Patient is a 46-year-old female who presents to your clinic with dull left lower back and pelvic pain. She denies any movements that make the pain worse or better. The patient also reports a crampy lower abdominal pain that increases after eating. Further interview of the patient reveals she frequents the restroom with urgency and that her stools are dark. In addition, the patient states that she has trouble getting through her day as she has felt more fatigued recently.
Patient is a direct access, self-pay, without a physician’s referral. During the initial physical therapy examination, palpation of the thoraco-lumbar musculature does not reveal pain. Active and passive movements at trunk rotation, side bending, and forward flexion do not increase low back pain but result in increased abdominal discomfort. Hip flexion also does not reveal increased pelvic discomfort. Special tests such as palpation of McBurney point and the Pinch-an-inch test are positive for increased abdominal tenderness. Palpation of the left iliopsoas muscle and resisted left hip flexion does not increase low back pain; however, the tests do reproduce abdominal tenderness.