Hip-focused physical therapy for older adults with chronic low back pain, hip pain, and hip muscle weakness may offer promise to address pain-related disability and functional limitations. NIA-funded scientists recently conducted a clinical trial comparing hip- versus back-focused therapies. Their findings, published in The Lancet Rheumatology, indicate that both therapies improved mobility with the hip therapy resulting in greater reduction in low back pain-related disability.
Low back pain is very common among older adults and is the leading cause of musculoskeletal disability worldwide. Additionally, older adults with chronic low back pain are at greater risk for losing functional abilities (such as activities of daily living), being institutionalized, and dying. Previous research that focused on improving low back pain only included participants age 37 to 56 years on average, and risk factors such as hip pain and muscle weakness were not assessed.
For this new trial, University of Delaware, Duke School of Medicine, and University of Pittsburgh researchers sought to determine whether a hip-focused intervention tailored to the characteristics of older adults age 60 to 85 with chronic low back pain, plus hip pain and weakness, would reduce pain and functional limitations when compared to a non-tailored, spine-focused intervention. They recruited 184 participants and randomly assigned them to hip- or spine-focused physical therapy.
The results showed a modest difference favoring the hip-focused treatment for low back pain–related disability immediately following the 8-week intervention, but no difference at 6 months. There was no difference of gait speed between the groups. However, further analyses found that 46% of participants in the hip-focused group and 33% in the spine-focused group had a substantial improvement in disability scores (50% or greater reduction in disability scores); while 53% of the hip-focused participants and 60% in the spine-focused participants had substantial improvement in gait speed. In addition, hip-focused treatment was associated with improvements in chair-rise performance at 6 months and 6-minute walk test performance at 8 weeks and 6 months.
According to the researchers, this is the first clinical trial to assess the efficacy of a tailored intervention matched to an at-risk subgroup of older adults with chronic low back pain and coexisting hip pain and muscle weakness. These findings also provide a potentially important precision medicine example of how task-specific exercise interventions based on particular risk factors may be applied to improve physical function for older adults with chronic pain.
Source: Hicks GE, George SZ, Pugliese JM, et al. Hip-focused physical therapy versus spine-focused physical therapy for older adults with chronic low back pain at risk for mobility decline (MASH): A multicentre, single-masked, randomized controlled trial. Lancet Rheumatology. 2024;6(1):E-10-E20. doi: 10.1016/S2665-9913(23)00267-9.
