Chronic Disease and Exercise

The Link Between Low Back Discomfort and Restricted Hip Mobility

The link between low back discomfort and restricted hip mobility has been proven by numerous studies. This has been proven in both the sporting community and the general populace. For instance, numerous studies in the sporting community have shown declines in passive hip media rotation among sportsmen and women in squash, golf, and tennis. Studies that have been conducted have supported the need to use exercise as a form of intervention targeting the hip in individuals with recurrent low back pain or chronic pain that is not specified. For instance, Burns , Mintkin, Austin, Cleland (2011) utilized hip mobilization techniques and gave some hip stretching exercises in patients who had chronic low back pain and after three sessions, 5 of the 8 involved patients reported a perceived decrease in the disability. Half of the patients experienced minimal pain changes while three reported minimal clinical changes in their functioning (Burns et al. 2011).

Effectiveness of Exercises in Treating Chronic Back Pain

Additionally, Kendall, Schmidt & Ferber (2010) provided participants with non-specific low back pain a hip abductor strengthening protocol and after three weeks significant pain decreases and hip strength improvements were found (Kendall, et al. 2010). However, these studies have not determined the most effective exercises that can be utilized to achieve maximum results. Moreover, there lacks a study that investigates the effect of exercise treatment targeted specifically at the hip of individuals with chronic back pains. Based on this background, the aim of the study was assessing the level of effectiveness inherent in different forms of exercises targeting the hip with pain in persons with reduced low back pain or non-specific chronic with concurrent reduced hip rotation. The purpose of the study was showing that some exercises were effective than others meaning that caregivers and chronic patients should choose the most appropriate method that applies to their condition.

Procedures/Methodology

The research done was a randomised trail which compared multi-directional hip strengthening and hip stretching exercises with a home exercise program involving stretching of the hip in individuals who had non-specified chronic or recurring back pain with concurrent reduced rotation of the hip. Participants of the study were recruited from Victoria, Australia through advertisement in local newspapers and posters. The inclusion criteria was adults who were aged 18 and above with recurrent low back pain or non-specific chronic with a reduced concurrent hip rotation. Chronic low back pain was defined as symptoms that presented more than half the days in a 12-month period with a single or multiple occurrence episodes. On the other hand, recurring low back pain was defined as those symptoms having multiple episodes in one year. The main reason why recurrent and chronic low back pain were chosen for inclusion was because they had a likelihood of observing the outcome measures. Respondents were screened for eligibility via a phone call and those who met the initial inclusion criteria were invited for assessment. The initial assessment was conducted through participants completing a questionnaire that addressed various issues regarding demographic and medical history. Additionally, they completed were required to complete a habitual physical activity questionnaire. Moreover, to determine eligibility, hip rotation was measured. The exclusion criteria included individuals who reported a history of spinal surgery, spinal infections, those with pregnancy, cancer patients and the ones with marked spinal deformity. The study also excluded individuals how did not exhibit a reduction of hip rotation of either left or right hip. Before being engaged in the study, all the participants were given a consent form to read and sign. The study estimated a sample size of 10 respondents per group. The respondents were blinded to the exercise groups that the researchers randomised them to. One assessor was responsible for recruitment of the respondents, data collection and implementing the intervention programs.

Findings/Results & Discussion

Thirty participants were involved in the study, six of them did not complete the study, and two respondents could not be followed up. Some of the reasons for non-completion included obtaining abdominal problems or injuries during exercises and not undergoing the entire exercise program. All the exercise groups showed improvements in left and right hip rotation measures with no major differences between the groups between baseline and post-intervention. Briefly, the results showed that all exercise groups experienced an improvement in function and pain. The results showed that the most effective exercise when groups were compared was hip strengthening as it helped in improving functional disability. From these results, the primary findings of the study was that exercises targeted at the hip can be of benefit in improving function and pain in persons with recurrent or chronic lower back pain with concurrent hip rotation that was reduced. Thus, having continues home-based exercises for approximately six weeks of either multi-directional hip stretching, hip rotation stretching, and hip strengthening exercises were capable of effectively improving function and lower back pain. According to the authors, the significance of their study is for clinicians to identify an intervention’s aim before implementing it on the patient. For instance, if the aim of the patient is to improve functioning, clinicians should administer hip strengthening exercises as the recommended intervention. On the other hand, if the primary intention of the patient and the clinician is pain improvement, prescribing hip strengthening or stretching exercises is recommended.

Conclusion

The authors of the article concluded that individuals with reduced hip rotation and non-specific chronic lower back pain benefited highly from clinical interventions which provided exercises that targeted specifically at the hip. The benefits that these persons would gain included improving their function and pain. However, while both strengthening and stretching exercises were effective engaging in the former proved most beneficial in function improvement.

Personal comments

Personally, the lesson from this study is that clinicians should seek to understand the most appropriate exercise interventions before prescribing them to chronic patients. However, what is apparent is that when the right exercises are applied to patient which chronic problems, there is improvement in form of reduction of pain and increase in their functionality. The issue is prescribing the right exercise techniques to specific chronic diseases. The strength of this article is the fact that it was a randomised trial research. However, a weakness is the lack of assessor blinding and the lack of ability to analyse the intention to treat. In future, I can apply the results of this study to have chronic patients with hip problems prescribed with appropriate exercises that relate with the primary aim.

References

Burns, S. A., Mintken, P. E., Austin, G. P., & Cleland, J. (2011). Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. Journal of Manual & Manipulative Therapy, 19(2), 100-107.

Kendall, K. D., Schmidt, C., & Ferber, R. (2010). The relationship between hip-abductor strength and the magnitude of pelvic drop in patients with low back pain. Journal of Sport Rehabilitation, 19(4), 422-435.

Winter, S. (2015). Effectiveness of targeted home-based hip exercises in individuals with non-specific chronic or recurrent low back pain with reduced hip mobility: A randomised trial. Journal of back and musculoskeletal rehabilitation, 28(4), 811-825.