Article Sections

Introduction

Low back pain (LBP) is a common complaint, representing a significant source of disability and health care utilization globally.  The etiology is complex; structural changes to the spine (eg, degeneration of discs) are commonly associated with LBP but are also seen with high prevalence in asymptomatic patients.  Comorbid conditions (eg, obesity, physical deconditioning) also appear to play a role in the experience of pain.  Accurate diagnosis and management of LBP (including ruling out more serious disorders) are crucial to prevent chronic pain and improve patient outcomes.  This article primarily focuses on mechanical causes of LBP, discussing appropriate evaluation and management strategies, but also reviews the main nonmechanical etiologies to consider.

Anatomy and pathophysiology

The lumbar spine is composed of vertebrae, intervertebral discs, ligaments, muscles, and neural elements (

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Tables

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