Acute Lower Back Pain Case 1

A 35-year-old man bent down to pick up a heavy weight and felt severe pain in his back. He has no significant past medical history. There is no radiation to his legs and he has no neurological symptoms or signs. He is tender over L5 and the paravertebral muscles. He stands with an increased lordosis and forward flexion of his back is reduced. Walking is painful.

What is the most likely diagnosis?

What investigations are required for this patient in the emergency department (ED)?

How should you treat this patient?

The patient asks you about the prognosis of his pain. From your knowledge of the literature, what are you able to advise him?