Dear naveenedin

Thank you for this lovely post and well done for all your hard work with this client. may I just add to what has already been said so far...I more or less going to reiterate what everyone has said...

First of all, you didnt mention which rotation causes the pain left or right...also, does rotation to the contralateral side ease this pain even if its slightly...?
what about flexion and rotations? does this influence the pain...
also are his symptoms new? i know you said the problem was over a year ago? but has this just gradually worsened before meeting you or it went away and they suddenly came back? it is unclear when you say quickly settled and then he has right buttock and posterior thigh pain?
thirdly, does extension/turning bring the exact intensity of pain with the same referral even though you have treated? or is their any evidence of sacralization?
can this client extend better and rotate better?
what happens when he carries out the aggravating movements more slowly?

Symptoms you have described generally fit an extension-rotation impairment problem...and any of the spinal dysfunctions that will result in closure of posterior structures may be the cause as we all know...your Wikipedia reference-linkfacet joint problems, your large disc herniations, your degenerative spinal issues, spondylos etc
the problem for you is not reducing the symptoms however it seems its in maintaining whatever you gain in your sessions...

you seem to have done most of what needs to be done to be honest...

If the client cannot extend without pain or rotate without pain the travels the same distance then perhaps there isnt any change clinically...

I think the problem is your client is unable to maintain the right lumbopelvic relationship to keep the posterior structures open enough during extension and turning...

for this to happen we need range of motion and control

so yes you have mobilized with PAs and rotations but does that mean the vertebrae can move freely in rotation without constricting ? maybe not...maybe mobilization with movement is necessary, maybe muscle energy techniques may help to generally increase spinal ROM...he is 37, you have mentioned that x-ray is normal...by normal i presume all joint spaces are preserved with no real evidence of severe degenerative changes if any at all...

so flexion eases the pain and he can ride for miles...obviously because you are opening the posterior structures in flexion...yes, we need to give flexion exercises but the ultimate aim is to improve extension and rotation really, so maybe our management is not complete yet...
what happens when your client maintains a posterior pelvic tilt to the point of neutral and gradually extends his spine? does his pain lessen? what about when he does this and rotates...? does his pain lesson..?

if this is the case, your clients problem is with control and inability to recruit his spinal stabilizers when carrying out extension and rotation...

so yes he is doing all the right things but he needs to incooperate this into his activities of daily living with sound advice...for instance, you could advice him to always find that neutral spine before reaching up to th top cabinet in his kitchen...perhaps it is a good idea for him to come back with a list of activities that aggravates his back at ahome and at work...
if he is able to carry out these activities pain free...then you are on the right track...something that has been there for a year is not likely to clear quickly...

he should continue his pelvic tilts and flexion exercises...he should start spinal stabilization exercises in bed and using the gym ball...he can learn how to maintain that neutral spine in various positions, four foot kneeling, side lying, supine, sitting etc...he can gradually increase the time he is able to keep this position...his spinal stabilizers that have been switched off due to his initial back pain will turn back on helping to elongate his spine, this problem is neurally mediated...he can gradually include various activities maintaining this neutral spine...for instance...sitting, neutral spine and bringing knee up, or side lying , neutral spine and abduction or standing, neutral spine and upper limb elevation...
movements being slowly carried out to fully turn on these little muscles...

once he is able to extend his back with no pain, rotation can be added...all movements being slow...
you can gradually introduce him to activities that are similar to the movements in golfing...

The key to this clients maintenance is increase ROM and core stability...I agree most with Hallamshire Physiotherapy on this one