Lower Back Injury - Powerlifting

History: A 30-year-old female experienced a back injury in 2022, after moving, working a full-time healthcare job, and working extra in a bar. Her regular routine consists of 6 powerlifting sessions a week, with heavy compound lifts. During heavy deadlifts, she experienced a sudden discomfort on the right side of her lower back. She had no complaints during the night but was unable to get out of bed the next day. She experienced stiffness and “tingling shooting pain” on the right side of her back and her right leg. Unable to assume an upright position, she walked in a slightly bent-over stance all day and alternated between standing, walking, and lying down. Physical examination: An L4-L5 lower back injury, affecting the lower body's nervous system was evident. She experienced numbness in the right glute area, the right hamstrings, and the calf. She had a tingling sensation in her right leg occurring in various positions, restricted trunk flexion, full range of motion when extending and rotating the back, and numbness while urinating. Multiple physical assessments were done to examine the back area and the lower part of her body. Testing started on the left side and finished on the right side. An MRI was recommended to determine a herniated disc or a sciatic nerve impingement. Differential diagnosis: - Herniated disc L4-L5 - Impaired fascia Thoracolumbalis - N. Sciatic impingement. Test and results: - MRC scale for Muscle Strength: Quadriceps and Hamstrings L5/R5, Tib. Anterior L4/R3, Soleus, Gastrocnemius L4/R4 - Straight leg raise/Lasègue test: both legs positive - Slump test: radiating, shooting pain on the right - Fingertips to floor distance: limited by back and glute pain - Walking on heels: unable on either side - Walking on toes: unable on either side - Achilles tendon reflex: lack of reflex response on the right - Patellar tendon reflex: decreased reflex response on both sides - Plantar reflex: decreased reflex response on both sides - MRI scan confirmed: herniated disc L4-L5. Final working diagnosis: L4-L5 Herniated Disc. Treatment and outcomes: - 6 weeks of no compound lifts - Daily 30-60 min walks - 8 weeks of isometric back and ROM exercises - Stretching 2-4 reps per exercise, 10-30 sec. holds - From week 6 on low-intensity strength training 2-4 sets, 8-12 reps, 60-70% of 1RM - Swimming