Summary: Most patients with low back pain get better with physical therapy. But a new study suggests that people with low back pain plus hip pain would gain more from hip-focused physical therapy. Hip-focused physical therapy gives better pain relief than spine-focused physical therapy.
Low back pain is among the most common chronic pain conditions. Most adults will have low back pain at some point in life. But this pain is also very hard to manage, because it has many causes.
In some people it comes from sprains and strains. In others it comes from worn discs, or from weak muscles that support the spine. In many others it may follow mood disorders or even certain neurological conditions.
A problem with as many causes as low back pain is best treated with a mix of treatments. Painkillers alone are not enough. In many people, even opioids or other add-on drugs may not give enough relief. So drug-free treatments have a special place in low back pain care. That is why many people may gain from different kinds of physical therapy.
Does hip-focused physical therapy help low back pain?
This new study published in The Lancet Rheumatology set out to compare hip-focused physical therapy with spine-focused physical therapy. It studied older adults with chronic low back pain, hip pain, and weak hip muscles. Earlier research drove the study. It showed that older adults with both low back and hip problems function worse. They also face a higher risk of losing mobility than those with low back pain alone.
This randomized controlled trial included 184 people aged 60 to 85 years. Each was randomly placed in either the hip-focused or the spine-focused physical therapy group. After 8 weeks, researchers measured the results of the two programs.
The study found that hip-focused physical therapy worked much better than low-back-focused physical therapy. People in the hip-focused group had a bigger drop in disability from lower back pain than those in the spine-focused group. But both groups reported a similar gain in function. That suggests both methods are equally good for improving mobility.
Both approaches are equally safe and cause no side effects or harm. This study shows how hard low back pain can be to manage, and that it needs a personal approach. Hip-focused treatment helps most in people with both hip and lower back pain. Hip pain is common in people with lower back pain.
Who should consider hip-focused physical therapy?
In short, the study gives promising evidence that tailored hip-focused physical therapy can significantly cut disability in older adults who have both low back and hip pain.
Of course, more studies are needed. One question is how to combine hip-focused physical therapy with other standard methods. Another is which kinds of hip-focused physical therapy work best.
In the end, this study also shows how complex chronic pain is in people with low back pain. It is vital to tell apart patients with low back pain who also have hip pain from those who do not. It may be worth testing whether hip-focused physical therapy would help people with low back pain whose hips are not involved.
Frequently asked questions
What is the best way to relieve hip and lower back pain?
For older adults who have both, this Lancet Rheumatology trial favors physical therapy aimed at the hip. In 184 people aged 60 to 85, hip-focused therapy cut back-pain disability more than spine-focused therapy after eight weeks. Low back pain has many causes. So it responds best to a mix of treatments, not painkillers alone.
Is physical therapy good for lower back pain?
Yes. Most people with low back pain get better with physical therapy. Drug-free treatments matter because painkillers alone are often not enough; even opioids may fail to give enough relief. In the trial, the hip-focused and spine-focused programs improved function about the same, and neither one caused harm.
Why does hip pain matter if my problem is my lower back?
Hip pain is common in people with low back pain, and it changes the outlook. Earlier research found that older adults with both problems had worse function. They also had a higher risk of losing mobility than those with back pain alone. That is why you should tell your clinician about hip pain. It can point toward a hip-focused treatment plan.
Source:
Hicks, G. E., George, S. Z., Pugliese, J. M., Coyle, P. C., Sions, J. M., Piva, S., Simon, C. B., Kakyomya, J., & Patterson, C. G. (2024). Hip-focused physical therapy versus spine-focused physical therapy for older adults with chronic low back pain at risk for mobility decline (MASH): A multicenter, single-masked, randomized controlled trial. The Lancet Rheumatology, 6(1), e10–e20. https://doi.org/10.1016/S2665-9913(23)00267-9
Dr. Gurpreet Singh Padda, MD, MBA, MHP
