I have a patient (age 30) who has a structural Wikipedia reference-linkscoliosis with the convex aspect at 25 degrees evident at the th/lumbar junction. She was managed conservatively as a child with "gymnastic exercises" and never suffered from any pain.
8 months ago following a relocation she injured her back whilst unpacking and shifting furniture (classic rptd fl and rotation injury pattern).

She complains of a pain at the lumbosacral junction slightly left sided versus central. There are no neuro signs, no radiating symptoms. Her pain is worse on getting up in the morning but there is no consistant pattern. She now is rather wary of her back.

Main Problems found on examination are:
1. painful arc on lumbar spine flexion at 25% of her range of movement there is a catching pain that continues until half range and then she is pain free. same provocation of pain on return to upright but also very complex series of rotation in the lumbar region.
2. posture: flat lsp and ant rot of pelvis (no other biomech factors in lower limb chain)
3.Wikipedia reference-linkSIJ normal land mark positions but initially had the L psis higher than R which I treated with METs and traction to left leg. LLD no longer present.
4.TrAb/multif - activation very difficult and very quick to fatigue
5.overactive ER spinae during flexion of lsp
6. poor stability through the pelvic girdle with transfer of wt , poor gluts ++,tight hamstrings.
7. palp of L5/S1 facet L positive of her symptoms at end of range , and stiff Lsp generally.
8. unable to disassociate lsp and pelvis through flexion of Lsp in standing.

How have I treated.
Lots of stabilising exercises (Lsp/pelvis/LL), stretching.
Tried mobilising LS junction L and even soft tissue release/trigger point but if I give her more movement which she looks as if she needs
the pain gets worse. (ruled out Wikipedia reference-linkSpondylolisthesis)
McKenzie extensions and postural advice

My hypothoses of her problems were
1.LumboSacral compromise due to mm imbalance
2.global muscle system failure due to central stabilising insufficiency.
3.Wikipedia reference-linkfacet joint (L5/S1 left compromise)
4. possible disc compromise -reduced disc space L5/S1 and L4/5.
5. Scoliosis creating biomechanical changes through out the spine.


Any suggestions as to what may be causing the "catching" pain and suggestions for effective treatments.

The problem is not severe and infact on the first assessment I thought it would be pretty straight forward to deal with but No I have not done what I had hoped to do in the length of time that i had hoped.


Thank you for your help.



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