Short-term Response to Treatment Targeting the Thoracolumbar Junction in Patients With Hip Pain: A Case Series

In patients presenting with hip and groin symptoms, evaluation and treatment of the thoracolumbar junction (TLJ) may be underutilized. The TLJ is less recognized as a source of pain referral in these regions. The purpose of this case series was to describe the management of 3 patients with primary hip and groin pain who were treated with interventions targeting the TLJ.

The 3 patients in this case series presented with subacute or chronic complaints of hip and groin pain that had failed to resolve with typical treatments. They had undergone several inconclusive clinical testing procedures. Each patient underwent a detailed physical therapy evaluation and was found to have pain and mobility deficits at the TLJ. Once the therapist had determined that the patients' symptoms were likely of musculoskeletal origin, treatment commenced. Joint mobilization and exercise directed at the TLJ were used in each case. Marked improvements in pain, thoracic range of motion, and functional deficits were observed within 3 to 4 weeks, after an average of 6 treatment sessions. All patients returned to prior activity levels. Patients in cases 1 and 3 had improvements in hip mobility and strength without direct treatment to the hip.

This case series describes the management of 3 patients with hip and groin symptoms who were successfully treated with interventions targeting the TLJ. In patients reporting primary hip or groin pain, physical therapists should consider the TLJ as a potential source of symptoms and include treatment strategies directed at the TLJ, as warranted, after a careful examination and clinical-reasoning process.

Differential diagnosis, level 4. J Orthop Sports Phys Ther 2019;49(8):611-619. doi:10.2519/jospt.2019.8309.