PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1
The patient is a 17-year-old high school football quarterback. He has been currently lifting weights twice a week for the past few months for conditioning. He played in a football game the other night and was tackled from behind. He felt pain and tightness across his low back that has not been relieved by stretching. Now he has complaints of pain with standing and has a hard time receiving the ball when hiked due to pain in his lower back. After standing for extended periods of time, he feels tingling sensation down both of his legs. The onset of tingling has been since he was tackled from behind. Because he had increased symptoms, his coach has placed him on injured reserve until further notice.
Since he was 15, he has had complaints of low back pain during football and weightlifting season, but it was never significant enough to limit his sporting interaction. He was advised to lift less weight during his dead lift, and this reduced his pain. He has found it difficult to sleep and only finds relief when sleeping on his back with a pillow under his knees.
After the game, the patient went to see a physical therapist and had a positive prone instability test and slump test and was hypermobile at the L4–L5 level during passive intervertebral motion testing.
The patient had a follow-up X-ray that showed a small stress fracture of the L4–L5 pars.
(A) Spondylolysis with bilateral defects in the pars interarticularis (arrows). (B) Spondylolysis of the L5 vertebra (arrow) resulting in isthmic spondylolisthesis at L5–S1. (From Imboden J, Hellmann DB, Stone JH. Current Rheumatology Diagnosis & Treatment. 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Sensation, light touch testing (A) L4 level (B) L5 level (C) S1 level (From Lawry GV. Systematic Musculoskeletal Examinations. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)