Hands-On Versus Hands-Off Treatment of Hip-Related Nonspecific Musculoskeletal Diseases: A Systematic Review

Abstract

Background/Objectives: A manual approach combined with therapeutic exercise versus therapeutic exercise alone is a debated issue in the literature. The American College of Rheumatology guidelines "conditionally recommended against" manual therapy for the management of hip osteoarthritis. Manual therapy followed by exercise, instead, appears to lead to a faster return to sport than exercise alone for adductor groin pain. There is a need to understand which is the most effective treatment in the management of hip nonspecific musculoskeletal diseases. The aim of this systematic review is to determine which is the most effective treatment between manual therapy combined with therapeutic exercise and therapeutic exercise alone in subjects with hip nonspecific musculoskeletal diseases. Methods: This systematic review complies with the guidelines of the 2020 Prisma Statement. The databases consulted were Pubmed, Cinahl, and Web Of Science. The search was conducted from October 2004 to November 2023. The search string was developed following the PICO model. Free terms or synonyms (e.g., manual therapy, exercise therapy, hip disease, effectiveness) and Medical Subject Headings terms were combined with Boolean operators (AND, OR, NOT). The risk-of-bias assessment was conducted using Version 2 of the Cochrane risk-of-bias tool for randomized controlled trials and the Newcastle Ottawa Scale for observational studies. A qualitative analysis of the results was conducted through narrative synthesis of key concepts. When possible, quantitative analysis was conducted through statistical parameters. Results: Ten articles were analyzed. Results show no differences between the interventions analyzed. Preliminary evidence seems to favor the combined intervention for the outcomes of pain, ROM, and patient satisfaction, with other studies claiming an absence of differences. Only one study claims that therapeutic exercise alone is more effective for quality of life. Preliminary evidence seems to show that manual therapy does not seem to bring any benefit in addition to therapeutic exercise in mid- and long-term functionality, especially for hip osteoarthritis. Conclusions: There seems to be no difference in effectiveness between manual therapy combined with therapeutic exercise and therapeutic exercise alone in individuals with hip nonspecific musculoskeletal diseases.

Keywords: effectiveness; exercise therapy; hands-off; hands-on; hip disease; manual therapy.

Figure 1

PRISMA statement flow chart.

Figure 2

Rob-2 score evaluation.