Manual Therapy and Strengthening for the Hip in Older Adults With Chronic Low Back Pain

Inclusion Criteria:

• LBP duration ≥ 3 months
• LBP an ongoing problem for at least half days in past 6 months
• LBP intensity > 3 on scale of 0 (no pain) to 10 (worst pain imaginable)
• Classified into the "weak+painful" hip-spine subgroup based on two criterion.Participants must have: 1) hip internal rotation strength (normalized to body weight)in at least one hip that is < 0.26; and, 2) from the Hip Disability and OsteoarthritisOutcome Score (HOOS) Pain items P4-P8, a raw score sum of >5 (0-20 range, where higherscores indicate more pain interference with daily activities).

Exclusion Criteria:

• Previous hip fracture with surgical repair
• Previous hip fracture without surgical repair within the past 15 years
• Total hip replacement
• Known spinal pathology other than osteoarthritis (e.g. recent back surgery, vertebralfractures in the past year, rheumatoid arthritis, metastases)
• Non-ambulatory or severely impairment mobility (i.e. requires wheelchair)
• Folstein Mini-Mental State Examination score of < 24, indicating cognitive impairment
• Severe visual or hearing impairment
• Unable to read or speak English
• Red flags indicative of serious disorder underlying LBP (e.g. fever associated withLBP, significant unintentional weight loss > 10 pounds, pain that awakes or keeps oneawake at night)
• Significant pain the legs greater than the back
• Acute illness (e.g. hospitalization within the past 3 months or current infection)
• Inability to participate in study for the full six months for any known reason
• Received physical therapy for low back or hip within the last 3 months