One day following onset of pain and muscle guarding in the low back region, your patient stands with lumbar flexion and a sciatic scoliosis.Repeated flexion tests increase pain into the buttock.Repeated extension done after side gliding increases the pain in the midback and decreases the pain in the buttock.You begin treatment by:
A)Positioning the patient supine and having him bring both knees to his chest.
B)Placing the patient in intermittent traction at less than half his body weight for 20 minutes.
C)Having the patient lie prone and attempting passive extension with press-ups or prone propping maneuvers after side gliding the thorax.
D)Placing the patient on complete bed rest for at least 4 days, applying modalities and massage during that time.

Question

Quizplus · Accepted Answer

The patient's symptoms suggest a lumbar disc herniation with nerve root involvement causing pain into the buttock and sciatic scoliosis. The fact that repeated flexion tests increase pain into the buttock suggests that flexion-based exercises such as knee-to-chest may exacerbate the symptoms. Therefore, option A is not the best choice. Option D of complete bed rest is no longer recommended for management of acute low back pain as it has been shown to delay recovery and increase disability. Intermittent traction (option B) may provide some relief, but it is not a first-line treatment. Option C of attempting passive extension with press-ups or prone propping maneuvers after side gliding the thorax is the best choice as it can help relieve symptoms of nerve root compression while also addressing any thoracic spine dysfunction that may be contributing to the patient's symptoms.

One Day Following Onset of Pain and Muscle Guarding in the Low