Clinical Story: Low Back Pain after Deadlifting

Introduction 

A 36-year-old patient came to the therapy with acute low back pain after he injured himself doing a hex bar deadlift two days ago. He had not done the exercise in a while and was trying to strengthen his gluteal muscles, but he loaded too much weight, going from 145lbs to 170lbs without a proper gradual loading process. While he was fine the same day, the next morning he woke up in extreme pain, with muscle spasms, and a 9/10 localized pain in his low back. He denied any radiating symptoms down his legs but was unable to bend over or backward. Walking, sitting, and lying down with a pillow under the knees helped relieve the pain.

Differential Diagnosis

There were two possible diagnoses for the patient's condition: lumbar herniated disc and lumbar extensor muscle strain. However, to narrow down the possibilities to one, the therapist asked the patient if his pain worsened while he was coughing or sneezing. When the patient replied negatively, it became less likely that he had a lumbar herniated disc. The therapist then proceeded with the assessment.

Confirming the Diagnosis

The patient was asked to stand up and bend over and backward. He complained more of muscle spasms when bending forward, but the pain was worse when he bent backward. The therapist then placed a pillow in front of the patient and asked him to press it while pressing his belly and bending backward with his knees slightly bent. The patient was surprised that his pain had significantly improved, confirming the final diagnosis of lumbar extensor strain.

Treatment

The patient's pain pattern was strongly associated with movement, and he likely injured his low back due to improper hip hinge and pulling up the hex bar mostly through his lumbar spine. His early intervention and therapy included soft tissue release, such as psoas major and multifidus release, and hip stretches such as hip adductors and TFL. The therapist advised proper positioning in bed with pillows under knees when lying on his back and respecting the pain. The patient should stop and make adjustments if he feels pain anytime he does something wrong. The therapist recommended using heat for 1-2 times a day for calming down the spasming for 5-10 minutes each time. Once the lumbar spasms eased down, they started to gently stretch the hips and lumbar. Ten days later, the patient felt better and started his core stabilization exercises.

Conclusion

The patient was grateful that his low back issue was correctly diagnosed and treated. He could have gone to the ER and had an X-ray or MRI, which would have been even more expensive and time-consuming. The therapist emphasized that they treat the "behavior," not the pathology.