This patient has two conditions that would create this particular pain pattern; scoliosis with multifidus and quadratus lumborum atrophy would cause low back pain, and Facet Syndrome would also cause this pain pattern. The differentiating factor is that the pain worsens after working out. If scoliosis were the causative factor, the symptoms would have presented much sooner and be more constant and arise from everyday activities and not solely from working out.

The variable here is that this patient’s symptoms do not occur every time she exercises. However, she is not always exercising in the same gym. It is important to understand what the patient is doing and how they are doing it when they are experiencing pain. This patient has been doing weight bearing activity on a variety of surfaces. As with running, some surfaces absorb shock, and some do not. Further discussion revealed that the floors that she had been exercising on were not designed for shock absorption.  

This patient was diagnosed with Facet Syndrome of the lumbar and lumbosacral spine with secondary muscle spasm. The scoliosis was determined to be a slow progressing condition in which unilateral atrophy from her kidney surgery created the process of spinal bending and rotating. This condition was slow and insidious, and she had been living with an undiagnosed scoliosis developing for many years. The use of orthotics over the years did support her spinal elements as her curve was developing over time. 

Question: What treatment would you apply?