Muscular pain in lower back

[otley258]

I know there is a simple answer to this, and I have just missed it. If anyone can help I would be grateful.

My patient is c/o LBP on his right side. His TRUNK AROM is FLEX 3/4; S-FLEX (L) 1/2; S-FLEX (R) 1/2 all restricted by pain in the very localised area of his lower back.
The thing that is throwing me is that EXT is completely pain free.

In sitting Trunk Rot to R is 3/4, and again limited by the same localised pain.

I am wondering, although deep, whether there is a muscle strain of Longissimus Thoracis, as the pain is in that region.

The patient is a 55 yr old male whose pain results from a sudden turn to his right 2/52 ago. His condition is improving but wondered if it is common for Trunk Ext to be pain free.

Thanks in anticipation

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[nmarman]

More likely strain to the ql muscle with lumbar facet irritation very common in recriational golfers.
Use facet provocative testing to first rule this out positive kemps with no leg pain will do.
Also palpating flank deep is very important to establish ql muscle irritation.
Ask patient to describe pain when bending laterally ask for differences in character and location. Bending away irrites muscle bending towards irritates facet joints.
Flexion requires ql muscle to fire in stabilisation action leading to pain.
Does that help?

[violablue]

And if there's strain to the QLs, check the glute medius and minimus too. They have a trigger point pattern that encourages one another to remain in a painful state.

[GrantP]

agree with the others. also check SIJ, and away from site such as Thoracic, CT and Cervical to rule out if this is causing more global type muscle spasm. also check for any neural tethering.

good luck

[otley258]

Hi everybody, I am touched by all your advice

Thanks everyone - it is all really helpful

[JayPhysio]

Check the lats and serratus posterior inferior. If full arm elevation causes increased lumbar lordosis then they are likely tight. Any problems with deep breathing?