Lower thoracic syndrome - a differential screen for back pain following vertical compression injury: a case report

A 36-year-old male experienced left sided back and radiating flank pain, following a fall on his buttock. A detailed medical evaluation ruled out the presence of red flags. Initial examination revealed positive findings of comparable local tenderness over the left T11, T12 and left paraspinal area, and a 2 cm shortening of the left leg. 8 treatment visits for a period of 4 weeks addressed mechanical dysfunction at the T11, T12, lumbar and pelvic region, comprising manual therapy, therapeutic exercise and pain relieving modalities. Reduction of local tenderness, back and radiating flank pain was observed. Additionally, resolution of the persistent apparent shortening of his left leg was observed, following a high velocity thrust (HVT) manipulation of the T11, T12 segments. The vertebral motion segment of T11, T12, the thoracoabdominal nerves, the 12th rib, the quadratus lumborum and the serratus posterior inferior are speculated to be potential symptom mediators. The findings in the case report suggest the lower thoracic region to be included during the evaluation process of back pain, especially when the mechanism of injury is a vertical compression.