Manual Therapy and Strengthening for the Hip in Older Adults With Chronic Low Back Pain

Inclusion Criteria: * LBP duration ≥ 3 months * LBP an ongoing problem for at least half days in past 6 months * LBP intensity \> 3 on scale of 0 (no pain) to 10 (worst pain imaginable) * Classified into the "weak+painful" hip-spine subgroup based on two criterion. Participants must have: 1) hip internal rotation strength (normalized to body weight) in at least one hip that is \< 0.26; and, 2) from the Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain items P4-P8, a raw score sum of \>5 (0-20 range, where higher scores indicate more pain interference with daily activities). Exclusion Criteria: * Previous hip fracture with surgical repair * Previous hip fracture without surgical repair within the past 15 years * Total hip replacement * Known spinal pathology other than osteoarthritis (e.g. recent back surgery, vertebral fractures in the past year, rheumatoid arthritis, metastases) * Non-ambulatory or severely impairment mobility (i.e. requires wheelchair) * Folstein Mini-Mental State Examination score of \< 24, indicating cognitive impairment * Severe visual or hearing impairment * Unable to read or speak English * Red flags indicative of serious disorder underlying LBP (e.g. fever associated with LBP, significant unintentional weight loss \> 10 pounds, pain that awakes or keeps one awake at night) * Significant pain the legs greater than the back * Acute illness (e.g. hospitalization within the past 3 months or current infection) * Inability to participate in study for the full six months for any known reason * Received physical therapy for low back or hip within the last 3 months