Hip Manual Therapy Improves Low Back Pain

Research shows range of motion restrictions of the hip are associated with low back pain.  People with low back pain have less hip rotation range of motion compared to people without low back pain.  It is also common for people with low back pain to have side-to-side differences in hip rotation range of motion.  For example, one hip may rotate a total of 75 degrees, and the other hip only 60 degrees.  Hip mobility restrictions can be due to stiffness in the joint capsule or muscles which cross the joint.  Restricted hip mobility due to joint stiffness is best treated with manual therapy performed by a physical therapist.

Hip internal rotation restrictions are closely linked to low back pain.   This movement involves rotating the thigh inward towards the midline of the body.  This hip must internally rotate when the leg is behind the body during the normal gait cycle.   If this motion is unavailable at the hip, the movement must then occur at the spine.  Hip internal rotation must also occur when performing any type of pivot or change of direction when walking.   Many sports activities, such as swinging a golf club, require large amounts of hip rotation.  If the motion is not available at the hip, the spine must compensate.  This often results in abnormal movement and stress to the structures of the low back.

Proven Benefits of Hip Manual Therapy

A 2017 study published in the Journal of Evaluation in Clinical Practice investigated the effects of providing manual therapy and exercise targeting the hips in people with low back pain.  Half of the participants received treatment to the spine only.  The other half received treatment to the spine and hips.  The group who were treated with manual therapy and exercise targeting the hips were more satisfied with their treatment.  They also reported greater improvements in pain and disability compared to the group who only received treatments to the spine.

Hip Manual Therapy Techniques

Three hip joint mobilization techniques were utilized in the previously mentioned study.  Examples of these techniques are included below.   Manual therapy techniques are individualized based on findings from the physical examination.   All mobilization techniques are performed without pain.  Only a mild stretching sensation is felt by the patient during these treatments.  Immediate improvements in hip range of motion occur in most cases.  However, in order for these improvements to be sustained, home exercises are prescribed.

Closing Thoughts

There is no one magic treatment for low back pain.  Abdominal and low back strengthening exercises can be effective.  However, the best results usually occur when multiple treatments are combined and patients are taught to self manage.  Treatment focused only on the spine is often only partially effective.   The low back and hips are very closely linked.  Outcomes are improved when treatments are also directed to the hips.  In order for results to be sustained, an exercise program targeting hip mobility and hip strength are also included.