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Your patient has complaints of increasing low back pain during the day.Her job requires repetitive lifting and reaching overhead (25 lb maximum) .On examination, you note that on forward bending she has difficulty moving smoothly midrange and that on side bending to the left there is an acute angle in the midlumbar region.Additional tests lead you to hypothesize that she has clinical instability in the midlumbar region.This could be caused by all of the following except:
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