When the Spine Speaks Through the Leg: A Case Analysis

Patient profile :

Age and Gender – 22-year-old male

Occupation – student studying for the UPSC exam

Complaints – low back pain and right leg pain

1)History

In May 2024, while performing RDL with a 50 kg barbell, a sudden, sharp pain developed in the lower back, accompanied by a mild cracking sound. The pain persisted in the lower back and gradually radiated to the back of the right leg.

After that, he consulted a doctor and took an MRI. He was told that he has a disc bulge with nerve compression. The doctor prescribed painkillers and suggested undergoing physiotherapy management that includes IFT and traction for one month; the pain got reduced. Also, he avoided going gym for 6 months. 

In December 2024, he resumed going to the gym. A few days later, while doing leg extension with 60 kg, he developed mild back pain again. A week later, when he did 40 kg hack squats, he experienced a sudden sharp back pain after which he was not able to straighten his right knee.  He also reported numbness and radiating pain in his right leg. After that, he came for a consultation with us. 

Training load on the day of pain onset:

Squat – 40kg(4 sets)

Leg extension –40 to 60kg ( 4sets)

Hack squats – 40kg ( 3 sets)

After that leg day, he started feeling pain in his lower back and the back of his right leg

No past medical history or injury.

Physical activity status:

From Jan 2024 to  May, 2024, he did strength training intermittently, without a proper training program. No training after pain onset in May 2024. 

He began strength training again in December 2024.  Pain recurred in the middle of December.  No other physical activity. He was being sedentary as he sat for about 10-12 hours every day for studying.   

Sleep:

He sleeps 4 to 5 hrs(poor sleep). 

Stress:

He was stressed as he had the UPSC exam interview in Delhi within a month, and he was worried about the pain during travel.

Objective and expectation:

He wants to become pain-free while lifting weights. 

2)PAIN ANALYSIS:

1) Intensity –  8/10      

2) Aggravating factor – more than 5 minutes of sitting, standing, walking, cough & sneeze 

3) Relieving factor – Rest, lying

4) Location – Low back belt region, radiating to the posterior side of the right leg 

5) Duration – 1 week of severe pain, previously on/off pain for 6 months (from May 2024)

6) Type of pain – Neuropathic pain

7) Character- continuous pain

8) Irritability – High (pain spikes up within 5 minutes of an activity )

9) Sensitivity – High (takes longer to settle )

10) Lifestyle Impact – high (impact on daily activities )

11) Fear of movement –  significant pain-related fear present during forward bending, RDL, and squats. 

Psychosocial factor analysis: 

Cognitive: not affected, he has clarity in his thoughts on pain.

Affective: Slightly affected. He’s worried as his daily activities, and studying are affected. 

Social: Not affected much. 

Clues from the history and pain analysis:

He is leading a sedentary lifestyle as he is studying for UPSC exam. Because of that, he sat in the same place for more than 10 to12 hours. Even though he was going gym every day for one hour, he is not physically active for the rest of the day. 

Also, he does not follow a proper programmed strength training and also irregular with the  training. Further we need analyse his mobility, strength, and load management to understand the reason for his pain.. 

3)PHYSICAL EXAMINATION:

1) Observational findings:

   There is no swelling and redness, and no change in gait. 

2)ROM analysis:

 3)Mobility screening:

Forward bending – poor (unable to touch the front thigh)

Overhead squat – poor ( unable to  squat below 90°, hip shifted to left side,)

4)Stability screening:

Strength testing- Isometric break test:

Single leg sit to stand: unable o perform in both the legs. 

5)Palpation:

No pain on palpation

6) Special tests:

SLR – Positive

Crossed SLR – Positive

Slump test – Positive

SI joint (Laslett Cluster tests – compression, distraction, ganslen’s test, thigh thrust, sacral thrust tests) – Negative

Shopper’s cart- negative

4) INVESTIGATION: MRI