Effectiveness of Physical Therapy Interventions for Low Back Pain Targeting the Low Back Only or Low Back Plus Hips

The Effect of Physical Therapy Interventions Directed at the Low Back Versus Low Back and Hips for Individuals With a Primary Complaint of Low Back Pain: A Randomized Clinical Trial

Low back pain (LBP) is the leading cause of disability worldwide and has substantial impacts on pain and function for an individual. Some individuals with LBP seek physical therapy for their condition. The purpose of the study is to determine whether individuals with LBP have improved pain and disability following physical therapy targeting either the low back only or low back plus hip(s).

Often, individuals with LBP also have concurrent impairments in strength and/or range of motion of one or both hips. Physical therapists may or may not decide to treat the concurrent hip impairments for an individual with LBP based on their clinical decision making. Currently, it is unknown which approach leads to superior patient outcomes in terms of pain and disability.

Inclusion Criteria:

• Modified Oswestry Disability Index (ODI) ≥ 20%
• Numeric Pain Rating Scale (NPRS) of ≥ 2 points
• Primary complaint of low back pain with at least one hip impairment in one or both hips

Exclusion Criteria:

• Contraindications to manual therapy

• Severe trauma to the lumbar spine or hip(s) in the last 6 weeks

• 'Red flag' symptoms including:

  • Tumor
  • Metabolic disease
  • Rheumatoid arthritis or other systemic rheumatologic disorders
  • Acute fracture
  • Bowel/Bladder dysfunction
  • Prolonged history of corticosteroid use
  • Evidence of central nervous system involvement

• Two or more positive neurologic signs consistent with nerve root compression:

  • Diminished muscle stretch reflexes of lower extremity
  • Muscle weakness in any lower extremity myotome
  • Diminished or absent sensation in any lower extremity dermatome

• Spinal surgery in the last 6 months

• Total Hip Arthroplasty

• Currently pregnant or post-partum ≤ 6 months

• Osteoporosis

• History of cancer within the last 12 months

• Inability to understand the English language