Patients with non-specific LBP commonly experience instability in the spinal and pelvic-hip column. The diagnostic criteria vary due to the wide range of the suspected aetiology of PS. Most researchers identified the presence of PS as deep gluteal or buttock pain while a few studies described it as non-discogenic sciatica, indirectly implying non-specific LBP. Piriformis syndrome (PS) is a multifactorial disorder with age, gender, and work-related factors contributing significantly to the incidence in high-risk populations. Furthermore, PS is among the primary causes of sciatica, buttock pain, and LBP. In Malaysia, approximately 17.2% of patients with LBP and chronic buttock pain were clinically diagnosed with PS. PS is a complex condition that is often underdiagnosed or misdiagnosed as chronic hip pathologies and LBP, with the prevalence ranging widely from 0.3% to 36%. Patients with LBP might also conjunctionally suffer from piriformis syndrome (PS). Similar results were observed in previous surveys conducted in Malaysia, as the incidence of LBP was approximately 12% in a semi-rural community, whereas the prevalence of LBP among commercial vehicle drivers and medical students was high at 60% and 68%, respectively. LBP is among the leading causes of disability worldwide, with 37% of patients reporting at least monthly experiences or recurrent episodes of back pain. Low back pain (LBP) is the pain generated between the lower 12th rib margins and the lower gluteal folds. These findings may assist to elucidate the actions and functions of piriformis and gluteus muscle in LBP with and without PS. Meanwhile, a significant association between piriformis thickness and gluteus maximus thickness was observed (R = 0.44, accounted for 19% of the variance) in the LBP − PS group. With the adjustment of age and gender, piriformis thickness, gluteus maximus strength, and gluteus medius activation in prone lying with hip ERABEX demonstrated a significant association, but no independent effect of age and gender was detected within the range. Stepwise linear regression for LBP + PS revealed a significant association between piriformis thickness and gluteus maximus strength (R = −0.34, accounted for 11% of the variance) and gluteus medius activation in prone lying with the hip in an externally rotated, abducted, and extended (ERABEX) position (R = 0.43, accounted for 23% of the variance). Piriformis thickness was inversely correlated with gluteus maximus strength (r = −0.4, p < 0.05) and positively correlated with gluteus medius activation (r = 0.48, p < 0.01) in LBP + PS. Resultantly, the one-way ANOVA test demonstrated no significant difference in piriformis thickness between LBP + PS and LBP − PS ( p > 0.01). The thickness, strength, and activation of piriformis and gluteus muscles were measured using ultrasonography (USG) and a surface electromyogram, respectively. Negative radiography, specific symptoms, and a positive PS test were applied for PS diagnoses. A total number of 91 participants (LBP + PS ( n = 36), LBP − PS ( n = 24), and healthy ( n = 31)) were recruited in this study. This is a case-control study conducted at HSNZ and UiTM from 2019–2020. This study aimed to investigate the association between the thickness, strength, and activation of piriformis and gluteus muscles (maximus and medius) among low back pain (LBP) patients with and without PS. Nevertheless, the relationship between piriformis thickness and morphological and functional changes of the gluteal muscles in PS remains unclear. Low back pain might be related to piriformis syndrome (PS), which is a disorder presented as muscular spasm and hypertrophy that is strongly associated with piriformis thickness. Low back pain is a serious threat to human health and the illness jeopardizes the human workforce and pressurizes the health system in the community.
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