Young climber with gradual onset lower back pain, no method of injury but seemingly climbing related. No functional or diurnal problems but pain during climbing.

In clinic – AROM normal, all special tests negative and no pain on palpation. Neuro screen -ve. Posture – anterior tilted pelvis.

So, up to this point I was going nowhere but obviously needed to get to the bottom of this. The only things I had to go on was the patient’s comment that only hurts when climbing and this anterior pelvis.

Up to this point I had decided to assess and treat the patient’s hip and thigh muscles with muscle energy techniques (METs) and noticed a shortening of their quads but no corresponding in their hip flexors (Thomas test) as you would expect with more chronic lower backs. Testing did NOT reproduce symptoms however it did tie in with the anterior pelvis and I looked into this further next session.

Treatment – soft tissue massage of tight paraverts and METs.

Plan – Movement assessment on the climbing wall