Quick Case: Management of Acute Lumbar Pain | Modern Manual Therapy Blog

Quick Case: Management of Acute Lumbar Pain


A patient I work with regularly for a centrally sensitized pain state (Dx with CRPS), had an acute onset of LBP after seeing 3 plays in one weekend.
Reminder - Terminology post here


In general, her left side from head to foot has some degree of discomfort and pain, with certain "hot spots" being her left inguinal area, hip, and lumbar spine. After the first play, she had bilateral lower lumbar pain, but left greater than right.

Even a patient with a persistent pain state can still be treated for an acute episode like any other rapid responder, despite her overall pain state being slow responding. Objectively, I found
  • MSF (toe touch) was pain free, but required effort to reach her toes
  • MSE was DP
  • REIS was DP with deviation to the right (loss of ability to load the left)
  • SGIS FN to right, DP, mod loss to the left
  • REIS with left hip flexed, ankle plantarflexed (taking left hip extension out of the equation), significantly less pain and very little deviation
Normally, if this happened, she responded to press ups, but had not tried SGIS.


Prior to manual intervention

decreased REIS (for her)
First pic has loss of lumbar EIS, with deviation to the right, second pic shows her extension from the side.

Manual intervention consisted of
  • light IASTM to lumbar patterns left greater than right, this inhibited the increased tone in her lumbar and QL area
  • pain free QL and psoas release
  • hold relax in prone knee bend to improve hip extension
After this, REIS looked like this
No more deviation/pain


You can see she is not deviating to the right any longer and is getting to her end range. In fact, her end range REIS was greater than it had been before, meaning she was not performing REIS in standing to end range on previous sessions!

She left pain free and her MSF was now FN, easily able to reach her toes with no visible or perceivable effort on her part. HEP consisted of REIS hourly with some SGIS if she notices onset of left LBP and loss of SGIS in the mirror.

Remember, don't forget to check the hip for a loss of extension or as a contributing factor if someone is deviating with their EIS test!

Keeping it Eclectic....

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