Patient 45 year old male, presented with R thoracic-lumbar back pain. Pain started 4 days ago after lifting heavy object. Pain was not immediately but an hour later when he tried to sweep the floor. He rested for the next three days and then saw dr. which prescribed anti-inflammatories. He felt better getting up the next day but a wrong movement ( he is not sure what specifically) set his pain of again. When the pain starts it is debilitating and he can't move - feels if muscle goes into uncontrollable spasm. No referred pain. Gets some relief when lying on the painful side - can't lie on the opposite side at all
On examination: He was standing in lumbar flexion but could straighten up when asked to without aggravating symptoms. When asked to do lumbar flexion this flared up his pain at the beginning of the movement and was so bad that he had to sit down before the pain settled and he could straighten up. It was decided not to continue with further assessment as any movement after this was painful.
Very tender on T10 on R. No pain on deep breathing Overlying muscle spasm T7 - L3 mainly on right.
My question is, how do you treat this patient without making him worse - any suggestions

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