Effectiveness of stretching techniques in piriformis syndrome management: a systematic review

Piriformis Syndrome (PS) is a neuromuscular condition characterized by gluteal pain resulting from sciatic nerve compression. As conservative management is the first-line treatment, this systematic review evaluated the effectiveness of stretching techniques used alone or in combination with other rehabilitation interventions. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251084880). Twelve studies published between 2015 and 2025, involving 572 participants with clinically diagnosed PS, were identified through searches of PubMed, Scopus, Web of Science, and Google Scholar. Methodological quality was assessed using the McMaster Critical Review Form, the PEDro scale for randomized controlled trials, and the ROBINS-I tool for non-randomized studies. Owing to substantial heterogeneity, a narrative synthesis was performed. Of the twelve included studies, four were Randomized Controlled Trials (RCTs). A meta-analysis was not performed due to significant heterogeneity in interventions and outcome measures; therefore, a narrative synthesis is presented. Combined interventions generally demonstrated greater improvements in pain, function, and range of motion than stretching alone. Notable limitations included protocol heterogeneity, small sample sizes, and a lack of long-term follow-up. Current evidence suggests that stretching techniques, particularly when incorporated into multimodal rehabilitation programs including MET, therapeutic ultrasound, or strengthening exercises, may improve pain, ROM, and functional outcomes in patients with PS. Nevertheless, the evidence remains limited by methodological heterogeneity and insufficient long-term follow-up. High-quality randomized controlled trials using standardized intervention protocols are needed to strengthen the evidence base.