What the heck?! Here’s an interesting case of back pain! Can you figure it out?

A 20 year old male athlete has been performing 125 pound deadlift exercises recently. During his last session, he rapidly escalated to 6 reps at 235 pounds. He developed crampy lower back pain two hours later. The pain became rapidly worse, and he was evaluated at a hospital two days later.

He complained of unrelenting back pain, and could not get up or turn from a supine position. He denies taking any medications or supplements. There is no history of trauma.

On exam, he had firm and painful paraspinal muscles. Buttocks, thighs, and legs were nontender. All pulses were present. Straight leg raise and reverse straight leg raise tests were normal bilaterally. The abdomen was soft and nontender.

What are you thinking? What additional workup is needed at this point?

Post your comments below, or tweet them out. Tomorrow, we’ll walk through the diagnostic stuff, and Monday will be the big reveal.