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Low back pain (or lumbago) is a common musculoskeletal disorder affecting 80% of people at some point in their lives. It accounts for more sick leave and disability than any other medical condition.[1] It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.
Most cases of lower back pain are due to benign musculoskeletal problems and are referred to as non specific low back pain. They are generally believed to be due to a sprain or strain in the muscles of the back and the soft tissues,[2] especially if the pain arose suddenly during physical load to the back, and the pain is lateral to the spine. The rate of serious causes is less than 1%.[3] The full differential diagnosis includes many other less common conditions.
Mechanical:
Apophyseal osteoarthritis
Diffuse idiopathic skeletal hyperostosis
Degenerative discs
Scheuermann’s kyphosis
Spinal disc herniation (slipped disc)
Spinal stenosis
Spondylolisthesis and other congenital abnormalities
Fractures
Leg length difference
Restricted hip motion
Misaligned pelvis – pelvic obliquity, anteversion or retroversion
Abnormal Foot Pronation
Inflammatory:
Seronegative spondylarthritides (e.g. ankylosing spondylitis)
Rheumatoid arthritis
Infection – epidural abscess or osteomyelitis
Neoplastic:
Bone tumors (primary or metastatic)
Intradural spinal tumors
Metabolic:
Osteoporotic fractures
Osteomalacia
Ochronosis
Chondrocalcinosis
Psychosomatic
Tension myositis syndrome
Paget’s disease
Referred pain:
Pelvic/abdominal disease
Prostate Cancer
Posture
Depression
Oxygen deprivation
Low back pain is more likely to be persistent among people who previously required time off from work because of low back pain, those who expect passive treatments to help, those who believe that back pain is harmful or disabling or fear that any movement whatever will increase their pain, and people who have depression or anxiety.[6] A systematic review (2010) published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association reviews the factors that predict disability from back pain.[44] The data quantified that patients with back pain who have poor coping behaviors or those fear activity are about 2.5 times as likely to have poor outcomes at 1 year.
Exercise appears to be slightly effective for chronic low back pain.[35] The Schroth method, a specialized physical exercise therapy for scoliosis, kyphosis, spondylolisthesis, and related spinal disorders, has been shown to reduce severity and frequency of back pain in adults with scoliosis.