Mrs Hawthorne, a 34-year-old pharmacy assistant, suffered an episode of acute lower back pain unloading a tumble dryer at home and subsequently developed intermittent moderate discomfort radiating into her left buttock and posterior thigh to the knee after sitting for more than 30 minutes at a time, and pain in the left groin area when getting up and walking. She was referred to physiotherapy by her GP after conservative measures were not sufficient to alleviate the problem.

After a thorough examination, it was clear that the problem was a strained deep lumbar paravertebral muscle causing a rotated pelvis and left-sided piriformis syndrome and iliopsoas syndrome. This results in a contracted piriformis muscle deep in the buttock area compressing the sciatic nerve, and inflammation of the iliopsoas bursa (a small fluid-filled sac under the iliopsoas tendon in the groin area). It was also evident that the original cause of the injury was most likely due to some postural dysfunction and poor core stability.

Treatment consisted of specific joint mobilisation and manipulation of the lumbar spine and thoracic spine to restore normal spinal and pelvis alignment. Specific soft tissue techniques were used to release the spinal muscles and contracted muscles in the pelvis. Mrs Hawthorne was given advice and exercises on posture, stretching and core stability.

At the end of the course of treatment, Mrs Hawthorne had a full recovery and was able to return to her everyday activities pain-free. She planned to continue with the advice and exercises to prevent the injury reoccurring.