ProActive Physical Therapy, Tucson, Arizona.
Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, Arizona.
J Geriatr Phys Ther. 2019 Jul/Sep;42(3):196-206. doi: 10.1519/JPT.0000000000000148.
Hip abductor dysfunction is common in individuals with chronic low back pain (CLBP). Previous research investigating abductor strengthening in the heterogeneous CLBP population is sparse and has failed to target those patients most likely to benefit. The aim of the current case series was to describe the physical therapy management and outcomes of 3 patients with CLBP matching a previously identified subgroup characterized by substantial hip abductor weakness.
Three nonconsecutive patients with CLBP-a 77-year-old man, a 78-year-old woman, and an 85-year-old woman-were treated in an outpatient physical therapy clinic. All 3 patients matched a previously identified CLBP subgroup characterized by substantial hip abductor weakness.
Patients were treated using a targeted exercise approach consisting mostly of hip abductor strengthening for 11 to 17 visits over 8 to 10 weeks. Patients received additional treatments including heel lift and pain neuroscience education when indicated.
By discharge, all patients had made clinically important improvements in pain (3- to 7-point reduction on the Numeric Pain Rating Scale), function (10- to 16-point change on the Modified Oswestry Disability Index), and perceived improvement (6-7 on Global Rating of Change Scale). Lumbar range of motion was painless, and hip abductor strength was improved from 2+/5 to 3+/5 in all 3 patients. These gains were maintained at 3-month follow-up.
The current case series describes the use of a targeted exercise approach consisting mostly of hip abductor strengthening in a group of patients with CLBP and hip abductor weakness. The results indicated that this approach may be effective in reducing pain and improving function, particularly for older patients.
髋关节外展肌功能障碍在慢性下腰痛（CLBP）患者中很常见。既往研究中针对 CLBP 异质人群的外展肌强化研究较少，且未能针对最有可能受益的患者进行针对性治疗。本病例系列研究旨在描述 3 例 CLBP 患者的物理治疗管理和结局，这些患者与之前确定的亚组相匹配，其特征为髋关节外展肌无力明显。
3 例非连续的 CLBP 患者（1 例 77 岁男性、1 例 78 岁女性和 1 例 85 岁女性）在一家门诊物理治疗诊所接受治疗。所有 3 例患者均与之前确定的 CLBP 亚组相匹配，其特征为髋关节外展肌无力明显。
患者采用靶向运动疗法治疗，主要包括髋关节外展肌强化，治疗共 11-17 次，持续 8-10 周。根据需要，患者还接受了其他治疗，包括足跟抬高和疼痛神经科学教育。
出院时，所有患者的疼痛（数字疼痛评分量表降低 3-7 分）、功能（改良 Oswestry 功能障碍指数改善 10-16 分）和感知改善（整体变化量表评分为 6-7 分）均有明显的临床改善。腰椎活动度无痛，所有 3 例患者的髋关节外展肌力均从 2+/5 提高至 3+/5。这些改善在 3 个月的随访中得到维持。
本病例系列描述了在一组 CLBP 合并髋关节外展肌无力患者中使用主要包括髋关节外展肌强化的靶向运动疗法。结果表明，这种方法可能对减轻疼痛和改善功能有效，特别是对老年患者。
