Physical Therapy Effective for Hip Pain, but More Research Needed

Physical therapy as a whole can help reduce hip pain, even the type caused by femoroacetabular impingement (FAI) syndrome but more randomized controlled trials (RCTs) are needed to weigh the pros and cons of specific interventions, according to a new study.

The systematic review and meta-analysis, “Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain,” was published in the British Journal of Sports Medicine.

“The true prevalence of non-arthritic hip pain in the general population is unknown, however the burden of hip pain is high, with younger adults with hip-related pain reporting poor patient-reported outcome scores for pain, physical activity and quality of life where work and family commitments are large,” they wrote.

“Non-surgical treatment approaches should be the first-line options for musculoskeletal pain conditions (evident from clinical guidelines for osteoarthritis (OA) and low back pain, due to the far greater costs and risks associated with surgery.”

The purpose of the study was to determine the effectiveness of physical therapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain.

Around 1,722 papers were identified, 14 of which were selected for analysis. Sham treatments were compared to no treatment or other treatment like hip arthroscopic surgery.

The 14 studies included 7 pilot and 3 full scale RCTs and 542 patients (283 men, 259 women). Mean participant age ranged from 27 to 38 years. The studies demonstrated considerable variability in the risk of bias, the outcomes reported, and the interventions performed. The researchers say that because of this there were limited opportunities for meta-analysis.

Primary outcomes included patient-reported hip pain and function while secondary outcomes included physical function measures like hip joint range of motion, hip muscle strength, functional task performance, electromyography (EMG) and motor control, balance and proprioception, biomechanics and gait analysis.

The researchers did not find any full-scale placebo-controlled randomized controlled trials of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favoring physiotherapist-led intervention over no treatment post-arthroscopy; to weak effects (-0.32 (95% CI 0.57 to 0.07)) favoring hip arthroscopy over physiotherapist-led treatment.

“The risk of bias in included studies, as well as limitations in included study methodology should be considered in the interpretation of the results of this systematic review. Physiotherapist-led interventions may improve pain and function in young and middle-aged adults experiencing hip pain, including those with FAI syndrome. There was limited evidence of larger effects for interventions that included targeted strengthening exercise programs and were 3 months duration. Hip arthroscopy surgery had a weak positive effect compared with a physiotherapist-led intervention at 8-12 months. Future full scale RCT[s] undertaking a head to head comparison of physiotherapist-led intervention for hip pain are required,” they concluded.