Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series

Abstract

Study design: A case series of consecutive patients with chronic low back pain.

Background and purpose: In patients with chronic low back pain (CLBP), the importance of impairments at the hip joints is unclear. However, it has been postulated that impairments at the hip joints may contribute to CLBP. The purpose of this case series was to investigate the short-term outcomes in patients with CLBP managed with impairment-based manual therapy and exercise directed at the hip joints.

Methods: Eight consecutive patients (mean age: 43·9 years) with a primary report of CLBP (>6 months) without radiculopathy were treated with a standardized approach of manual physical therapy and exercise directed at bilateral hip impairments for a total of three sessions over approximately 1 week. At initial examination, all patients completed a numeric rating pain scale (NPRS), Oswestry disability index (ODI), fear-avoidance beliefs questionnaire (FABQ), and patient-specific functional scale (PSFS). At the second and third treatment sessions, each patient completed all outcome measures as well as the Global Rating of Change (GROC).

Results: Five of the eight (62·5%) patients reported ‘moderately better’ or higher (>+4) on the GROC at the third session, indicating a moderate improvement in self-reported symptoms. These five individuals also experienced a 24·4% reduction in ODI scores.

Discussion: This case series suggests that an impairment-based approach directed at the hip joints may lead to improvements in pain, function, and disability in patients with CLBP. A neurophysiologic mechanism may be a plausible explanation regarding the clinical outcomes of this study. A larger, well-controlled trial is needed to determine the potential effectiveness of this approach with patients with CLBP.

Keywords:

• Chronic low back pain
• Hip
• Impairment
• Lumbar
• Manipulation
• Manual therapy

The authors would like to thank Edward Foresman, PT, DPT, for assisting with the treatment of patients in this case series. In addition, we would like to graciously thank Robert Mathewson, PT, for his support of our research endeavors. Additionally, we would like to thank Terry Cox, PT, DPT, for his contributions to initial development of the project.