Derrick is a 45-year-old removal man who has had severe low back pain for 6 days. He was lifting a washing machine and felt his back “go”.
He now has unilateral leg pain that radiates below the knee to the foot or toes. The leg pain is much worse than the back pain.
He had a similar episode 2 years ago when he fell 3 steps. He suffers with hypertension and gastric reflux disease.
He takes Ramipril 10mg daily and Omeprazole 20mg twice a day. The pain is localised in the lower back with no radiation.
He is systemically well with no fever, nausea or diarrhoea. He has full control over bladder and bowels.
No numbness or saddle paraesthesia. Patient is on B12 injections for deficiency. He has taken paracetamol yesterday.