Low back pain (LBP), discomfort, tension, or stiffness below the costal margin and above the inferior gluteal folds, is one of the most common conditions encountered in primary care, second only to the common cold. LBP has an annual incidence of 5%, and a lifetime prevalence of 60%-90%. It is the leading cause of disability in the United States for adults younger than 45 years of age, and is responsible for one-third of workers' compensation costs and accounts for direct medical costs in excess of $38 billion per year. At any given time 1% of the US population is chronically disabled and another 1% temporarily disabled as a result of back pain. Numerous studies report a favorable natural history for acute and subacute LBP, with up to 90% of patients regaining function within 6-12 weeks with or without physician intervention. Recent studies, however, suggest that back pain is often recurrent and chronically disabling. Approximately 85% of back pain has no readily identifiable cause, and up to one-third of all patients will develop chronic low back pain. This chapter reviews a detailed evidence-based approach to the assessment, diagnosis, and management of the adult patient with acute, subacute, and chronic LBP.
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LBP is a heavy medical and financial burden to not only the patients who are experiencing the ailment, but also to society. The US Preventive Services Task Force recently produced a recommendation statement on primary care interventions to prevent low back pain in adults. Currently there is insufficient evidence to support or rebuke routine use of exercise as a preventive for low back pain. However, regular physical activity has been shown to be beneficial in the treatment and the limitation of recurrent episodes of chronic low back pain. Lumbar supports (back belts) have not been found ...