A 50-year-old male construction worker presents to the ...



A 50-year-old male construction worker presents to the office for evaluation of the acute onset of pain and paresthesia radiating down the posterior aspect of his right leg, from his buttock to the lateral aspect of his foot. Physical examination reveals a 2.0-m (6'7") tall male weighing 166 kg (365 lb). Deep palpation of the right buttock between the sacrum and the greater trochanter reproduces the pain. Neurologic examination is negative. Imaging reveals:

• Moderate to severe osteoarthritis of the lumbar spine

• Facet hypertrophy of L4 and L5

• Right-sided foraminal stenosis at L4-L5

• Grade I spondylolisthesis of L5-S1

• Herniated nucleus pulposus of the L5-S1 intervertebral disk

The most appropriate osteopathic manipulative treatment for this patient is

A) counterstrain to the piriformis

B) high velocity, low amplitude to the low thoracic spine

C) high velocity, low amplitude to the sacrum

D) muscle energy to the lumbar spine

E) muscle energy to the psoas muscle while prone

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