I'm curious how you all would treat the patient I saw today. 33 y/o, in 2007, fell off a Humvee with all his gear on. After this he had bad back pain for some time, but it got better and for the next 4 years or so, had on and off back pain. In Jan this year, he was doing somy heavy dead lifting, felt something in his back ("it wasn't a pop"), and had pretty bad back pain, and unlike before, this pain has persisted. Pain is worse on the right. All axial, but occasional radiation to the groin. Also after activity will sometimes radiate down the legs, but not the same leg each time and doesn't sound like any particular pattern. Pain worse with bending and twisting. Relieved with rest and also movement. Heat and TENS helps. Chiro has been not very helpful. PT hasn't helped. Elavil doesn't help him sleep and doesn't seem to help with the pain. About the time he had the accident, he started going through a divorce and recently started seeing mental health because of some serious life stressors related to that (kid custody issues). He doesn't smoke. ODI = 55%. PCL-M = 25. PHQ-9 = 9. Exam shows paraspinal tenderness lower back. MRI shows disc dessication at L4/5 and L5/S1 with some loss of height but still >50%. He has a prominent HIZ at both levels. L5/S1 has a mild right subarticular herniation, but no foraminal or central canal narrowing. No modic changes. Besides the continued core strengthening (a goal of doing a plank for 2 minutes is what I told him), mental health for biofeedback, CBT and guided imagery, yoga, Chiro, possibly accupuncture, recommendation for aerobic excersize, and possible other pharm options you would definitely offer, would you offer him interventions? If so, what?