Hi Folks,

I have only been practicing for a few months. I am having trouble sorting out one of my patients with low back pain.

History: 1.5 years of low back pain. Insidious onset. Reports that pain worsens with prolonged standing and is the worst in sidelying at night (supine is fine).

Observations: 25 year old male of medium build. Decreased lumbar and thoracic curves. Increased cervical lordosis with head forward posture. Decreased bulk in glute max R and L.

O/E:
ROM: lumbar is basically full but patient has increased pain with
extension and rotation/side flexion to both sides.
Neuroscan: is unremarkable.
Palpation: is very tender from L2 to S1 bilaterally along facets. Also
very tender over quadratus lumborum on both sides. No
increase in resting tone of hip external rotators.
Special testing: Much increase in pain with general lumbar torsion
test to both sides.
Diagnostic Imaging: None.

We have been working on core abdominal strengthening. He doesn't tolderate manual therapy well because of the tenderness. Manual traction has been helpful.

Any other treatment ideas?

What is the root problem?

Despite the lack of hard neuro signs, could this be disc involvement?

What are other possible pathologies?

Thanks!

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