Hip and Lumbar Spine Physical Examination Findings in People Presenting With Low Back Pain, With or Without Lower Extremity Pain

Post on February 24, 2017 by André Broussard, D.C.

Authors: Heidi Prather, DO1, Abby Cheng, MD2, Karen Steger-May, MA3, Vaibhav Maheshwari, DO4, Linda Van Dillen, PT, PhD5

Study Design
Prospective cohort study, cross-sectional design.

Background
The hip-spine syndrome is described in patients with known arthritis of the hip. This study describes the hip examination findings of people presenting with low back pain (LBP).

Objectives
To (1) report examination findings of the hip in patients with LBP and (2) compare pain and function in patients with positive hip examination findings to those in patients without positive hip examination findings.

Methods
An examination and validated questionnaires of spine and hip pain and function were completed. Pain and function scores were compared between patients with and without positive hip findings.

Results
Consecutive patients (68 women, 33 men) with a mean age of 47.6 years (range, 18.4–79.8 years) participated. On physical examination, 81 (80%) had reduced hip flexion; 76 (75%) had reduced hip internal rotation; and 25 (25%) had 1, 32 (32%) had 2, and 23 (23%) had 3 positive provocative hip tests. Patients with reduced hip flexion had worse LBP-related (mean modified Oswestry Disability Index, 35.3 versus 25.6; P = .04) and hip-related function (mean modified Harris Hip Score, 66.0 versus 82.0; P = .03). Patients with reduced hip internal rotation had worse LBP-related function (mean Roland-Morris questionnaire, 12.4 versus 8.2; P = .003). A positive provocative hip test was coupled with more intense pain (median, 9 versus 7; P = .05) and worse LBP-related (mean Roland-Morris questionnaire, 12.1 versus 8.5; P = .02) and hip-related function (mean modified Harris Hip Score, 65.8 versus 89.7; P = .005).

Conclusion
Physical examination findings indicating hip dysfunction are common in patients presenting with LBP. Patients with LBP and positive hip examination findings have more pain and worse function compared to patients with LBP but without positive hip examination findings.

Level of Evidence
Symptom prevalence, level 1b. J Orthop Sports Phys Ther 2017;47(3):163–172. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6567

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