Hello all.

I've recently seen a client and would like to see what you think.

Subjectively,

27 tear old male who presented with low back pain for ~3 months.
Pain is located L3/L4 level felt centrally and lateral to the spinous process with severity 4/10. Described as an "ache" occasionally gets a "dart" with movements (cannot say specifically what mvts).

Describes pain as being worst in the morning and in the evening after working. Loosens out in the morning after shower etc and can work etc.

Cannot remember a specific incident that brought pain on. Hs never had any back trouble before. Had an op for Gilmores groin last year, no problems since. Doesnt smoke.

Had seen a chiropractor for ~6 sessions. Found some relief after first two sessions, nothing since. Imrovement that came with Rx is still present. Had seen a physio previously and was told something re sciatic nerve.... (i really dont think there is any indication).

Works in gardening.

No red flags present etc.


Objectively,

Observation- quite good static posture in standing. Slightly flat back posture if anything. Hyperactivity in low thoracic erector spinae bilaterally.

Active movement- flexion=full and painfree
ext= limited 3/4 range pain as above 5/10
lateral flexion= full and painfree bilaterally
combined mvts- ext and lateral flex (B) 6/10.

Palpation- PAIVMS Central PA T10-l5 no pain elicited, some muscle spasm l2 and l3. Pain elicited 5/10 bilaterally with PA pressure approx 3 cms lateral to L3 SP. Obvious spasm in low thoracic and upper lumbar erector spinae.

Full neuro exam- NAD

Pelvic mobility- decreased ppn re pelvic position when sitting. Problems finding a neutral position.

Sacro Iliac joint- clear. Tx spine clear. Hips clear.

I may have forgotten some things here...

It would seem that its an inflammatory type pain due to its 24 hr pattern. Im thinkin some minor tear of the disc with associated sensitisation of the disc (not nerve). More than likely has been unable to heal as client continues to work in manual labour...

Treatment focused on relieving the spasm with heat, massage. Gentle extension exs in prone within limits of pain to promote acceptance of movement. Pelvic mobility and ppn exs. Education and advice re general posture and manual handling. Started some core stability work.

He has not seen a medic yet, i have advised to get an x-ray and NSAIDS etc.

any ideas? much appreciated

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