A 50 year old patient has been suffering from severe buttock pain whilst sitting for about 3 weeks. He doesn't kow what caused it but says that it is probably after lifting a heavy box. He feels pain in the left buttock, and walking and lyign supine eases the pain. The pain seemed to be aggravating until this morning, when the pain decreased slightly. He doesn't have and sensory abnormality.

During trunk flexion, his fingers reach till just below the knees and thinks that before, he used to reach lower. The movement is stopped by pain. ON trunk extension, the has slight pain at the end of ROM. Left side flexion is limited by pain, which on right side flexion no pain is felt.

Right straight leg rain was till about 70-80 degrees, and pain was felt in the left buttock. Left straight leg raise was also till about 80 degrees and the patient only felt very slight pain. However, the patient didnt seem sure about the pain after both SLR. And so I decided to redo them some minutes later. He didnt fell any pain limiting the SLR then! The slump test was immediatley positive even before carrying out the combined leg extension.

I thought of a minor disc prolapse, and gave him some McKenzie exercises to do. During the exercises the patient did not complain pof any pain. But immediately after the exercises he was in severe pain.

Do you have any ideas please?

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