It is often thought to be functional or psychosomatic by employers, physicians or friends. The typical patient presents with a history of persistent aching low back pain and stiffness, especially in the morning upon rising. The pain generally goes to the buttock and thigh to the level of the knee. It is aggravated by sitting erect. When acute, even the simplest motions of the back are excruciatingly painful.
Physical findings show minimal limitation of lumbar flexion.
Generally, there is pain on extension and facet tenderness on palpation. When acute, there would be muscle spasm, guarding and severe intolerance to any lumbar motion. EMG is negative except for when a herniated disc is also present, and it may cause compression of the nerve root, thus revealing evidence of radiculopathy. Acute Stage - bedrest with analgesics, muscle relaxants with mobilization as soon as possible. An intraspinal analgesic infusion will achieve pain relief and allow mobilization.