.06 ), however, the control group showed a tendency to increase NRS scores in the third week.Conclusion: HILT combined with shoe lift insertion is more effective in reducing the intensity of piriformis myofascial pain in patients with NSLBP and LLD.