This chapter, written for undergraduate medical students and post-graduate doctors in training, presents information on how to manage back pain — a case which they are likely to encounter in the future in a general practice setting. It presents the case of an 83-year-old man who has back pain. He tells that over the last 3 years he has lost power in his legs making it difficult to get up out of a chair or climb the stairs and that he has become unsteady when walking. The chapter provides details of the patients' medical history and the key findings of clinical examination, together with initial investigation results data for evaluation, and helps them develop their skills of clinical reasoning. Key questions then prompt the student to evaluate the patient, and reach a decision regarding their condition and the possible treatment plan.