Lower Back Pain

Key points

• Lower back pain (LBP) is one of the most common presentations in practice; most cases are non-specific/muscular, but certain 'red flag' features should prompt further investigation
• Red flags: age < 20 or > 50 years, history of previous malignancy, history of trauma, systemically unwell (e.g. weight loss, fever), thoracic pain, morning stiffness suggesting an inflammatory cause
• Facet joint pain: may be acute or chronic; pain worse in the morning and on standing, typically improved by leaning forward
• Spinal stenosis: pain, numbness and weakness worsening on walking, resolving on sitting or leaning forward ('shopping trolley sign')
• Ankylosing spondylitis: typically a young man with lower back pain and stiffness of gradual onset, worse in the morning and improving with exercise
• Peripheral arterial disease: pain on walking (claudication), relieved by rest, with absent or reduced peripheral pulses