Hi folks,

My patient 37yr old male, v.keen golfer had a sciatic pain yrs ago, which settled quickly. Recently with no trauma, he got right sciatic pain, which is two pains, pain A and B. pain.A is on on his right bum cheek and pain.B on post thigh. no radiating pain under knee, no paresthesia of feet. The agg.factors are twisting and turning of spine, and when doing service in golf, tat rotn movt brings his pain. cough and sneeze. his x-ray is normal. he has no redflags, and no signs of ankloysing spondylitis/hip pathology.

On obj assessment, he has sway back, v.limited movt of his lumbar spine. he has very little isolated movt of lum spine. Pt acheives spine extension by flexing hip and knee. On palpn, the lumbar joints are v.stiff as if u push against a brick. Spinal ext reproduces his pain, and quadrant make it worse. He has v.tight hamstring and piriformis, which makes him naturally restricted sp.flexion. His dermatomes and myotomes are fine. He has a postive slr and slump test.

I am sure sc.n is irritated. I have treated with rotn,lat.flexion and pa mobs of lumbar spine. home prog, nerve gliding movts(david butlers), and flexion exercises, ql and piriformis stretches.

My patient reports of slight improvement of symptoms.My patient could cycle for miles with no pain, but when he twist he get tat sharp pain. he is not on any pain medications or amytripillin. he is nt off work. But he is still not hughely improved. My prob is how can i get him, back to golf. i feel manual therapy is only of short effect and is the stiffness is beyond its remit. Every time after manual therapy, his agg movts is making less painful, but no longlasting effect. I have advised the pt, to get onboard with home ex's. We are actually a bit stuck now.

i know it is muddled, Any suggestions will be deeply appreciated.

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