Steve is a 22-year-old first-year graduate student in molecular biology who was referred by his friend. Steve has a 6-week history of right lower back pain, right buttock pain, and radiating right leg pain. The pain began without any particular inciting event that he can identify. The pain radiates from the right lower back and buttock into the right posterior thigh, lateral thigh, calf, and into the right dorsum of the foot. Steve’s right lateral lower leg feels numb to him.

Steve’s pain got much worse 1 week ago after a long car ride. In general, Steve says that his pain is worse with sitting and better with standing and/or walking. For the last week, since the long car ride, Steve has had trouble sleeping because he has trouble finding a comfortable position when lying down. A few times, the pain has woken him from sleep. When he sits for more than a few minutes, he rates the pain as 9/10 on VAS. He says the pain is also generally worse in the morning when he first wakes up.

Steve has been taking ibuprofen and acetaminophen but these medications have not been helping. He has trouble studying because of the pain. He does not feel as though his leg is weak. He has no changes in bowel or bladder habits. Upon closer questioning, Steve does recall an intermittent history of lower back pain and occasional right leg pain over the last 2 years since a long airplane ride, but he is quick to emphasize that the symptoms had always been very mild and so he did not take much notice of them.

Steve likes to work out and exercise although since starting graduate school he reports that he has not found time to go to the gym. Steve has no imaging studies of his lumbar spine and has not had any treatments for his back other than the over-the-counter medications that he has been taking.