Back Pain, Low
Back Pain, Low
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- Low back pain (LBP) is extremely common and includes a wide range of symptoms involving the lumbosacral spine and pelvic girdle.
- Characterized by duration or associated symptoms
- Duration (1)[A]
- Acute (<6 weeks)
- Subacute (>6 weeks but <3 months)
- Chronic (>3 months)
- Associated symptoms (1)[A]
- Localized/nonspecific “mechanical” LBP
- Back pain with lower extremity symptoms
- Systemic and visceral symptoms
- A specific cause is not found for most patients with LBP. Most cases resolve in 4 to 6 weeks.
- Rule out “red” flag symptoms indicating the need for immediate intervention.
- System(s) affected: musculoskeletal, neurologic
- Synonym(s): lumbago, lumbar sprain/strain, low back syndrome
- 1-year incidence for first episode: 6.3–15.3% (2)
- 1-year incidence for any episode: 1.5%–36% (2)
- A very common primary care complaint (1)
- Lifetime prevalence: 84% (1)
- Global point prevalence: 9% (1)
- Chronic point prevalence in United States: 13.1%
- Predominant sex: male = female
- Age: The highest incidence is in the 3rd decade (20 to 29 years); overall prevalence increases with age until age 65 years and then declines (1).
Etiology and Pathophysiology
LBP can be commonly due to muscle spasm/tension. Estimated 39% of chronic LBP due to disk degeneration. 30% estimated to be from facet joint syndrome. Other possibilities include sacroiliac injuries/degeneration and spinal stenosis. Age-related degenerative changes of the lumbosacral spine and atrophy of supporting musculature may contribute as well (2)[A].
- Age (1)[A]
- Activity (lifting, sudden twisting, bending) (1)[A]
- Obesity (1)[A]
- Sedentary lifestyle (1)[A]
- Physically strenuous work (1)[A]
- Psychosocial factors—anxiety, depression, stress (1)[A]
- Genetic factors (2)
- Heavy operating equipment (2)
- Poor flexibility (2)
- Smoking (1)[A]
- Maintain normal weight (1)[A].
- Adequate physical fitness and activity (1)[A]
- Stress reduction (1)[A]
- Proper lifting technique and good posture
- Smoking cessation
- There is insufficient evidence to recommend for or against routine preventive measures in adults.
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