A 45-year-old man presents to primary care with a complaint of lower back pain that started 2 days ago. He states that he was gardening and felt his back “lock up” while bending forward to pull weeds. The pain is localized to the lower lumbar region with some radiation into the right buttock, but it does not extend below the knee. He reports the pain is 7/10 in severity, exacerbated by movement, and partially relieved by lying perfectly still. He works as an accountant and spends most of his day sitting. He denies any history of trauma, unintentional weight loss, fever, or night sweats. He reports no changes in bowel or bladder function and no numbness in the saddle region. His past medical history is significant for mild hypertension. He takes no regular medications and has no known drug allergies.

He is afebrile. His blood pressure is 135/85 mmHg with a heart rate of 78 bpm.