04-07-2009, 08:04 AM
A 30-year-old man has had increasingly severe
low back pain
since lifting a heavy object at work 3 days ago. The
pain does not radiate
and is not associated with bowel or bladder problems.
He has a history
of occasional stiffness and mild pain in his lower
back. There is
bilateral paravertebral muscle tenderness in the
lumbar region and limited
flexion of the lumbosacral spine. Examination of the
lower extremities
shows normal muscle strength and sensation;
straight-leg raising is
negative bilaterally. Deep tendon reflexes at the
knees and ankles are
normal. Which of the following is the most
appropriate next step in
management?
A
) Exercises to strengthen abdominal muscles
B
) Exercises to strengthen paravertebral muscles
C
) Bed rest for 5 to 7 days
D
) Use of a muscle relaxant
E
) Use of a nonsteroidal anti-inflammatory drug
low back pain
since lifting a heavy object at work 3 days ago. The
pain does not radiate
and is not associated with bowel or bladder problems.
He has a history
of occasional stiffness and mild pain in his lower
back. There is
bilateral paravertebral muscle tenderness in the
lumbar region and limited
flexion of the lumbosacral spine. Examination of the
lower extremities
shows normal muscle strength and sensation;
straight-leg raising is
negative bilaterally. Deep tendon reflexes at the
knees and ankles are
normal. Which of the following is the most
appropriate next step in
management?
A
) Exercises to strengthen abdominal muscles
B
) Exercises to strengthen paravertebral muscles
C
) Bed rest for 5 to 7 days
D
) Use of a muscle relaxant
E
) Use of a nonsteroidal anti-inflammatory drug