Questionnaire/history: Site? Onset? Injury? Characteristics? Radiation? Night pain? Pain intensity? Exacerbating factors? Relieving factors? Associated symptoms? - Numbness (eg perianal, perineal or genital sensory loss)? - Weakness? - Resent-onset urinary retention or incontinence? - Unexpected laxity of the anal sphincter? - Resent onset faecal incontinence? - Unexplained weight loss? - Other? Past medical history? Current medication? Painkillers? Drug allergies? Examination: Gait? Posture? Skin changes/bruising/rash? Deformity (eg step deformity)? Swelling? Limitation of range of movement (ROM)? Straight leg raising? Tenderness? Weakness? - Knee extension? - Ankle eversion? - Ankle dorsiflexion? Loss of sensation? Changes to reflexes? Loss of anal tone (if indicated)? Temperature? Management: According to cause, if musculoskeletal: Advised: - Ibuprofen or offered naproxen if no contraindications (with gastroprotective treatment) (+/- paracetamol) - Codeine if nonsteroidal anti-inflammatory drugs (NSAIDs) contraindicated, not tolerated or ineffective - Diazepam 2 mg up to three times a day for up to 5 days if muscle spasms - Local heat - A firm cushion between the knees when sleeping on the side, or several firm pillows propping up the knees when lying on the back - To stay active, resume normal activities and to return to work as soon as possible - Prolonged bed rest not recommended - Normal movements may produce some pain which should not be harmful if activities are resumed gradually and as tolerated, no need to be pain-free before returning to normal activities or work - Work adjustments can make an early return to work possible, this may be arranged by an Occupational Health department if available - Keeping as active as possible and exercising regularly is important to reduce the risk of recurrence - To read information at www.backcare.org.uk - To seek medical advice if any red flag symptoms or signs (especially if worsening pain, bilateral leg pain, weakness in legs or feet, perianal, perineal or genital sensory loss, urinary retention or incontinence, faecal incontinence) and to contact own GP if no improvement or ongoing symptoms after 3-4 weeks Reference(s): NICE CKS: Back pain - low (without radiculopathy)