Description

• 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

Epidemiology

Incidence

• 1-year incidence for first episode: 6.3–15.3% (2)
• 1-year incidence for any episode: 1.5–3.6% (2)
• A very common primary care complaint (1)

Prevalence

• 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 65 years and then declines (1).

Etiology and Pathophysiology

Risk Factors

• 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]

General Prevention

• 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.