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Patients with lasting LBP often have weak muscles around hip

Variety of exercise interventions typically recommended for these patients

Low back pain (LBP) has recently become the largest cause of disability throughout the world. There are many ways in which LBP can be treated, but current guidelines show strong evidence to support exercise as one of the best treatments available. Despite the fact that exercise therapy is known to be effective, it's still not clear exactly which types of exercises are best for people with chronic (long-lasting) LBP. Treatment decisions for these patients are based on the physical therapist's evaluation and usually tend to include strengthening the abdominal and lower back muscles, but one alternative is to focus on the muscles surrounding the hips, too. It's possible that weakness of these muscles may be common in LBP patients and may therefore need to be addressed, but it's not clear how many of these patients experience this. Therefore, a study was conducted to assess the prevalence of hip muscle weakness and tenderness of the hip and lower back in patients with chronic LBP.

Large group of LBP patients matched with healthy subjects

A group of 151 patients with chronic LBP were invited and agreed to participate. They were then matched with 75 healthy control subjects, who did not have a history of more than three months of LBP. All participants were then examined for muscle strength of numerous muscles in and around the hip, including the gluteus medius (outside of hip), gluteus maximus (largest of hip muscles) and the tensor fasciae latae (TFL, located in thigh and related to gluteus maximus). Tenderness, or the reproduction of patients' pain, was also measured.

Gluteus medius weakness common in many LBP patients

Results showed that patients with chronic LBP displayed a few signs of hip muscle dysfunction, including gluteus medius weakness and tenderness of both gluteal muscles. Upon further analysis, it was found that the gluteus medius muscle weakness actually contributed to patients' chronic LBP. Based on these findings, it's possible that physical therapy programs that focus on strengthening these weak muscles can lead to greater benefits with better overall outcomes. Therefore, physical therapists should be sure to consider gluteus medius strength and address it when it's weak to improve their interventions and reduce pain more efficiently for these patients.

-As reported in the May '15 issue of the European Spine Journal

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