i have a question regarding treatment for you. this is the most complicated pt i have seen till date, obese patent, 70 years old, complains of pain leg with walking, relived by sitting but also pain with bending forward, sitting too long

CT scan results:

grade 1 retrolithesis of L3 on L4, anterolithesis of L4 on L5, retrolithesis of L5 on S1, no fracture

L3-L4, L4-L5, L5-S1: hypertrophy of ligamentum flavom, bilat neuroforaminal narrowing because of disc bulge leasing to spinal stenosis

so my dilema is i can't give him flexion exercises because that would worsen the disc bulges but i can't give extension exercise because that will worsen the spondylolithesis of L4 0n L5

his LE strength is very good, no neurlogical deficits.

i have been working on hamstring flexibility, hip flexors atretghing, and strenghtening the global core mm like bridging, and have worked on TA activation, multifidi

any suggestions?

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