Low Back Pain in Adults

Sources

1. American Physical Therapy Association, ChoosePT. Physical therapy guide to low back pain. Checked October 6, 2026.
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   Low back pain is “typically the area between the lower ribs and buttock crease”; self-confidence and perceived ability to cope “may be predictive of who may not recover as expected”; “Bed rest for longer than one day can slow your recovery”; if pain “lasts more than a few days or gets worse, schedule a visit with a physical therapist”; loss of bowel or bladder control or numbness in the groin or inner thigh means the emergency department “at once”; the evaluation covers health history, symptoms, “the quality and quantity of your movements,” tests for a serious problem and how you use your body at work, home, sports and leisure; “For most cases of low back pain, imaging tests such as X-rays, CT scans, and MRIs are not helpful”; treatment may include manual therapy including spinal manipulation, strengthening and flexibility exercises, education, training on lifting, bending, sitting and sleeping positions, a physical activity program to do on your own, and ice, heat or electrical stimulation; “You can contact a physical therapist directly for an evaluation”; look for experience with orthopedic problems or board certification, residency or fellowship in orthopedic physical therapy; ask for recommendations and about experience with low back pain.
2. Lucas JW, Connor EM, Bose J; National Center for Health Statistics. Back, lower limb, and upper limb pain among U.S. adults, 2019 (NCHS Data Brief No. 415). Checked October 6, 2026.
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   “In 2019, 39.0% of adults had back pain” in the past 3 months, the most prevalent site of pain; back pain rose with age from 28.4% at 18–29 to 45.6% at 65 and over; women 40.6%, men 37.2%.
3. MedlinePlus, US National Library of Medicine. Low back pain - acute. Checked October 6, 2026.
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   “Low back pain is the number two reason that Americans see their health care provider”; most often caused by a sudden injury to the muscles and ligaments; “Most people with back pain improve or recover within 4 to 6 weeks”; tests are usually not ordered “during the first visit or for 4 to 6 weeks unless you have certain symptoms”; reduce activity for the first couple of days, “bed rest is not recommended,” and avoid heavy lifting or twisting for 6 weeks, restarting exercise after 2 to 3 weeks with walking, a stationary bicycle or swimming; “use ice for the first 48 to 72 hours and then use heat”; follow package instructions for over-the-counter pain relievers; sleep curled up with a pillow between the legs, or with a pillow or rolled towel under the knees on your back; “Many people feel better within 1 week”; referral to a physiatrist or orthopedist if pain lasts longer than 1 month; the symptoms that need a provider right away; lifting, sitting and driving advice and quitting smoking for prevention; spinal manipulation is done by “a chiropractor, osteopathic doctor, or physical therapist.”
4. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356–2367. doi:10.1016/S0140-6736(18)30480-X (PMID 29573870).
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   “For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause”; only a small proportion have a specific pathological cause such as a fracture, malignancy or infection; “central pain-modulating mechanisms and pain cognitions have important roles” in persistent disabling low back pain.
5. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514–530. doi:10.7326/M16-2367 (PMID 28192789).
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   Because “most patients with acute or subacute low back pain improve over time regardless of treatment,” start with superficial heat, massage, acupuncture or spinal manipulation, and if drugs are wanted, NSAIDs or skeletal muscle relaxants; for chronic low back pain start with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, EMG biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy or spinal manipulation; then NSAIDs first line, tramadol or duloxetine second line, and opioids only when other treatments have failed and benefits outweigh risks.
6. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018;391(10137):2368–2383. doi:10.1016/S0140-6736(18)30489-6 (PMID 29573872).
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   Guidelines recommend first-line non-drug care, “including education that supports self-management and resumption of normal activities and exercise,” and “prudent use of medication, imaging, and surgery”; the review describes “inappropriately high use of imaging, rest, opioids, spinal injections, and surgery.”
7. American Academy of Orthopaedic Surgeons, OrthoInfo. Cauda equina syndrome. Checked October 6, 2026.
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   A rare disorder and “a surgical emergency”; see your doctor immediately for bladder or bowel dysfunction (unable to urinate or unable to hold urine) or severe or worsening loss of or altered sensation between the legs, over the buttocks, in the inner thighs or back of the legs, or in the feet; “earlier treatment does, however, offer the best outcomes.”
8. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews. 2010;(6):CD007612. doi:10.1002/14651858.CD007612.pub2 (PMID 20556780). For acute low back pain, advice to stay active gave small improvements in pain and function compared with advice to rest in bed.
9. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021;(9):CD009790. doi:10.1002/14651858.CD009790.pub2 (PMID 34580864). Published September 28, 2021, in issue 9 (Crossref lists issue 10).
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   249 trials: “moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain”; the effect on function was small; exercise is probably more effective than advice or education alone or electrotherapy, with no difference from manual therapy.
10. American Academy of Orthopaedic Surgeons, OrthoInfo. Low back pain. Checked October 6, 2026.
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    In most cases low back pain “goes away on its own within a few weeks”; muscle soreness from an unaccustomed activity “usually goes away within a few days”; disk herniation, disk degeneration and facet osteoarthritis (“Smoking has also been found to accelerate disk degeneration”), spinal stenosis, degenerative spondylolisthesis, and compression fractures, which “are a common cause of back pain in the elderly” after minor trauma in osteoporosis; talk to your doctor about pain “that is always present regardless of your activity level or position”; pain may be sharp, dull or a “charley horse” cramp, “Most people find that reclining or lying down improves their low back pain,” and bending, lifting, sitting, standing and walking can worsen it, with “good days and bad days”; sciatica “without back pain” is possible; call your doctor if pain does not improve within a few weeks or comes with fever, chills or weight loss, and seek attention right away for leg weakness or loss of bladder and bowel control; the exam includes bending, reflexes, strength and sensation; muscle relaxers “can make you drowsy”; “Traction is often used, but there is no scientific evidence of its effectiveness”; braces “are not always helpful”; “It is best to try nonsurgical options for 6 months to 1 year before considering surgery.”
11. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015;36(4):811–816. doi:10.3174/ajnr.A4173 (PMID 25430861).
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    33 studies, 3,110 people with no back pain: disk degeneration in 37% at age 20 and 96% at 80, disk bulge 30% and 84%, protrusion 29% and 43%, annular fissure 19% and 29%; findings “must be interpreted in the context of the patient’s clinical condition.” Published online November 27, 2014; the April 2015 issue is cited.
12. Stanton TR, Henschke N, Maher CG, Refshauge KM, Latimer J, McAuley JH. After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine. 2008;33(26):2923–2928. doi:10.1097/BRS.0b013e31818a3167 (PMID 19092626).
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    In 353 people who had recovered, recurrence within a year ranged from 24% to 33% depending on the definition: “about 25% of subjects will have a recurrence in the next year. It is difficult to predict who will have a recurrence within the next year.”
13. da Silva T, Mills K, Brown BT, et al. Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy. 2019;65(3):159–165. doi:10.1016/j.jphys.2019.04.010 (PMID 31208917). With monthly follow-up, “Within 12 months after recovery, 69%” of participants had a recurrence of an episode of low back pain and 40% a recurrence that limited activity.
14. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. doi:10.1136/bmj.h444 (PMID 25694111).
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    41 trials, 6,858 participants: multidisciplinary rehabilitation “more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability”; compared with surgery, little difference in outcomes and more adverse events with surgery.
15. George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1–CPG60. doi:10.2519/jospt.2021.0304 (PMID 34719942).
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    The American Physical Therapy Association guideline: exercise including trunk strengthening and endurance, specific trunk muscle activation, aerobic, aquatic and general exercise for chronic low back pain, with “no clear evidence of superiority of one exercise type or approach over another”; thrust or nonthrust joint mobilization; massage for short-term relief; neural mobilization for chronic low back pain with leg pain; no mechanical traction for chronic low back pain with leg pain; Mechanical Diagnosis and Therapy; pain neuroscience education alongside exercise or manual therapy, and active treatments (yoga, stretching, Pilates, strength training) rather than education alone; and, restating its 2012 recommendations, education that stresses “the anatomical/structural strength inherent in the human spine,” the “overall favorable prognosis,” early resumption of normal activities “even when still experiencing pain,” and “improvement in activity levels, not just pain relief.”
16. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Last updated July 29, 2026. Checked October 6, 2026.
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    Acute means “Less than 3 months duration” and chronic “A 3-month duration or longer”; “Do not routinely offer imaging in a non-specialist setting” (1.1.4); self-management advice with “encouragement to continue with normal activities” (1.2.1); consider a group exercise programme (1.2.2); do not offer belts or corsets, foot orthotics, rocker sole shoes, traction, acupuncture, ultrasound, PENS, TENS or interferential therapy (1.2.3–1.2.12); manual therapy “only as part of a treatment package that includes exercise” (1.2.7); “Promote and facilitate return to work or normal activities” (1.2.15); oral NSAIDs at the lowest effective dose for the shortest possible time (1.2.22–1.2.24); “Do not offer paracetamol alone” (1.2.26); “Do not offer opioids for managing chronic low back pain” (1.2.28); no SSRIs, SNRIs, tricyclics, gabapentinoids or antiepileptics for low back pain (1.2.29–1.2.30); “Do not offer spinal injections for managing low back pain” (1.3.1); radiofrequency denervation for selected chronic pain after a positive diagnostic block (1.3.2–1.3.3); “Do not offer spinal fusion for people with low back pain unless as part of a randomised controlled trial” (1.3.9) and no disc replacement (1.3.10). The recommendations on psychological therapy and combined programmes were withdrawn in July 2026.
17. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain: overview, symptoms and causes. Checked October 6, 2026.
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    “one of the most common medical problems in the United States”; acute pain “usually lasts a few days to a few weeks,” subacute “lasts 4 to 12 weeks,” chronic “lasts longer than 12 weeks and occurs daily”; more common in people who are not physically fit and “particularly after the age of 45”; jobs with heavy lifting, pushing, pulling or twisting, or a desk job with poor posture; “If you chronically have poor sleep, depression, or anxiety, back pain can be more frequent and more severe”; genetics play a role in some disorders; causes can interact and “no specific cause can be identified” in some; the symptoms that warrant a doctor; mechanical, inflammatory (ankylosing spondylitis) and other medical causes (osteoporosis, kidney stones or infections, endometriosis, spine infections, rarely tumors, pregnancy). Last reviewed February 2023.
18. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5(6):e316–e329. doi:10.1016/S2665-9913(23)00098-X (PMID 37273833).
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    “In 2020, low back pain affected 619 million” people, projected to reach 843 million by 2050; “Low back pain remains the leading cause of YLDs globally”; 38.8% of years lived with disability were attributed to occupational factors, smoking and high BMI.
19. Menezes Costa L da C, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613–E624. doi:10.1503/cmaj.111271 (PMID 22586331).
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    33 cohorts, 11,166 participants: in acute pain, the mean pain score out of 100 fell from 52 to 23 at 6 weeks, 12 at 26 weeks and 6 at 52 weeks; “Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain.”
20. National Institute for Health and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management (NG65). Checked October 6, 2026.
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    Refer low back pain “that started before the age of 45 years and has lasted for longer than 3 months” when 4 or more of: onset before 35, “waking during the second half of the night because of symptoms,” buttock pain, “improvement with movement,” improvement within 48 hours of NSAIDs, a first-degree relative with spondyloarthritis, current or past arthritis, enthesitis or psoriasis (1.1.5); axial spondyloarthritis “affects a similar number of women as men” (1.1.4).
21. MedlinePlus, US National Library of Medicine. Low back pain - chronic. Checked October 6, 2026.
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    “Often, the exact cause of the pain cannot be found”; greater risk if you are over age 30, overweight, pregnant, do not exercise, feel stressed or depressed, smoke, or have a job with heavy lifting, bending and twisting or whole body vibration “such as truck driving”; some people need job changes, counseling, retraining or occupational therapy.
22. American Academy of Orthopaedic Surgeons, OrthoInfo. Herniated disk in the lower back. Checked October 6, 2026.
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    “most people feel better within a few weeks or months without surgery”; the soft center pushes through the outer ring and can press on nerve roots; “Men between the ages of 20 and 50 are the most likely to suffer from a herniated disk.”
23. American Academy of Orthopaedic Surgeons, OrthoInfo. Lumbar spinal stenosis. “Spinal stenosis happens most often in adults over 60”; “People with spinal stenosis often feel better when they lean forward or sit down. Standing up straight or walking usually make the pain worse”; pain, numbness or tingling in the buttocks or legs. Checked October 6, 2026.
24. American Academy of Orthopaedic Surgeons, OrthoInfo. Preventing back pain at work and at home. Checked October 6, 2026.
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    “preventing all back pain may not be possible”; combine walking or swimming with core exercises; “Being overweight puts added pressure on your spine and lower back”; smoke and nicotine make disks degenerate faster; the lifting, sitting and workstation guidelines quoted on this page, including standing to stretch once an hour; “There is no evidence that one brand or type of mattress is better than another” and firmness “is a matter of personal preference.”
25. American Physical Therapy Association. Direct access advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment,” though some provisions tied to treatment without a referral persist in a number of states. Checked October 6, 2026.
26. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain: diagnosis, treatment, and steps to take. Checked October 6, 2026.
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    The history covers the kind of pain, its location, when it started, what you were doing, how severe it is and what makes it better or worse; the exam tests reflexes, muscle strength and sensation; “Most people do not need additional testing”; X-rays, MRI, CT, EMG, bone scans and blood tests are used to rule out or confirm a cause; avoid bed rest and increase activity gradually; TENS treatments “are not always effective for reducing pain.”
27. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine. 2011;154(3):181–189. doi:10.7326/0003-4819-154-3-201102010-00008 (PMID 21282698).
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    Imaging is indicated only for severe progressive neurologic deficits or signs of a serious or specific underlying condition; otherwise “routine imaging is not associated with clinically meaningful benefits but can lead to harms.”
28. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American Journal of Neuroradiology. 2015;36(12):2394–2399. doi:10.3174/ajnr.A4498 (PMID 26359154).
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    In adults 50 or younger, disk bulge, degeneration, extrusion, protrusion, Modic 1 changes and spondylolysis were more common in those with back pain than in those without.
29. da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of recurrence of low back pain: a systematic review. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(5):305–313. doi:10.2519/jospt.2017.7415 (PMID 28355981).
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    “A history of previous episodes of LBP prior to the most recent episode was the only factor that consistently predicted recurrence of LBP”; the research “does not provide robust estimates of the risk.”
30. Steffens D, Maher CG, Pereira LS, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Internal Medicine. 2016;176(2):199–208. doi:10.1001/jamainternmed.2015.7431 (PMID 26752509).
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    21 trials, 30,850 participants: exercise combined with education reduced the risk of an episode of low back pain, exercise alone may reduce it, and education alone, back belts and shoe insoles “do not appear to prevent LBP.”
31. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews. 2006;(1):CD004750. doi:10.1002/14651858.CD004750.pub2 (PMID 16437495).
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    “moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability” in acute and sub-acute low back pain, and adding exercise helps further; “No conclusions can be drawn about the use of cold.”
32. Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689 (PMID 30867144).
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    “SMT produces similar effects to recommended therapies for chronic low back pain”; clinicians should inform patients of the potential risk of adverse events.
33. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;(9):CD001929. doi:10.1002/14651858.CD001929.pub3 (PMID 26329399). “We have very little confidence that massage is an effective treatment for LBP”; improvements in pain were seen only in the short term, with only minor adverse effects.
34. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225. doi:10.1136/bmj.h1225 (PMID 25828856). “High quality” evidence that paracetamol is ineffective for reducing pain intensity and disability in the short term in people with low back pain.
35. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3):1–95. doi:10.15585/mmwr.rr7103a1 (PMID 36327391). “Nonopioid therapies are at least as effective as opioids for many common types of acute pain,” including low back pain; “Nonopioid therapies are preferred for subacute and chronic pain.”
36. American Academy of Orthopaedic Surgeons, OrthoInfo. Spine conditioning program. Checked October 6, 2026.
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    Warm up with “5 to 10 minutes of low impact activity, like walking or riding a stationary bicycle”; “You should not feel pain during an exercise”; continue for 4 to 6 weeks, then 2 to 3 days a week to maintain strength and range of motion; step-by-step directions, repetitions and target muscles for the kneeling back extension, sitting rotation stretch, knee to chest, bird dog, hip bridge and abdominal bracing, as quoted in the exercise cards above.
37. Fritz JM, Magel JS, McFadden M, et al. Early physical therapy vs usual care in patients with recent-onset low back pain: a randomized clinical trial. JAMA. 2015;314(14):1459–1467. doi:10.1001/jama.2015.11648 (PMID 26461996).
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    220 adults with back pain for less than 16 days and no symptoms below the knee: four sessions of early physical therapy gave “statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care”; “There was no improvement in pain intensity.”
38. Centers for Medicare & Medicaid Services. Physical therapy services (Medicare.gov). Checked October 6, 2026.
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    Part B “helps pay for medically necessary outpatient physical therapy”; “After the Part B deductible, you pay 20% of the Medicare-approved amount”; your doctor or other provider “must certify that you need it”; “There’s no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.”
39. Verbeek JH, Martimo KP, Karppinen J, et al. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database of Systematic Reviews. 2011;(6):CD005958. doi:10.1002/14651858.CD005958.pub3 (PMID 21678349). “moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability.”
40. Centers for Disease Control and Prevention. Adult activity: an overview. “Adults need at least 150 minutes of moderate-intensity physical activity a week, such as 30 minutes a day, 5 days a week,” and “2 days of muscle-strengthening activity each week.” Checked October 6, 2026.
41. Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996–2016. JAMA. 2020;323(9):863–884. doi:10.1001/jama.2020.0734 (PMID 32125402).
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    “In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion,” 57.2% paid by private insurance, 33.7% by public insurance and 9.2% out of pocket.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Seek urgent medical attention for any of the symptoms listed above.