Patients and methods: This randomized controlled trial included 48 patients with PS between February 3, 2024, and August 23, 2024. The patients were randomized into DN and ESWT groups. The ESWT group received three sessions of ultrasound-guided ESWT, and the DN group received three sessions of ultrasound-guided DN. Static stretching exercises were given to both groups. Clinical evaluations were assessed with the visual analog scale (VAS), Oswestry Disability Index (ODI), and Lower Extremity Functional Scale (LEFS) at baseline and one and three months after treatment.

Results: Forty-four patients completed the study, with 23 patients (18 females, 5 males; mean age: 49.6±8.9 years; range, 33 to 70 years) in the ESWT group and 21 patients (16 females, 5 males; mean age: 50.4±9.2 years; range, 33 to 64 years) in the DN group. In both groups, there was a significant improvement in VAS pain, ODI, and LEFS scores at one and three months of follow-up compared to baseline (p<0.001). However, no significant difference was observed in VAS, ODI, and LEFS scores between the groups (p>0.05).

Conclusion: In this study, the combination of DN and stretching exercise, as well as ESWT and stretching exercise, was effective in terms of pain relief and functionality in patients with PS during a three-month follow-up period. These two treatment methods can be effectively used in patients with PS. Extracorporeal shock wave therapy can be considered as an alternative treatment method, particularly in patients with needle phobia. Keywords : Dry needling, extracorporeal shock wave therapy, pain management, piriformis muscle syndrome, sciatica