None listed
Conditions
Brief summary
Hip osteoarthritis can cause pain and difficulty with everyday activities such as walking, standing, and stair climbing. Some people with hip osteoarthritis also show changes in movement or mobility around the lower thoracic and lumbar spine. This study will investigate whether a six-week programme of spinal manual therapy directed to T11-L5 is associated with changes in hip pain and physical function in adults with hip osteoarthritis. Participants will receive the same manual therapy intervention, and outcomes will be measured before and after treatment. The study is a proof-of-concept study and is intended to provide preliminary information to help decide whether a future controlled trial is warranted.
Interventions
Participants will receive a protocolised manual therapy intervention directed to the lower thoracic and lumbar spine, specifically T11 to L5. The intervention will be delivered individually and in-person at Consultancy House Clinic, Dunedin, by the student researcher, a registered physiotherapist with postgraduate training in orthopaedic manual therapy and 10 years of clinical experience. Participants will receive six treatment sessions over up to six weeks, with at least three days between sess
Participants will receive a protocolised manual therapy intervention directed to the lower thoracic and lumbar spine, specifically T11 to L5. The intervention will be delivered individually and in-person at Consultancy House Clinic, Dunedin, by the student researcher, a registered physiotherapist with postgraduate training in orthopaedic manual therapy and 10 years of clinical experience. Participants will receive six treatment sessions over up to six weeks, with at least three days between sessions. The first session will last approximately 60 minutes, and each remaining session will last approximately 30 minutes. The intervention will include segment-specific manual therapy directed to the clinically identified level or levels between T11 and L5. Where appropriate, this may be followed by mobilisation with movement during a patient-relevant active movement. Segment-specific manual therapy may include high-velocity low-amplitude manipulation or graded non-thrust posterior-to-anterior mobilisation. Manipulation is optional and will be used only when clinically appropriate and with participant consent. Where mobilisation is used, it will typically be delivered at Grade III to IV for two to three sets of 30 to 60 seconds per targeted level. Mobilisation with movement will be used only when the trial application produces immediate improvement in pain, range, ease, or function during the selected movement, and when indicated, will be delivered for two to three sets of 6 to 10 repetitions. Treatment will be individualised according to segmental mobility findings, contraindications to thrust treatment, symptom irritability, participant preference, tolerance, clinical judgement, and immediate treatment response. Participants will be advised to continue their usual daily activities and established routines, but not to start any new exercise programme, manual therapy, physiotherapy, or other new treatment for hip or spinal symptoms during the intervention period unless clinically necessary. Attendance, techniques used, dosage, movement tested for mobilisation with movement, immediate response, adverse events, and protocol deviations will be documented in the treatment record. Treatment will be delivered manually (hands-on) using Maitland mobilisations and Mulligan Mobilisation With Movement (MWM). No instrument-assisted devices. Standard positioning equipment: adjustable plinth and pillows. A mobilisation belt may be used for the Mulligan MWM glide, depending on the technique and segment treated. Tools: Treatment will be delivered manually (hands-on) using Maitland mobilisation and Mulligan MWM concepts; no instrument-assisted devices will be used. Standard positioning equipment includes an adjustable treatment plinth and pillows. A mobilisation belt may be used during Mulligan Mobilisation with movement (MWM) techniques for stabilisation or force application, depending on the technique and segment treated.
Sponsors
University of Otago
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants must meet all of the following criteria: - Age 45 years or older. - Activity-related hip pain. - Morning stiffness absent or lasting 30 minutes or less. - Hip pain present on most days for at least three months. - Presence of at least one positive lower thoracic or lumbar impairment finding identified during functional movement screening or segmental mobility assessment from T11 to L5.
Exclusion criteria
Participants will be excluded if any of the following are present: - Primary lateral hip pain consistent with extra-articular pathology such as greater trochanteric pain syndrome or gluteal tendinopathy. - Clinical history suggestive of secondary hip osteoarthritis, such as prior hip-related bony injury or fracture, developmental dysplasia of the hip, Perthes disease, slipped capital femoral epiphysis, or avascular necrosis, identified through participant self-report during the subjective assessment. - Symptoms suggestive of an alternative primary diagnosis requiring medical review, such as fracture, infection, tumour, or acute traumatic pathology. - Inflammatory arthropathy or systemic musculoskeletal conditions such as rheumatoid arthritis. - Previous hip or knee arthroplasty on either side. - Advanced hip osteoarthritis likely to require surgery, defined as currently on a waiting list for total hip arthroplasty or previously advised or referred for surgery. - Planned hip or lumbar spine surgery during the study period. - Corticosteroid injection to the hip region within the past three months. - Contraindications to spinal manual therapy identified during clinical screening, or inability to tolerate manual therapy due to pain severity. - Neurological conditions or physical impairments unrelated to the hip affecting lower limb function. - Inability to understand or complete study assessments, adhere to study instructions, or commit to the intervention and follow-up schedule.
Outcome results
None listed