title: Effects of manual therapy and exercise targeting the hips in patients with low-back pain-A randomized controlled trial.
abstract: BACKGROUND
  The benefits of providing manual therapy and exercise targeting the hips in individuals with mechanical low-back pain (LBP) are not well established.
  
  
  OBJECTIVE
  The objective in this study is to determine whether a formal prescriptive treatment protocol for the hips improves outcomes in patients with a primary complaint of mechanical LBP.
  
  
  METHODS
  Eighty-four (84) subjects (50 males, 46.1 ± 16.2 years) were randomized to 1 of 2 groups: pragmatic treatment of the lumbar spine only (LBP) (n = 39) or pragmatic treatment of the lumbar spine and prescriptive treatment of bilateral hips (LBP + HIP) (n = 45). Pragmatic treatment of the lumbar spine was based upon published clinical guidelines. Prescriptive treatment of the hips involved the use of 3 hip exercises targeting the gluteal musculature and 3 mobilization techniques targeting the hips. Subjects were assessed at baseline, 2 weeks, and at discharge with the following measures: Modified Oswestry Disability Index, Numeric Pain Rating Scale, a global rating of change (GRoC) score, the patient acceptable symptom state (PASS), and patient satisfaction.
  
  
  RESULTS
  At 2 weeks, significant differences between groups differences were found in GRoC and patient satisfaction (P < .05) favoring the LBP + HIP group. At discharge, there were significant differences on the Modified Oswestry Disability Index, numeric pain rating scale, GRoC, and patient satisfaction favoring the LBP + HIP group (P < .05). Effect sizes were small to medium.
  
  
  CONCLUSIONS
  Our findings suggest that a prescriptive treatment of the hips may be of clinical value to individuals presenting with the primary complaint of mechanical LBP.
authors.affiliation: University of Colorado, Aurora, CO, USA.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-7985-8565
authors.initials: M
authors.lastname: Bade
authors.affiliation: Clinica Alemana de Santiago, Santiago, Chile.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cobo-Estevez
authors.affiliation: Intermountain Medical Center Physical Therapy, Murray, UT, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Neeley
authors.affiliation: Franciscan St. Francis Health, Indianapolis, IN, USA.
authors.forename: Jeevan
authors.initials: J
authors.lastname: Pandya
authors.affiliation: TRIA Physical Therapy and Education Center, Bloomington, MN, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Gunderson
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D002081:Buttocks; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006615:Hip; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*