I saw a patient a few days ago and I cannot get close to the problem although she tells me she is much better after my treatment I cannot fully understand the problem.
She is 47 year old woman working in child care
she presented with lower back pain on left side laterally to the spine at around L2-L3 level. She also presented with knee pain and pins and needles and numbness in her left knee. The two pain always came together and at the same time. The knee pain is worse than back pain.

Subjectively there was not specific pattern during the day or with activity
the pain is described as an strong ache 8/10. and has been lasting 3 weeks and is constant.
There were no redflag appart from occasional night pain that responded to painkillers and anti-inflammatories.

Objectively
general observation: her Left hip was lower than right in standing but with no leg length discrepencies and noticeable Wikipedia reference-linkscoliosis.
Active range of movement: she had no movement restriction in her spine or knee.
PAIVM revealed generral stiffness in Lx but did not reproduce pain
Hip was clear
Knee clear
Piedalu test for sacro-illiac joint was positive on Left.
Slump test and prone neural tension test were negative
Normal myotome
Dermatomal deficit on L in L3 distribution
palpation: Area of tightness (like trigger point) around one inch laterally of spine at L3 level deep to erector spinae, her pain in the knee shot up when papated that area.

I gave her gentle massage in this area and some rotation stretches in supine
as well as MET for L hip

She initially felt worse but phone me saying she was much better the next day.

I cannot see the connection between the area of tenderness, lack of movement restriction or agravating pain and the knee pain

Anybody has any ideas

Similar Threads: