Case 1
Ernest Mboto, aged 66, farmer. Problem: Persistent dull low lumbar back pain for ten weeks, worse at night and steadily becoming more intense.
History of injury: No
Site and Radiation: Central lower lumbo-sacral, radiation 
into both buttocks when severe.
Type of Pain: Boring deep ache, unrelenting and 
continuous.
Onset: Insidious
Aggravation: Movement and activities such as 
lifting and gardening.
Relief: None apart from analgesia.
Associated Features: Malaise, fatigue, muscular 
weakness, recent weight loss 2kg.
Urinary symptoms: Increasing frequency, difficulty 
starting and stopping micturition.
Physical examination
Inspection: Gait and movement: Limited with 
protective movements.
Posture: Flattened lumbar lordosis.
Palpation: Mild tenderness to deep palpation 
over L4 and L5.
Movement: All movements (flexion, extension 
and lateral flexion), restricted and 
protective.
General: Patient appears unwell. No neurological 
abnormalities. Examination of chest, 
CVS, abdomen and urine normal.