Does Back Pain Always Require an MRI?
A 39-year-old male presents with the onset of acute low back pain. He was doing some yardwork, including pulling out large bushes, when he experienced the acute onset of low back pain, radiating down the back of the left leg. Since that time, the pain has worsened in intensity and he is having difficulty bearing weight on the leg. He initially took 800 mg ibuprofen, and this provided a small degree of relief, but he has not taken any medication since the problem initially occurred. The patient has no significant medical history. His general physical examination is within normal limits. On neurological examination, he has severe pain with active movement of the lower extremity, but only minimal pain with passive movement of the lower extremity. He has a positive straight leg raise but no other neurological deficits. The patient is requesting an MRI of the lumbar spine, saying “I’m sure I slipped a disk or something.” What would you do at this point? Discussion Acute low back pain is one
