Upon examination, the patient was afebrile and exhibited normal vital signs. He exhibited significantly reduced and painful global ranges of lumbar motion. Seated and supine straight leg raise produced bilateral leg pain to the calves. Valsalva was positive for localized lower back pain. Neurologic examination revealed 0/5 Achilles muscle stretch reflexes, 4/5 motor strength of bilateral plantar flexion, dorsiflexion, eversion and inversion. Palpation revealed painful trigger points with jump signs affecting the quadratus lumborum and the gluteal musculature. Intervertebral segmental dysfunction was noted affecting L1/2 and the left sacroiliac joint.
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