This patient with subacute low back pain would most likely benefit from a trial of massage therapy. Back pain is classified as acute (lasting <4 weeks), subacute (lasting 4-12 weeks), or chronic (lasting >12 weeks); therefore, this patient's clinical findings are consistent with a subacute process. The overall prognosis for most forms of musculoskeletal back pain without neurologic or systemic findings is excellent, and 90% of patients recover within 6 weeks with self-care (remaining active and application of superficial heat) and pharmacologic therapies (acetaminophen or NSAIDs). Patients who do not improve in that time frame may benefit from additional therapeutic interventions, such as spinal manipulation or massage therapy. Massage therapy has been shown to be an effective intervention in patients with subacute or chronic back pain symptoms and would therefore be an appropriate treatment to recommend to this patient. Patients should also be informed that most low back pain resolves spontaneously without intervention.

Bed rest had been historically recommended as a treatment for back pain but has been shown to decrease functional recovery and increase pain levels in many patients. Based on these data, patients with low back pain, such as this one, should be encouraged to maintain their daily activities, if possible.

Despite their anti-inflammatory effect, systemic glucocorticoids (such as prednisone) have not proved effective in treating low back pain when used either for brief treatment periods or longer courses.

Lumbar support has not been demonstrated to be effective in treating low back pain, even in physically active patients. It would therefore not be an appropriate treatment for this patient.