Back Pain, Low



  • Low back pain (LBP) is extremely common and is characterized by duration or associated symptoms.
  • Duration
    • Acute (<6 weeks)
    • Subacute (>6 weeks but <3 months)
    • Chronic (>3 months)
  • Associated symptoms
    • 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%; 1-year incidence for any episode: 1.5–3.6%


  • Lifetime prevalence: 84%
  • Predominant sex: male = female
  • Highest incidence in ages 20 to 29 years; prevalence increases with age until 65 years and then declines.

Etiology and Pathophysiology

  • LBP can be commonly due to muscle spasm/tension.
  • ~39% of chronic LBP due to disk degeneration, ~30% from facet joint syndrome. Other possibilities include sacroiliac injuries/degeneration and spinal stenosis.

Risk Factors

  • Age
  • Activity (lifting, sudden twisting, bending)
  • Obesity
  • Sedentary lifestyle
  • Physically strenuous work
  • Psychosocial factors—anxiety, depression, stress
  • Genetic factors
  • Heavy operating equipment
  • Poor flexibility
  • Smoking

General Prevention

  • Maintain normal weight.
  • Adequate physical fitness and activity
  • Stress reduction
  • Proper lifting technique and good posture
  • Smoking cessation

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