A 56- year-old man visits his physician complaining of lower back pain for 1 week. He was moving to a new house and carrying a lot of furniture during the last 2 weeks. He does not remember any injury or trauma to his back. His pain is not radiating, improving by rest and ibuprofen and worsening by movement. Medical, surgical and family histories are unremarkable. On examination, vital signs are within normal limits. There is a diffuse tenderness over the lumbar area. Neurological examination is normal. Laboratory tests are normal.
What is the most appropriate next step of management for this patient?
A- Complete bed rest with ibuprofen for 3 days
B- X-ray of lumber spine
D- HLA-B27 testing
E- Refer to a rheumatologist