Is there hip muscle weakness in adults with chronic non-specific low back pain? A cross-sectional study

BACKGROUND: Patients with chronic low back pain may present changes in hip muscles. However, there is still limited and controversial evidence of the association between hip muscle weakness and chronic low back pain and whether this weakness can be assessed with functional tests. The purpose of this study was to assess whether there is hip muscle weakness in patients with non-specific chronic low back pain and whether there is an association between the positive Trendelenburg and Step-Down tests and hip muscle strength. METHODS: This cross-sectional study included 40 patients with chronic low back pain and 40 healthy participants, assessed in an outpatient clinic in Vitória, Espírito Santo, Brazil. Muscle strength was measured for the hip abductors, adductors, extensors, internal rotators, and external rotators using isometric manual dynamometry and functional stability was measured by the Trendelenburg and Step-Down tests. Muscle strength was compared using the t test for independent samples and the chi-square test. The association between the tests and strength was performed using a binary logistic regression analysis. RESULTS: Healthy participants showed a statistically significant greater muscle strength for the right hip abductors (mean difference [MD]: 28.1%, 95% confidence interval [CI]: 9.4 to 46.9), right adductors (MD: 18.7%, 95% CI: 6.2 to 31.2), right internal rotators (MD: 8.7%, 95% CI: 1.5 to 15.8), right extensors (MD: 21.1%, 95% CI: 6.2 to 31.2), left abductors (MD: 30.4%, 95% CI: 11.9 to 49), left adductors (MD: 18.4%, 95% CI: 3.7 to 33.2), and left extensors (MD: 21.6%, 95% CI: 6.6 to 36.5). There was no difference between groups for the positive functional tests, and there was no association between the tests and hip muscle strength. CONCLUSION: Patients with chronic low back pain tend to have hip abductors, adductors, and extensors weakness. Furthermore, the functional tests should not be associated to hip muscle strength in patients with chronic low back pain.