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Physical Therapy Management of Patients With Chronic Low Back Pain and Hip Abductor Weakness

Peterson, Seth PT, DPT1,2; Denninger, Thomas PT, DPT3

Journal of Geriatric Physical Therapy: July/September 2019 - Volume 42 - Issue 3 - p 196–206
doi: 10.1519/JPT.0000000000000148
Case Series
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Background and Purpose: Hip abductor dysfunction is common in individuals with chronic low back pain (CLBP). Previous research investigating abductor strengthening in the heterogeneous CLBP population is sparse and has failed to target those patients most likely to benefit. The aim of the current case series was to describe the physical therapy management and outcomes of 3 patients with CLBP matching a previously identified subgroup characterized by substantial hip abductor weakness.

Case Description: Three nonconsecutive patients with CLBP—a 77-year-old man, a 78-year-old woman, and an 85-year-old woman—were treated in an outpatient physical therapy clinic. All 3 patients matched a previously identified CLBP subgroup characterized by substantial hip abductor weakness.

Intervention: Patients were treated using a targeted exercise approach consisting mostly of hip abductor strengthening for 11 to 17 visits over 8 to 10 weeks. Patients received additional treatments including heel lift and pain neuroscience education when indicated.

Outcomes: By discharge, all patients had made clinically important improvements in pain (3- to 7-point reduction on the Numeric Pain Rating Scale), function (10- to 16-point change on the Modified Oswestry Disability Index), and perceived improvement (6-7 on Global Rating of Change Scale). Lumbar range of motion was painless, and hip abductor strength was improved from 2+/5 to 3+/5 in all 3 patients. These gains were maintained at 3-month follow-up.

Discussion: The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.

1ProActive Physical Therapy, Tucson, Arizona.

2Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona.

3ATI Physical Therapy, Greenville, South Carolina.

Address correspondence to: Seth Peterson, PT, DPT, 10550 North La Canada Dr, Suite 160, Oro Valley, AZ, 85737 (sethp@proactivept.com).

Each participant was informed that data concerning the case would be submitted for publication and were actively engaged throughout the process. Patient confidentiality was protected.

The authors declare no conflicts of interest.

Kevin Chui was the Decision Editor.

© 2019 Academy of Geriatric Physical Therapy, APTA
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