Hip OA: Manual Therapy (MT) or Exercise Therapy (ET)?
Reference:French HP et al Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter RCT. Arch Phys Med Rehabil. 2013 Feb;94(2):302-14.
Over 130 patients with hip OA were randomized to 1 of 3 groups: ET, ET+MT and waitlist controls.
The patients in both the ET and ET+MT groups received 8 PT sessions over 8 weeks.
Basic Conclusion: After 8 weeks, those in the exercise therapy program had significantly greater functional scores, hip ROM, and patient-perceived improvements compared to the control group. However, the addition of manual therapy to exercises provided no added benefit in pain or function, except for higher patient satisfaction.
Personal Comment: There are a few conflicting studies out there. Some find manual therapy to be valuable, while others find it a waste of time.
I feel manual therapy works best when applied to those with mild or moderate hip OA. Once the hip has progressed to bone on bone, manual therapy seems to be of little value.
I also believe the type of manual therapy provided makes a difference. I am a strong proponent of mobilizations with movements (MWMs) as proposed by Brian Mulligan, PT.
I find that most manual therapy studies to date do not use MWMs and still study traditional static mobilizations. So when they conclude that manual therapy is not effective, I take it with a grain of salt.
The next hip OA study you read, ask 2 questions. Firstly, how far gone were the patients with hip OA? Secondly, did they use MWMs?
Posted on: July 03, 2015