Comparison of hydrotherapy and manual therapy in osteoarthritis of the hip.

INTERVENTION: Patients will participate in 5‐week hydrotherapy (group A) or manual therapy (group B) programme 2 times a week. Each session will last for approximately 45 minutes. Hydrotherapy (Watsu) will take place in a pool with a warm water (32‐34 degrees Celsius). Before the first session the therapist will explain how the Watsu therapy session starts and ends. The therapist and patient dressed in swimwear together will enter the pool. The patient, supported by the therapist lies on his/her back in the water and closes his/her eyes. Supported mainly by the forearms placed under the head and initially under the pelvis the therapist moves the patient through the water in flowing, rhythmical motions which includes intermittent gentle massage and stretching. During each session the therapist will perform the same techniques in a sequence recommended by Worldwide Aquatic Bodywork Association (WABA): breath dance, slow offering, freeing the spine, one leg slow offering, two legs slow offering, accordion, accordion in rotation, near leg rotation, far leg rotation, arm leg rock, thigh press, arm play and lift, chest opening, leg press, arm back around, lengthening spine, spine pull, undulating spine, hip push, seaweed, figure 4 (it is the name of movement sequence), breath dance, wall return. There should be no conversation between the patient and therapist during therapy, however patient should inform about any pain during therapy. The distance between the patient and the therapist ranges from full arms length to close cradling. After a session of approximately 45 min, the therapist assists the patient to a seated position in the pool. Next, the patient shower, dress, rest for 5–15 min and then leave. Manual therapy in group B will take place indoor. It will consists of hip joint traction, post isometric muscle relaxation of identified shortened muscles surrounding the hip joint, trigger point therapy. In both groups all manipulations will be repeated until the therapist stated optimal results of the session. In both groups a physical therapist will administrate the intervention. It will be one‐on‐one face‐to‐face exercise session. There will be an attendance list to monitor patients adherence to intervention. CONDITION: hip osteoarthritis low back pain PRIMARY OUTCOME: Functional status (Hip range of motion, assessed using a goniometer) Gluteus medius, tensor fasciae latae activity (sEMG). ; ; It is a composite primary outcome. Pain (VAS scale 0‐10) SECONDARY OUTCOME: Functional status (questionnaire ‐ OSWESTRY) Functional status (questionnaire ‐ HARRIS HIP SCORE) Functional status (questionnaire ‐ ROLAND ‐MORRIS) Functional status (questionnaire ‐ WOMAC) lumbar erector spinae muscles activity (sEMG) INCLUSION CRITERIA: ‐ Primary osteoarthritis of the hip (stage II according to the American College of Rheumatology classification) ‐ No systemic contraindications to undertake the proposed forms of exercise ‐ Written consent to participate in a clinical trial