DRAMATIC SHORT-TERM EFFECT OF HIP MOBILIZATION IN THE

TREATMENT OF CHRONIC LOW BACK PAIN: A CASE REPORT

David P. Robbins, PT, DPT, OCS
Manual Therapy Fellowship
Fellow - Regis University Manual Physical Therapy Fellowship Program

Patient Description Initial Treatment Clinical Relevance

33 year-old male Army mechanic
Primary complaint of low back pain An impairment-based manual
x 18 months therapy treatment approach for hip
►Occasional radiation to the right heel
mobility yielded within-session
and fifth toe and short-term between-session
►Began insidiously while he was
changes that were clinically
deployed to Iraq meaningful

Low-velocity prone grade III posterior to anterior Low-velocity supine High-velocity supine Patient did not meet accepted
(P-A) glides of the right hip in neutral and “figure grade III anterior to long-axis traction criteria for success in any of the
Classification 4” positions posterior (A-P) glides manipulation in a loose- four classification schemes
Met 2/5 criteria for manipulation1 bilaterally packed position Suggestions for future research:
►No current pain distal to the knee bilaterally
►Low score [7/42] on FABQ W ►Long-term effects of such
Home Exercise Program: Partner-assisted A-P mobilizations bilaterally at least twice a day
Met 1/4 criteria for success with treatment
stabilization exercises2 Results
►Identification of a subset of
►Age < 40
Immediate within-session reduction of low back pain following the A-P mobilizations and long-axis patients with low back pain most
►Normal neurological exam
traction hip manipulations likely to respond to manual
►No directional preference
Pain free with full standing lumbar flexion. therapy directed at the hips.

2 days later: References

Other Findings Modified ODI NPRS
GROC score of +5
LBP at end-ranges of lumbar flexion (MCID 6 points) (MCID 2 points) 2.Flynn TW, Fritz JM, Whitman JM et al. A clinical
40 (“quite a bit better”) 10
prediction rule for classifying patients with low
and extension without overpressure 35
9
8 back pain who demonstrate short-term
Hip and LBP at end range right hip 30 7 improvement with spinal manipulation.. Spine.
25 6 2002. 27(24): 2835-43.
Flexion with overpressure 20 5
3. Hicks GE, Fritz JM, Delitto A, McGill SM.
4
Mildly limited right hip extension 15 3 Preliminary development of a clinical prediction
10 rule for determining which patients with low back
versus the left side. 5
2
1 pain will respond to a stabilization exercise
0 0
program. Annals of Physical Medicine and
Initial 2-days Initial 2-days Rehabilitation. 2005. 86(9): 1753-62.