35 y/o female with 7-year h/o LBP, bilateral groin pain, and right anterior thigh pain. Sx's worsened in the last 4 years. Sx's aggravated with sit 1 hour, stand 30 minutes, bending and changing positions.

(+) SLR at 85 degrees bilaterally with increased LBP. Localized pain at L4-5, L5-S1 left > right. Lumbar ROM limited 50%, fingers to knees with increased LBP. Extension and side-bending the spine was asymptomatic.

Treatment consisted of joint mobilization, traction, and therapeutic exercise (including lower extremity stretching, L/P stabilization with focus on neuromuscular control). Sx's improved subjectively 50%. Despite gradual decrease in subjective complaints, the patient's lumbar flexion remained limited at 50%.

We performed ATM2 flexion for 10 repetitions. Lumbar flexion increased to 75%, more than ½ down tibia with fingers without pain. Unfortunately, the patient is leaving the country in one day for the next couple months. We will follow-up with patient when she returns.