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MASH Treatment for Low Back and Hip Pain

MASH treatment: Image of a manual therapist working with a patient with low back and hip pain

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Table of Contents

Low back and hip pain are often more than passing discomfort; they can lead to significant health issues that impact independence and quality of life, especially for older adults.

Understanding the relationship between the hip and lower back is crucial for addressing the root causes of pain and finding effective treatment solutions.

The MASH treatment protocol, which combines manual therapy, strengthening exercises, and education, offers a promising approach to managing and alleviating low back and hip pain.

By exploring this innovative method and the importance of professional guidance, you can take proactive steps toward relieving pain and enhancing your overall well-being.

The Relationship Between Low Back & Hip Pain

Low back and hip pain often indicate significant health conditions that can create a disabling and costly scenario for many older adults. These conditions can stem from a variety of sources, from acute injury to degenerative diseases, making them difficult to treat appropriately. 

Your spine and hips are interconnected, so pain originating in one of these areas tends to lead to pain and complications in the other.

It’s not just about treating one of the issues; it’s about understanding the relationship between your hip and lower back to better address the root cause of your pain and discomfort. 

But the real danger lies in the potential loss of autonomy. Losing joy in your favorite activities, experiencing pain and difficulty moving in daily activities, and slowly losing your independence can significantly impact your quality of life. 

Understanding just how important it is to do more than simply manage your discomfort (which is still essential) is the key to breaking the cycle of low back and hip pain and maintaining an active, independent lifestyle. 

I’ve used many different treatment methods for my older adult patients with low back or hip pain and have seen varying levels of success with each.

Like many other treatments, MASH offers a structured approach to low back and hip pain that deserves our attention.

What is MASH Treatment for Low Back and Hip Pain?

MASH treatment: a physical therapist evaluates a senior patient's hip pain while he lies on the floor.

A relatively new approach, MASH, or Manual Therapy and Strengthening Treatment for the hip, is a specialized physical therapy treatment protocol designed to alleviate low back and hip pain. 

The treatment combines several techniques that help improve strength and mobility, which are proposed to benefit older adults.

A study published in The Lancet Rheumatology explains that MASH treatment involves three main components: 

  1. Manual Therapy: These maneuvers can include hands-on techniques such as hip mobilizations and manual stretches. They increase flexibility and reduce stiffness in joints, contributing to pain relief. 
  2. Strengthening Exercises: This variety of exercises builds muscle and increases support around your hip joint to help alleviate stress on your hip and lower back. The MASH regimen features hip strengthening exercises and functional movements like squats and step-ups. 
  3. Education: Understanding how your body works can empower and motivate you to manage your pain more effectively by doing things that will help your body heal, so education on the anatomy of the spine and hip is a core component of MASH treatment. 

After the MASH trial, conducted between November 2019 and April 2022, this hip-centered therapy has been evangelized as reducing disability from low back and hip pain.

But was this approach more effective than spine-focused or other therapy treatments that have shown success in the past?

Does MASH Treatment Work Better than Other Treatments?

Traditionally, the focus on treating and managing low back pain has been on the spine. However, the MASH study mixed things up, aiming to shift this perspective by looking at the value of treatments that zero in on the hip. But why? 

Older adults often experience low back pain and hip problems at the same time. Finding ways to alleviate back pain by addressing hip issues was proposed as a more effective treatment—and this novel approach has shown promising results. 

Most skilled orthopedic doctors and physical therapists understand the intimate relationship between the hip and lower back and incorporate treatments for both areas into their treatments for lower back and hip pain.

However, this is often based on clinical expertise rather than detailed research. Fortunately, MASH research has provided evidence to show that it works.

Results of MASH Research

Immediately following an eight-week intervention, those who received hip-focused therapy in the MASH trial showed a more significant reduction in disability from low back pain compared to those who underwent spine-focused therapy.

While both treatments were effective in improving walking speed, hip-focused therapy proved to reduce pain-related disability significantly. 

Spine-focused therapies are still very effective and can benefit those experiencing low back pain. But having another tool in the toolbox for treating low back and hip pain—one with research backing it up—is exciting! 

The more tools available to combat low back and hip pain, the more difference can be made for older adults whose hip condition affects their lower back. This is the case for many people, making interventions like MASH all the more critical. 

The Importance of Working with An Expert

MASH treatment: a physical therapist works has a consultation with a senior patient.

Moving through life with low back and hip pain can be challenging, and when it comes to making decisions on how to go about your treatment, things can get overwhelming.

MASH treatment shows us that while desirable results are possible with a spot treatment, individually tailored care that considers other parts of your body may be the best approach to care. 

A healthcare professional, like a physical therapist, can provide you with valuable expertise and design a treatment plan that aligns with MASH protocols to fit your specific needs better. 

Along with personalized care like manual therapy, a professional will ensure you perform exercises correctly to avoid injury and get the best results. They’ll also monitor your progress and adjust your treatment plan as needed. 

With any treatment, including MASH, it’s best to speak with your doctor or PT before starting. They’ll be able to tell you if a hip-focused approach to treatment is a good option for you based on your health and specific needs and answer any questions about MASH.

As a Doctor of Physical Therapy, I’ve designed many treatment plans for older adult patients suffering from low back and hip pain. Many of those plans include treatments for both areas with added customization for each patient.

Between my clinical experience and the evidence provided by research, I feel confident stating that MASH is a safe and reliable intervention for low back and hip pain.

Remember that there are many ways to achieve the desired results with lower back or hip pain treatment. With the right support, you can alleviate your pain and improve your overall quality of life. 

Talk to your PT today to see how MASH can help you alleviate pain and get back to doing what you love.

Key Takeaways

  • Low back and hip pain are interconnected and can significantly impact the quality of life, especially for older adults.
  • Treating both the hip and lower back together can be more effective than focusing on one area alone.
  • Loss of autonomy and independence due to pain can affect daily activities and overall well-being.
  • MASH (Manual Therapy and Strengthening Treatment for the hip) combines manual therapy, strengthening exercises, and education to alleviate low back and hip pain.
  • Manual therapy includes hands-on techniques like hip mobilizations and stretches to increase flexibility and reduce stiffness.
  • Strengthening exercises in MASH focus on building muscle and support around the hip joint to reduce stress on the hip and lower back.
  • Education on the anatomy of the spine and hip helps patients manage pain more effectively.
  • The MASH trial showed a significant reduction in disability from low back pain and improved walking speed compared to spine-focused therapy.
  • Personalized care from a healthcare professional ensures proper exercise performance and treatment adjustments.
  • Consulting with a doctor or physical therapist before starting any treatment, including MASH, is essential for tailored care.


  1. Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017 Apr 18;12:14. doi: 10.1186/s13013-017-0121-3. PMID: 28435906; PMCID: PMC5395891.
  2. Pugliese JM, Coyle PC, Knox PJ, Sions JM, Patterson CG, Pohlig RT, Simon CB, Weiner DK, George SZ, Piva S, Hicks GE. The Manual Therapy and Strengthening for the Hip (MASH) Trial: Protocol for a Multisite Randomized Trial of a Subgroup of Older Adults With Chronic Back and Hip Pain. Phys Ther. 2022 Jan 1;102(1):pzab255. doi: 10.1093/ptj/pzab255. PMID: 34751784; PMCID: PMC8831280.