A 39-year-old man, who works as a landscape installer, visits your office for the first time. He says he has had chronic back pain for the past 3 years. He describes the pain as dull, nonradiating, and located in the lower midline back. He says the pain is worse with prolonged physical activity. He uses ibuprofen occasionally, but says it does not help much.

The physical and neurologic examinations are normal. He has no sensory or motor deficits. The straight leg raising test is negative. His vital signs are normal and his body mass index (BMI) is 30.6.