10/05/2025
Definition
Low Back Pain (LBP) is defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica).
Epidemiology
One of the most common causes of musculoskeletal complaints.
Affects up to 80% of adults at some point in their lives.
Peak incidence: 30–50 years.
Leading cause of disability globally.
Classification
Based on Duration:
Acute: < 6 weeks
Subacute: 6–12 weeks
Chronic: > 12 weeks
Based on Cause:
Mechanical (non-specific) – 90% of cases
Non-mechanical – infections, tumors
Referred pain – from pelvic/abdominal organs
Clinical Features
Pain is localized in the lumbar region
May radiate to buttocks or legs (sciatica)
Worse with movement, lifting, or prolonged sitting
May improve with rest (mechanical) or worsen at night (red flag)
Associated symptoms: stiffness, decreased range of motion, tenderness
Red Flag Signs (Suggest Serious Pathology)
Age > 50 or < 20
History of cancer, trauma, infection
Night pain or rest pain
Unexplained weight loss
Fever, chills
Neurological symptoms (e.g., saddle anesthesia, bladder/bowel dysfunction)
Differential Diagnosis
🟢 Mechanical Causes:
Lumbar strain/sprain
Herniated disc
Spinal stenosis
Degenerative disc disease
Spondylolisthesis
Facet joint arthritis
🔴 Non-Mechanical Causes:
Vertebral osteomyelitis, epidural abscess
Tuberculosis spine (Pott’s disease)
Metastatic cancer, multiple myeloma
Inflammatory diseases: Ankylosing spondylitis
🔵 Referred Pain:
Renal colic
Pancreatitis
Aortic aneurysm
Gynecological conditions (e.g., endometriosis)
Investigations
History & Physical examination (first line)
Imaging:
X-ray (if red flags present or >6 weeks of pain)
MRI – for neurological symptoms, suspected infection or malignancy
Lab tests: CBC, ESR, CRP (if infection/inflammation suspected)
Management
Conservative (First-line for mechanical LBP):
Rest (brief), NSAIDs, muscle relaxants
Physiotherapy & posture correction
Heat therapy
Activity modification
Specific Treatment (based on cause):
Antibiotics for infection
Surgery for cauda equina syndrome, severe stenosis, tumors
Steroids or biologics in inflammatory arthritis
Prognosis
Majority improve within 4–6 weeks
Recurrence is common
Chronic pain may lead to disability if not managed properly
