Summary: Forty six years old female was assessed in physiotherapy OPD of Helping hand institute of rehabilitation Sciences Mansehra complaining of back pain. She had history of the same for 15 years. Her back pain aggravated 4 years ago after lifting a heavy weight. At that time she was treated by orthopedic surgeon through lumbar traction and pain medication. The severe pain resolved for more than two years. Her back pain recurred 3 months ago in an excruciating manner and disabling form. No

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... medy was relieving her pain. Key finding during objective examination were: Decrease SLR Right more than left; decrease range of motion of lumbar spine on all planes; severe pain on passive inter vertebral movement; decrease myotomal strength within the distribution of L and decrease mobility. 5 Findings on MRI were: grade 2 spondylolisthesis, multiple level disc herniation and bulges. Out of the box and novel Physiotherapy interventions such as specific extension maneuver at L5S1 level, Mobilization of SIJ and segment above L were useful in reduction of pain and restoration of her 5 mobility. She received 24 physiotherapy sessions extended over 2 month's duration and became asymptomatic. The case was initially seen in April 2014 and last seen was June 2015.