Approximately 2% of adults miss work each year because of low back pain. This complaint is most common in adults in their working years, usually affecting patients between 30 and 60 years of age. Although it is common in workers required to perform lifting and twisting, it is also a common complaint in those who sit or stand for prolonged periods. Low back pain is a recurrent disease that tends to be mild in younger patients, often resolving within 2 weeks, but can be more severe and prolonged as the patient ages. It is one of the most common reasons for young adults to seek medical care, second only to upper respiratory infections, and millions of healthcare
dollars are expended on this problem each year. In evaluating patients with low back pain, the clinician needs to exclude potentially serious conditions, such as malignancy, infection, and dangerous neurologic processes, such as spinal cord compression or cauda equina syndrome. Individuals without these conditions are initially managed with conservative therapy. Nearly all patients recover spontaneously within 4 to 6 weeks; only 3% to 5% remain disabled for more than 3 months. If patients do not improve within 4 weeks with conservative management, they should undergo further evaluation to rule out systemic or rheumatic disease and to clarify the anatomic cause, especially patients with localized pain, nocturnal pain, or sciatica.