Evidence Level

Aetiology and Prevalence

The majority (approximately 95% of cases) of acute low back pain is non-specific; serious conditions are rare causes of acute low back pain.

*LEVEL I, III: Deyo et al. 1992; Suarez-Almazor et al. 1997; Hollingworth et al. 2002

Common findings in patients with low back pain (e.g. osteoarthritis, lumbar spondylosis, spinal canal stenosis) also occur in asymptomatic people; hence, such conditions may not be the cause of the pain.

•LEVEL I, III: van Tulder et al. 1997a; Torgerson and Dotter 1976


History enables screening for features of serious conditions; however the reliability and validity of individual features in histories have low diagnostic significance.

•LEVEL III-2: Deyo et al. 1992; van den Hoogen et al. 1995

Physical Examination

Clinical signs detected during physical and psychosocial assessment must be interpreted cautiously as many tests lack reliability and validity.

•LEVEL III-2: LeBoeuf-Yde et al. 2002; Truchon and Fillion 2000; Knutson 2002; Waddell et al. 1980; Deyo et al. 1992

A full neurological examination is warranted in the presence of lower limb pain and other neurological symptoms.

•LEVEL IV: Waddell et al. 1982; McCombe et al. 1989

Ancillary Investigations

Plain xrays of the lumbar spine are not routinely recommended in acute non-specific low back pain as they are of limited diagnostic value and no benefits in physical function, pain or disability are observed.

•LEVEL III-2: Suarez-Almazor et al. 1997; Hollingworth et al. 2002; Kendrick et al. 2001; Kerry et al. 2002

Appropriate investigations are indicated in cases of acute low back pain when alerting features ('red flags') of serious conditions are present.

•LEVEL III-2: Deyo and Diehl 1986


A specific patho-anatomic diagnosis is not necessary for effective management of acute non-specific low back pain.

CONSENSUS: Steering Committee

Terms to describe acute low back pain with no identifiable pathology include 'lumbar spinal pain of unknown origin' or 'somatic lumbar spinal pain'.

•LEVEL IV: Merskey and Bogduk 1994

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