Common causes of back pain include nonspecific pain or muscle strain, herniated disk, spondylolysis, scoliosis, and Scheuermann’s kyphosis. Less common causes include tumor, Infection and sickle cell crisis. If nonspecific back pain is suspected, treatment may include home-based exercise, physical therapy, or nonsteroidal anti-inflammatory drugs. If the history And physical examination suggests underlying pathology, radiography, complete blood count, erythrocyte sedimentation rate and a C - reactive protein measurement should be performed. Follow-up magnetic resonance imaging, computed tomography, or bone scanning may be needed depending on the suspected cause. It is generally accepted that the following factors warrant immediate evaluation: patient age younger than four years, persistent symptoms, Self-imposed activity limitations, systemic symptoms, increasing discomfort, persistent nocturnal pain, and neurologic symptoms.