Postural Loading disorder + motor control

Hi guys. This week I had a case of postural loading disorder with motor control dysfunction component at the musculoskeletal outpatient clinic that I think it is interesting to share with everyone. The patient complained of pain on upper Lx after sitting. No history of injury. Asking about his hobbies I found out that the position of the sport (1h/per day) that he has been palying for 2 years was in full Lumbo-thoracic flexion. He use to get pain during and after training, but now the pain is gone after he started some Lx mobility exercises. Assessing his ROM, his active Lx fl was full and pain free, ext was full and painful 8/10 at EOR and he was hinging at T12-L1. He had a slumped posture and the apex of his kyphosis was around T-12-L1 (spot where he was complaining of pain). PIVMS were hyper (into ext) at L1 and PAIVMs stiff L4-S1 and painful at T12 and inter space T12-L1. At the end of the O/E a found out that he had a flexion and extension motor control disorder. When I was assessing his ability to find neutral spine in sitting, after a few verbal and manual cues, he could adopt neutral spine and his pain was gone. As my first intervention I gave him some education & hand out about core stability (local and global system), taught him to adopt neutral spine + TA activation in sitting, standing and 4 pt kneeling and started to add arm movements. That was as much I could give him before he would start activating global muscles. My supervisor suggested me that I could tape him vertically from around T11-L2 (including the segments that were at fault) so he could have a feedback to don’t flex the spine in sitting. This case it was quite straight forward, because the symptoms decreased immediately once the neutral spine was adopted. Usually loading disorders that come after sustained flexion after prolonged periods of time cannot be reproduced during the assessment, so my supervisor showed me another way to reproduce the pain by pressing down on the patient’s shoulder loading the spine for a few seconds to bring the pain one. Then we can ask the patient to adopt the neutral spine and then press again and assess if the pain relieves or not. That is a way to show the patient why keeping the neutral spine and practicing that is important. It also a way to have an objective measure for ax and re-assessment for the time that pain comes on.
I think it is always good to have another ways to assess objectively what we are looking for if the common assessment procedures don’t reproduce the patient’s symptoms. I hope this become useful for you guys if a patient with this sort of presentation come across in the future.