Links between the Hip and the Lumbar Spine (Hip Spine Syndrome) as they Relate to Clinical Decision Making for Patients with Lumbopelvic Pain.
Heidi Prather, Linda van Dillen
PMID 31074168WHAT IT FOUND
Hip and low back pain can overlap, and hip range of motion may influence lumbar motion.
Hip arthroplasty sometimes improved low back pain, but causal links are unclear.
Key findings
01Radiographic hip osteoarthritis does not consistently match hip pain symptoms.
02After hip arthroplasty, some patients reported improvement in low back pain: 58.4% (997/1707) of those with preoperative mild or greater low back pain improved in one cohort.
03People with low back pain often have less hip internal rotation and passive hip flexion, and chronic low back pain is associated with earlier and greater lumbopelvic rotation during hip external rotation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The authors state this narrative review is far from inclusive and selected literature for clinical and research relevance. The hip-spine syndrome subgroups used to organize the review have not been validated, and the terms pain and disability are mixed together. Radiographic degeneration is common without symptoms, so imaging findings alone cannot identify the source of a patient's pain. Improvement after hip arthroplasty shows post-surgical change, not proof that the hip caused the low back pain, and the authors state cause and effect are not fully understood. Some included studies are retrospective, small, or report single-session changes.
The easy way to misread this
Do not conclude that hip arthroplasty treats low back pain because the review reports improvement after surgery. The papers show post-surgical change, not proof that the hip caused the back pain, and the authors state cause and effect are not fully understood.