A 56- year-old man visits his physician complaining of lower back pain for 1 week. He was moving to a new house and carrying a lot of furniture during the last 2 weeks. He does not remember any injury or trauma to his back. His pain is not radiating, improving by rest and ibuprofen and worsening by movement. Medical, surgical and family histories are unremarkable. On examination, vital signs are within normal limits. There is a diffuse tenderness over the lumbar area. Neurological examination is normal. Laboratory tests are normal.
What is the most appropriate next step of management for this patient?
A- Complete bed rest with ibuprofen for 3 days
B- X-ray of lumber spine
C- Electromyography
D- HLA-B27 testing
E- Refer to a rheumatologist
Radiography of the lower back should be recommended in all cases of a new onset lower back pain after the age of 50. Bed rest and ibuprofen may improve his pain but it will not be helpful in diagnosis and management. There is no need now for further investigations unless there is something shown on x-ray.
The correct answer is B