Clinical Findings a. Symptoms and Signs: The most common cause of low back pain is (mechanical) strain. Patients complain of pain related to (overexertion). Pain may immediately follow lifting or other forms of exertion or may have a more (insidious) onset after prolonged physical activity. Many patients in this group demonstrate generally poor conditioning, with poor abdominal muscle tone and poor posture. Pain from lumbar strain is (exacerbated) by bending or lifting and relieved by rest. Pain is often described as a deep-seated aching that is dull and somewhat diffuse. Pain is most severe in the (lumbosacral) area and may radiate into the buttocks. Palpation reveals tenderness in the paraspinous area, with “trigger points” or “knots” in the erector spinae. (Spasm) of the paraspinous muscles is a common finding, and the patient may have a slight list toward the nonpainful side. Motion is limited by pain. Physical examination is remarkable for the lack of neurologic involvement. Deep tendon reflexes are present and (symmetric). Motor power and sensation in the lower extremities are normal. Rectal tone is normal. The straight leg-raising test is normal. This test is performed with the patient lying supine on the examining table. The examiner lifts the patient’s leg, which is extended at the hip and knee. This (maneuver) passively stretches the sciatic nerve and results in transmission of tension to the lumbosacral roots that contribute to the nerve. The lack of radicular leg pain associated with straight leg raising diminishes the likelihood of spinal nerve compression as the source or symptoms.
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