Knowing the epidemiology of certain conditions is essential to your clinical reasoning. I test for the most likely scenario and if there is no response then I test for the next most likely cause. Low back pain is a huge problem in our society. If the patient is not a senior, has had the problem off and on over the years and gets worse when stooping or sitting the pathophysiology is likely to be an increased pressure within the endplate area. The endplate is really the enthesis of the disc joint the vertebral body. The test used here increase the pressure at the endplate to even a greater level in the attempt to move edema out of the area.

• Side glide (note some lumbar flexion).
• Extension in lying (prone and supine).
• Home exercise and no flexion first thing in the morning.

If the pain worsens with exercise edema within the IVF may exist or maybe an enthesoopathy exists in the small muscles of the back.

• IVF traction.
• Segmental loading as per patient’s response.
• Probably not the QL.

Spinal morphology will improve and then is the time to introduce stretching and strengthening exercises. Thoracic symptoms are likely due to morphology and enthesopathies at the costovertebral areas.

• Mid T ext.
• Supine mid thoracic traction with bias (patient will guide you).