A patient was referred to me the other day with diagnosis of low back pain. He was a 40 year old, white male with about a 6 month history of low back pain (he pointed to the ‘small of the back’ and into the gluteal fold but was quite diffuse). He described it as mainly stiffness and tight, but also a dull achy pain. He only had sharp pains if he moved “a wrong way” and denies numbness, tingling, burning or any other LE symptoms.
He did not seek care for a long time as he thought it was normal due to the nature of his profession (construction worker), however, had no MOI that he is aware of; just slowly came on. He was quite bland in description of what makes symptoms worse/better and just said, “it is there pretty much all the time”. The subjective examination was not extremely detailed (but not uncommon for a male at this age and profession).
His clinical exam showed a 25% limitation with ‘pulling’ in small of back with both forward flexion and extension of the lumbar spine. He had symmetrical side-bending and rotation and limited ~10%. No directional preference was found for any increased or decreased amount of pain (again, he had no referral symptoms). DTRs were brisk and symmetrical and no myotomal weakness but trunk and hip musculature grossly rated at 4/5 on MMT scale. No pain to provocation to major lumbosacral structures in standing.
Other clinical features included negative SLR (I normally do not do this test if no referral symptoms but did not take but a few seconds. Main finding was hamstring tightness equally bilaterally. However, he did have the following positive SIJ tests.
1. Thigh Thrust.
2. ASIS Distraction.
3. Sacral Thrust.
What do you think about the clinical exam so far? What are your thoughts on the cause of patient’s symptoms and how to go about treating this? Stay tuned later in the week for part 2.