HIP POSTEROLATERAL COMPLEX STRENGTHENING IN PATIENTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN: A RANDOMIZED CLINICAL TRIAL.

Abstract

Background: Chronic nonspecific low back pain is an important health condition with a high prevalence worldwide and it is associated with enormous direct and indirect costs to the society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. A biomechanical approach that has been raised is that a weakness of the hip abductors, extensors, and lateral rotators musculature (posterolateral complex - PLC) would lead to excessive contralateral pelvic drop during weight-bearing activities such as walking, running, climbing up or downstairs, generating an overload in the lumbar area. Although the strengthening of the hip PLC is largely used in clinical practice for treating patients with hip and knee injuries, there is still a lack of evidence regarding patients with low back pain. Therefore, questions remain about the efficacy of the hip dynamic stabilization as an additional intervention to conventional treatment in a well design trial with statistic power. Objective: To determine the efficacy in terms of functional improvement, pain relief, strength, and kinematics variables of the hip PLC strengthening in patients with chronic nonspecific low back pain who receive conventional physical therapy. Methods: Seventy patients will be initially assessed by validated questionnaires, clinical and functional tests, hand-held dynamometry of the involved muscles, and gait analysis with a 2-D system. The subjects will be randomized to receive 10 treatment sessions over a period of 5 weeks based on the principles of conventional physical therapy, which consist of a combination of manual therapy techniques and exercises for spinal segmental stabilization (control group) or to receive conventional physical therapy plus the addition of hip PLC strengthening (PCL group). Clinical outcomes (pain intensity and function), strength, and kinematics variables will be collected at baseline and at 5 weeks after randomization. Data will be collected by a blinded examiner who will be unaware about the group allocation. Expected results: The results of this study may help in the decision making of physical therapists, as well as may reduce the enormous costs associated with chronic nonspecific low back pain. (AU)