Treatment Plan:

1. Anti-inflammatory techniques to initially settle constant ache and prolonged morning stiffness: iontophoresis, phonophoresis, ice, ultrasound. She was already on medication for inflammation.
2. Mobilize L3/L4 and L5/S1 as tolerated. Initial mobilization of specific distraction techniques progressing to gliding physiological techniques for the specific joints (L3/4 and L5/S1), with caution on protection of L4/5 during the maneuvers.
3. Initiate electro-stabilization with an NMES stimulator (Neuromuscular Electrical Stimulation used to improve muscle strength and prevent muscle atrophy) to facilitate the activity of multifidus, especially at L3–L5 on the right. Initiate NWB multifidus facilitation and NWB training, without and then with TheraBand. Progress multifidus training from side-lying to 4-point to standing, as tolerated.
4. Initiate correct diaphragmatic breathing, pelvic floor/transversus abdominis contraction, and Level I Core Stabilization. Progress as tolerated to Levels II–IV Core Stabilization.
5. Initiate flexibility exercises for the lower extremity.
6. Educate on lumbar spine biomechanics/function, proper positioning, breathing components, and breathing program/core stability.

Question: What findings were the most significant indicator of clinical instability?