Overview of low back pain
Low back pain or lumbar spine pain is defined as pain localised below the costal margin and above the inferior gluteal folds, with or without leg pain.
Most patients with low back pain seen in primary care will have a nonspecific nonserious local musculoskeletal condition with an acute and self-limited clinical course (see Nonspecific low back pain).
Low back pain associated with spinal nerve root involvement is typically due to a herniated lumbar disc (see Symptomatic lumbar disc herniation), but in older patients is usually due to lumbar canal or foraminal stenosis (see Symptomatic spinal canal stenosis).
A diagnosis of nonspecific low back pain is made after excluding serious pathology (eg spinal infection, malignancy, fracture) or an underlying systemic inflammatory disease (eg axial spondyloarthritis). Although serious pathology is rare in patients presenting with low back pain in primary care, clinical suspicion of such pathology should be raised by the presence of alerting features (see Serious pathologies requiring urgent management in patients with back and neck pain and their alerting features (‘red flags’)).
For advice on assessing a person who presents with back pain, see Assessment of back and neck pain.