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Is there hip muscle weakness in adults with chronic non-specific low back pain? A cross-sectional study
Open accessPublished version of a preprint
Abstract
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.
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![Fig. 3 Positions adopted for the Step-Down test. A: Right Step-Down; B: Left Step-Down [32, 41–43]](/paper-figures/ff2358d86b644a2da4a0b8b3e643bc82/is-there-hip-muscle-weakness-in-adults-with-chronic-non-specific-low-back-pain-a-figure-3.jpg)
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“Although up to 25% of patients with FAI can perform deep squats without pain,55 it is important to note that deep squats impose large amplitudes of hip joint stress56 and increase the requirements for hip flexion and hip internal rotation,54,57 the hallmark movements that contribute to impingement.”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [54]
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“A toe out stance also should be considered as this will promote a greater degree of hip external rotation and gluteal activation, thereby minimizing the potential for impingment.54,58”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [54]
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“This is important as patients with FAI have limited ability to posteriorly tilt the pelvis during squatting, which places them at greater risk for impingement.54”
From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [54]
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A systematic review of the global prevalence of low back pain
Hoy, D. G., Bain, C. J., Williams, G. M., MARCH, L. M., Brooks, P., Blyth, F., Woolf, A. D., Vos, T., & Buchbinder, R. (2012) · Arthritis & Rheumatism · doi:10.1002/art.34347 · Cited by 3,025
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Hip strength in females with and without patellofemoral pain.
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Research works printed but not linked: 1
- Global regional. National incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602. · DOI · Paper page
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A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice.
Straub, R. K., & Powers, C. M. (2024) · International journal of sports physical therapy · doi:10.26603/001c.94600 · Cited by 70
Hip biomechanics in patients with low back pain, what do we know? A systematic review
Pizol, G. Z., Miyamoto, G. C., & Cabral, C. M. N. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07463-5 · Cited by 18
Self-citationHow non-specific low back pain affects gait kinematics: a systematic review and meta-analysis
Farra, F. D., Lopomo, N. F., Fascia, M., Scalona, E., Cerfoglio, S., & Cimolin, V. (2025) · Frontiers in Pain Research · doi:10.3389/fpain.2025.1693068 · Cited by 6
Yodthee, T., Sitilertpisan, P., Paungmali, A., Sriburee, S., Chamnongkich, S., Jankaew, A., Quiggins, R., & Lin, C. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020666 · Cited by 3
Patterson, C. S., Asavasopon, S., Gharibvand, L., & Powers, C. M. (2025) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2025.106444 · Cited by 1
Metadata
- Authors
- Pizol, G. Z., Ferro Moura Franco, K., Cristiane Miyamoto, G., & Maria Nunes Cabral, C.
- Affiliations
- Universidade Cidade de São Paulo (BR)
- Corresponding author
- Pizol, Gustavo Zanotti
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2023-10-07
- Volume
- 24
- Issue
- 1
- Pages
- 798-798
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC10559475
- OpenAlex
- W4387429583
- Cited by
- 9
- References
- 41
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Aperfeiçoamento de Pessoal de Nível Superior – Brasil (Finance Code 001)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- chronic non-specific low back pain, hip muscle weakness, hip abductor strength, hip adductor strength, hip extensor strength, hip external rotator strength, Trendelenburg test, step-down test
- MeSH terms
- Adult, Cross-Sectional Studies, Hip, Humans, Low Back Pain, Muscle, Skeletal, Muscle Weakness, Muscle Strength
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