Low Back Pain Conditions

This section outlines the four diagnostic categories of LBP put forward by  Traeger, Buchbinder, Harris and Maher (2017).

  1. A problem beyond the lumbar spine (e.g., kidney stones)
  2. A serious disorder affecting the lumbar spine (e.g., epidural abscess)
  3. Radicular pain (e.g., related to intervertebral disc herniation) or neurogenic claudication (e.g., related to central spinal canal stenosis)
  4. Nonspecific low-back pain

Serious vs Non-Serious

Physiotherapists are often primary contact care practitioners and should remain vigilant in identifying LBP that is resulting from systemic and pathological sources that require medical referral.

This clinical resource focuses on the management of nonspecific low-back pain and radicular pain or neurogenic claudication as these conditions comprise more than 95% of low-back pain seen in primary care and can be effectively managed in this setting [1].

Previously un-diagnosed serious pathology is rare in LBP cases presenting to primary care clinicians. The most common serious pathology is vertebral fracture which has prevalence of approximately 0.9% [2].

Only in the severe cases is surgical intervention indicated over conservative physiotherapy management [3].

The infographic below provides an overview of possible musculoskeletal, visceral and systematic causes of LBP

Low Back Conditions

  • Serious spinal pathology

    Possible serious causes of back pain and associated symptoms:

    • New bladder or bowel disturbance, saddle numbness, lower motor neuron weakness (consider cauda equina syndrome)

    • New onset of fever and history of intravenous drug use, spinal procedure, immunosuppression (consider vertebral infection)

    • History of cancer that metastasizes to bone (e.g., breast, lung, prostate) (consider metastatic disease)

    • History of osteoporosis, systemic steroid use, trauma, older age (more than 65 years of age) (consider vertebral fracture if multiple features present)

    • Persistent symptoms (more than 12 weeks), age at onset is less than 45 years, inflammatory features (insidious onset, no improvement with rest, pain at night and/or early morning that improves with exercise or activity), peripheral manifestations (e.g., arthritis, enthesitis, uveitis, psoriasis) or family history of spondyloarthritis (consider axial spondyloarthritis)

  • Problems beyond the spine


    • Systemically unwell

    • Nonmechanical pain (i.e., pain that is unrelated to movement, functional neurological disorder)

    • Hip joint signs (consider hip joint disease)

    • Abdominal pulsations (consider abdominal aortic aneurysm)

    • Gynecologic, renal/urinary tract, gastrointestinal signs and symptoms (e.g., abdominal tenderness, hematuria) (consider visceral origin)

    • Atherosclerotic risk factors, claudication (consider vascular origin)

  • Radicular pain or neurogenic claudication

    Common Symptoms:

    • Leg pain in a spinal nerve distribution with or without low-back pain (consider radicular pain)

    • Sensory loss, reduced reflex, myotomal weakness in spinal nerve distribution (consider radiculopathy)

    • Bilateral buttock, thigh or leg pain, pseudoclaudication (consider central spinal canal stenosis (e.g., age-related degenerative changes including degenerative spondylolisthesis)
      Patients with these symptoms may have cauda equina syndrome or vertebral infection requiring urgent referral to a specialist.

  • Non-specific low back pain

    Clinical Presentation:

    • Back pain that does not fit into one of the above categories
    • Where a specific pathoanatomical diagnosis is not possible
  1. Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. N Engl J Med, 344(5), 363-370. doi:10.1056/nejm200102013440508
  2. Downie, A., Williams, C. M., Henschke, N., Hancock, M. J., Ostelo, R. W., de Vet, H. C., . . . Koes, B. W. (2013). Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ, 347, f7095.
  3. Deyo, R. A., & Mirza, S. K. (2016). CLINICAL PRACTICE. Herniated Lumbar Intervertebral Disk. N Engl J Med, 374(18), 1763-1772. doi:10.1056/NEJMcp1512658