If the patient has a history of lumbar trauma or strain, and if there is pain in both lower extremities, it may be due to lumbar spine or lumbar muscle injury, lumbar disc herniation, ankylosing spondylitis and other diseases of the locomotor system, and a lumbar spine CT, lumbar spine plain film or lumbar spine MRI should be performed to further clarify the cause. If none of these are present, the most likely cause is urinary stones, and a routine urine test or ultrasound should be performed to further clarify the diagnosis.
If all of these conditions have been ruled out, other urological conditions such as pyelonephritis and, if the patient is female, female genital conditions such as pelvic inflammatory disease should also be considered.