A. Causes

• Discogenic Pain: Intervertebral disc herniation or degenerative disc disease.
• Muscle Strain: Overuse, poor lifting mechanics, or acute injury to spinal muscles.
• Sciatica/Radiculopathy: Irritation or compression of the nerve root (often L4-S1).
• Spondylosis/Stenosis: Age-related degeneration and narrowing of the spinal canal.
• Segmental Instability: Poor muscle control allowing excessive movement between vertebrae.

B. Symptoms

• Pain: Localized ache or sharp pain, often worsened by specific postures or movements.
• Stiffness: Especially pronounced when moving from sitting to standing (gelling).
• Radiating Pain: Pain extending below the knee (sciatica) or into the buttocks.
• Neurological Signs: Numbness, tingling, or weakness in the leg/foot.
• Red Flag Symptoms: Saddle anesthesia, bowel/bladder changes (requires immediate medical referral).

C. Diagnosis

• History: Differentiation between mechanical pain (worse with movement) and inflammatory pain (worse with rest).
• Special Tests: Straight Leg Raise (SLR) to tension the sciatic nerve.
• Observation: Assessment for lateral shift or protective spasms during movement.
• Imaging: MRI is used when nerve root compression or serious pathology is suspected.

D. Physiotherapy Treatment Plan

• Pain Management: Modalities (heat/TENS) and manual therapy (mobilization) for symptom control.
• Core Stabilization: Retraining the Transversus Abdominis and Multifidus (e.g., Bird-Dog, Dead Bug).
• Postural Education: Training in optimal lifting techniques (hip hinge) and ergonomic seating.
• McKenzie Therapy: Use of repeated extension or flexion movements to centralize peripheral pain.
• Flexibility: Stretching tight Hip Flexors and Hamstrings which affect pelvic alignment.
• Nerve Glides: Gentle movements to improve the mobility of the affected nerve root.