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Dear all Thanks to everyone for their advice, it has been both really helpful and exceptionally interesting. My treatment with this patient following the first few replies (John and Rege) was based on reducing inflammation and avoiding provoking activities. After 24hrs of minimal activity with Diclofenac 50mg (3 daily) symptoms were significantly improved (eg. able to prone lie with minimal pain and NO pins and needles or numbness, able to stand and walk for approx. 5 mins with no neural signs again though still with pain (previously 1minute). I feel more confident with this patient as I am able to progess activity with no increase in neural signs- even though pain is still limiting to some extent. However (R) ankle reflex is still absent- is this normal, and is it significant for anything if it doesn't resolve? My progression of activity involved increasing amounts of sitting and walking with periods of offloading the spine to prevent further inflammation of the S1 nerve. This has been combined with core stability and glute work, again in lying-sitting-standing. I didn't take a classical McKensie approach (as I have little experience) but did use facets of it (as I understand it) by using pain-free positions (eg. in prone, with side flexion away from painful side and progressing to neutral as pain allowed). I didn't feel comfortable moving the patient into painful positions, especially repeatedly, because of the following reasons: 1) Over the previous week, when he had been in extension positions with pain, the neural signs had always followed, and then stayed for sometimes hours. It had been ISQ for 1 week. My approach was to calm the neural signs as a priority. 2) This seemed to indicate an inflammatory condition to me eg. inflammation of the S1 nerve was my rough hypothesis (although I was still unsure about the L5/S1 disc). Avoiding inflammatory actions made good sense to me. I was quite unsure about the disc hypothesis in the McKenzie approach, and read some of Mel Siffs comments on discs from previous postings, as well as Giffords editorial in Pain, and a chapter one of his books. The difference subjectively from the patients view was about 70% improvement over that 24hr period, and he was very happy. Even a week of restricted activity had severely afftected his mood. Over the weekend there has still been activity limitation by pain, as already mentioned, but I feel confident to progress with this. It is essentially in the lower back, with some radiation through the S1 distribution on standing & walking (but no p&n or numbness). However I would still very much like to hear any opinion on the relevance of the absent T-A reflex and any implications of this? Thanks Ben Fisher Junior Physio London, UK PS I would like to repeat that I have found the responses all very helpful, and feel quite privileged to be able to access this advice. Thanks.