Case Two Clinical Reasoning

A complex case of chronic low back pain is used to bring together the course’s clinical reasoning approach. The patient is a 33-year-old man with relatively low pain intensity but marked disability, long symptom duration, sleep disturbance, work absence, anxiety, depression, fear avoidance, catastrophizing, low self-efficacy, and multiple recent life stressors. His pain is aggravated by both mechanical and non-mechanical factors, and he also reports episodes that arise without a clear trigger. Assessment findings show normal movement, no notable protective behaviours, no symptom increase with repeated bending, and normal sensory testing for pressure, heat, and cold. These features are interpreted as fitting a nociplastic pain presentation rather than neuropathic or peripheral nociceptive pain. The main emphasis is on using the musculoskeletal clinical translation framework and a bubble diagram to organize the case, identify dominant contributing factors, and guide management. Learners are shown how psychosocial, health, and lifestyle influences outweigh movement factors in this case, leading to management focused on beliefs, stress, mood, sleep, activity, return to work, and possible psychological or medical support.