A 32-year-old male presents to the urgent care with the complaint of acute onset mid low back pain. History reveals his symptoms began three hours ago when he was cleaning out his garage and felt an immediate sharp pain in his lower back while moving a heavy box. The pain is described as sharp and stabbing, rated 5/10, and is worse with movement, up to 7/10, especially forward bending and rotation. He denies any radicular symptoms, numbness, weakness, or bowel and bladder dysfunction. Physical examination demonstrates an antalgic gait with a slightly forward posture. Straight leg raise reproduces his back pain. Strength, sensation, and deep tendon reflex testing are all normal. Osteopathic examination reveals L5 is flexed, rotated left, and sidebent left with associated lumbosacral myofascial restrictions.
Based on the osteopathic examination, his sacral somatic dysfunction is most likely a
- left-on-left sacral torsion
- left-on-right sacral torsion
- right unilateral sacral extension
- right-on-left sacral torsion
- right-on-right sacral torsion