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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...