Case history
Case history
A 38-year-old man with no significant history of back pain developed acute lower back pain when lifting boxes 2 weeks ago. The pain is aching in nature, located in the left lumbar area, and associated with spasms. He describes previous similar episodes several years ago, which resolved without seeing a doctor. He denies any leg pain or weakness. He also denies fevers, chills, weight loss, and recent infections. Over-the-counter ibuprofen has helped somewhat, but he has taken it only twice a day for the past 3 days because he does not want to become dependent on painkillers. On examination, there is decreased lumbar flexion and extension secondary to pain, but a neurologic exam is unremarkable.
Other presentations
Patients with musculoskeletal lower back pain have pain of a highly variable character, duration, location, and severity. The distinguishing features of this condition are the lack of neurologic findings in the lower extremities and absence of red flags. Red flags include recent significant trauma; minor fall or heavy lift in a potentially osteoporotic or elderly person; unexplained weight loss; immunosuppression; history of cancer; intravenous drug use; urinary tract infection; prolonged use of corticosteroids; osteoporosis; focal neurologic deficit with progressive or disabling symptoms; acute onset of urinary retention or overflow incontinence; fecal incontinence or loss of anal sphincter tone; saddle anesthesia; global or progressive motor weakness in the lower limbs; duration of lower back pain >6 weeks, not responding to conservative therapy.[3][4] Patients may complain of pain in the muscles or in the lumbosacral region of the spine. They commonly have pain radiation to the buttocks or thighs, but this does not typically extend distal to the knee.
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