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

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