Systemic manual therapy is better than exercises for hip pain: Does it really matter?

Recent hip-area pain studies quantified the rate of pain improvement attributed to therapeutic exercise. Hip-area pain was treated with SMT protocols. Improvement rates were measured. The primary purpose of this study was to compare rates of improvement from SMT protocols with rates of improvement from those previous studies. Other purposes are to identify the most effective SMT protocols, develop hypotheses as to the reasons for their success, and extrapolate the findings toward a more effective approach prescribing exercise-based interventions.

Cohort comparative analysis.

The rate of improvement was measured in 449 patients during 556 episodes of care using SMT protocols. Specific analysis to establish which protocols produced the highest rate of improvement was also done.

During 352 episodes of care, 63% of patients with hip symptoms improved compared to 54% in the study that used an exercise approach. This difference had a statistically significant (p < 0.001) moderate effect size (Hedges' g 0.36). The 13 SMT protocols found to be most effective are hypothesized to do so due to their decongestive, desensitization, and mechanical effects.

This study demonstrates the effectiveness of SMT over other interventions when treating hip pain. Decongestion, desensitization, and correcting of altered joint mechanics should be prioritized over "core" strengthening and stretching at least in the early stages of treatment, because it is less certain that a normal adaptive response to exercise loading would occur. However, exercises could still be used early to help with decongestion and desensitization if they have a cardiovascular-loading emphasis.