Author: Justin Mullner, MD
Patient Presentation:
A 15 year-old Caucasian male football wide receiver presented with progressively worsening left-sided, non-radiating low back pain that began during football camp 1 month prior.
History:
The patient denied any specific injury or trauma. The pain was sharp, 8/10 worse with cutting and pivoting motions during football practice and occasionally present at rest. He was still playing football but the pain had increased significantly over the last 4 days. Ibuprofen and ice helped relieve the pain.
<br>ROS: He denies fever, weight loss, paresthesias or neurologic symptoms. PMH: spina bifida occulta; L5 pars fracture 2 years prior.
Physical Exam:
Vitals: afebrile, BP 100/58, pulse 66.
<br>Back:
<br>No visible deformities or scoliosis.
<br>Tenderness to palpation over the left lower back just above the waistline.
<br>Full ROM with flexion and extension of the back. Pain with hyperextension of the back. Pain with lateral bending to both sides as well as with rotation of the torso.
<br>Positive stork test bilaterally, worse on the right.
<br>Lower extermities: Tight hamstrings.
<br>Patellar and Achilles tendon reflexes are 2+. Normal sensation in bilateral. Strength 5/5. Dorsalis pedis and posterior tibial pulses normal. Negative straight leg raise.
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