A 48-year-old woman presented to the office with a three-month history of lower back pain. The pain is constant, dull aching, and becomes worse at night. It does not improve with rest, but over-the-counter ibuprofen provides some relief. She has no relevant history. Her mother had breast cancer at the age of 55. She does not use illicit drugs or smoke. However, she drinks 10–12 units of alcohol most weeks. She worked part-time stocking the shelves in a supermarket and was very active and competitive tennis and badminton player.On examination, there is local tenderness present at L5/L6 level. There is no swelling or deformity. Her spinal movements are regular. Other examination findings are normal.