My reflection in October 2016: Non-specific lower back pain in Women’s health: Musculoskeletal masqueraders ...

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Figure 1 is from the article link is attached below in the article 

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Nothing is NEVER what it seems extraxt from Troyer (2007) Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain!
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When you see a 25-year-old female with 5 year Hx (history) on and off pain with sudden onset of severe left-sided lumbo-sacral, lower quadrant, buttock, and thigh pain.
She had pain on flexion and prolonged walking or sitting.
No eases
Disturbed sleep & awoken with pain
Bowels -NAD (nothing abnormally denoted) 
Bladder last 2 years Increased urgency and frequency

Objective examination (O/E)
reduced flexion with pain EOR (end of range) extension was clear.
Power 4/5 for Bilat Lower limbs
Reduced sensation 
Passive straight leg raise (PSLR) did not reproduce her leg pain only back pain,
Reflexes KJ & AJ both bilaterally present
Full passive range of motion (ROM) at the Hip
Negative Patrick's test.
Low BMI (body mass index)

Investigations -
MRI of lumbar NAD (nothing abnormally denoted)
Urine analysis negative for infections

Family Hx 
Strong Family Hx RA (rheumatoid arthritis) and hypothyroidism

Result
Turns out the nonspecific or mechanical low back pain is NOT THE PAIN DRIVER, this young lay had Endometriosis and left sided ovarian cyst....
You learn something new EVERYDAY!
For those that do not know endometriosis is, it is a COMMON gynaecological disorder in women between 25-30 and can mimic musculoskeletal symptoms and manifest as nonspecific low back pain. This is why you should always be thinking outside the box, because nothing is ever what it seems. Not ever patient who turns up at your door step will have MSK issues as the MAIN PAIN DRIVER (which I will be doing a reflection on another reflection/blog). Definitely a useful and one remember when you are deferentially diagnosing a patient :)

Article:
Troyer (2007) Differential Diagnosis of Endometriosis in a Young Adult Woman With Nonspecific Low Back Pain. Physical Therapy, Volume 87, Issue 6, 1 June 2007, Pages 801–810,

Link: https://academic.oup.com/ptj/article/87/6/801/2747261

Update- January 2019
​When I read this article it later came in handy when I came across a patient who actually presented with something very similar. We are currently working on their MSK issues - whilst they are being investigated to rule out other possible causes such as:

• Ovarian cyst
• Fibroid's
• Endometriosis

Update- March 2019 
They have been discharged from my care to continue managing their MSK low back pain with a graded exercise program and to stay under the care of gynecology for further management of their ovarian cyst and fibroid's.