There are symptoms like weakness or numbness in the legs what’s going on if we don’t have those symptoms what well that speaks to where we’re usually dealing with a soft tissue type injury again the muscles are the ligaments and because those are self-limiting by nature and usually respond to conservative measures such as the passage of time ice heat over-the-counter medications massage we really don’t need to work people up there’s there’s an over-reliance on imaging studies and in the US and a lot of people will have terrible pain for a day that’ll be gone within a couple of days so we end up having more x-ray CTS MRIs done that are needed and if we just allow a little bit of time and a little bit of easy treatments a lot of this muscle and back pain isn’t can be over treated and over evaluated right so I guess it’s kind of a tricky thing to do when you have a patient who’s in extreme pain and they want something to be done right away and at what point should someone go to the emergency room I know you should look out for some of those symptoms but when you’re in that much pain should it just be over-the-counter just to start off with well if the pain is truly intolerable there there certainly no bonus points in this life for suffering and and if you can’t get up out of bed or get up off the floor then definitely that does warrant an emergency evaluation and there are other things you’d want to consider if this was related to a recent trauma if there are significant neurologic symptoms associated with it you certainly don’t want to sit on that but what what we’re referring to and I believe dr. Vento was mainly referring to is that sort of run-of-the-mill ache in the low back it hurts it’s worse when you bend over and when you’re sitting you feel bit better when you lay back even if it’s moderate pain it will probably get better you