Etiology

• Disc Degeneration
• Periarthritis (muscle, fascia)
• OA - Osteoarthritis of the facet joints

Presentation

History:

• Pain is back-dominant – pain is felt most intensely in or over the:
  • back, buttock, coccyx, greater trochanter(s), groin
• Pain is always reproduced or increased in back flexion. Pain may be constant or intermittent.

Physical Examination:

• Back Exam
• The location on examination matches the location on history.
• The pain is reproduced or increased in back flexion.
• Prone Passive Extension should relieve the pain
  • Prone Extension Positive (PEP) = higher responsiveness to intervention
• The neurological examination is normal or unrelated to the pattern.

Exercise

PEP

Postural correction