Treatment of testicular pain using conservative management of the thoracolumbar spine: a case report.

Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care. A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve. We present the case of a 36-year-old policeman with a 5-year history of back pain and testicular pain of unknown origin. Physical examination of the thoracolumbar region revealed that active movement provoked the patient's buttock symptoms, and local mobility restrictions were present in the thoracolumbar region. A central disk protrusion at T12-L1 was noted on upper lumbar spine magnetic resonance imaging, which supports dysfunction of this region. The diagnosis of thoracolumbar stiffness led to implementation of passive and active mobilization of that region and to specific hip stretching and strengthening exercises. After a course of direct and guided physical therapy, the patient attained complete symptom resolution. The patient returned to full work duties as a police officer and resumed his full recreational activity. The excellent outcome achieved in managing this patient was attributed to identifying the origin of referred pain from the thoracolumbar junction.