Study Design: Case Study. Background: This case report describes the clinical course of a patient with right low back pain (LBP) and the use of clinical evaluation findings to initiate medical referral resulting in a diagnosis of cancer presenting as mechanical low back pain. Diagnosis: A 59-year-old male with primary complaints of progressive right-sided LBP affecting his job, sleep, and daily activities was seen by a physical therapist in an outpatient setting. The components of the patient’s history and physical examination were consistent with mechanical thoracolumbar dysfunction. However, clustered examination findings suggested the possibility of a more serious underlying disease. Considering a review of evaluation findings, the patient was referred to a physician for medical evaluation and diagnostic imaging to rule out a non-mechanical cause of symptoms. Medical diagnostic imaging discovered metastatic cancer as the primary cause of this patient’s thoracolumbar pain. Discussion: Physical therapists must perform systems screening and understand the clinical findings associated with the presence of serious underlying disease. In managing LBP systems, screening can provide an accurate differential diagnosis and guide the clinician in deciding if a physician referral is warranted.



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