Complex Cases: Radiculopathy, Thoracic Disc, Labrum & Lumbar
In this compelling episode of Week in Review, The FARM clinical team unpacks three challenging and educational cases that push us to think beyond textbook diagnoses and embrace a more integrative, movement-informed approach to patient care. These cases emphasize the power of regional interdependence—the idea that dysfunction in one area of the body often creates ripple effects throughout the kinetic chain. Through each story, we explore how digging deeper into biomechanics, neurodynamics, and compensatory strategies leads to more effective outcomes than chasing isolated symptoms.
The first case centers around a patient presenting with lower extremity radiculopathy—classic symptoms of nerve irritation such as burning, tingling, and weakness. However, there was one notable absence: low back pain. This forced our team to expand the diagnostic lens. Was this true radiculopathy, or could it be peripheral nerve entrapment mimicking radicular symptoms? Could chronic biomechanical overload from poor movement patterns be sensitizing the nerve along its peripheral path? Or could there be a stealth disc pathology—something subtle enough to evade imaging but potent enough to create downstream neural tension? We walk through the clinical reasoning process, highlighting the importance of neurodynamic testing, gait and movement analysis, and ruling out red herrings. Ultimately, this case reminds us that not all nerve symptoms originate at the spine—and treating the whole pathway is essential.
Next, we explore a rare but fascinating case of thoracic disc injury, a condition often underdiagnosed due to its vague symptoms and lower incidence compared to cervical or lumbar pathology. The patient, a competitive golfer, presented with mid-back stiffness, vague chest pressure, and reduced rotational control. On deeper inspection, faulty swing mechanics were placing repeated torque through the thoracic spine, particularly at the T7–T9 segments. The resulting disc dysfunction wasn’t obvious on initial assessment but became clear through repeated loading tests and functional movement breakdown. This case sheds light on how the thoracic spine often becomes the “forgotten middle child,” despite playing a pivotal role in athletic rotation and upper quadrant mechanics. By restoring thoracic mobility and sequencing through golf-specific drills, we were able to offload the disc, reduce symptoms, and get the athlete back to performance.
The final case features a torn hip labrum—but with a twist. The patient also exhibited clear signs of lumbar derangement, muddying the waters when it came to identifying the primary pain driver. The interplay between referred lumbar pain, altered gait, and compensatory hip loading created a confusing clinical picture. It’s here that the concept of regional interdependence shines: without addressing the lumbar spine’s contribution to the pain pattern, even the best hip rehab would have fallen short. By layering in repeated end-range loading for the spine, neuromuscular retraining of the core-hip complex, and gait restoration, we were able to treat the full picture—not just the joint.
This episode is a masterclass in clinical nuance. It reinforces the value of whole-body assessment, pattern recognition, and tailored intervention strategies that don’t just treat symptoms—they restore integrated function.