The patient who led us to pursue this question was a 62 year old female with a medical diagnosis of piriformis syndrome and gait abnormality. The medical treatment to date included prescribed medications and physician’s advice. The physical therapy diagnosis was low back pain (LBP), bilateral lower extremity (LE) pain, poor balance, and gait abnormality. The patient responded well to the McKenzie extension approach at the first visit and was instructed to perform extension-in-lying 10 times every 2-3 hours at home. At her next visit, two weeks later, she had improved slightly and responded to manual overpressure performed by the physical therapist with increased motion and decreased pain. Two weeks later, however, her symptoms had worsened and she reported that she had returned to the physician and is scheduled to have an MRI.