Last reviewed:September 2019
Last updated:October  2018



History and exam

Key diagnostic factors

  • obesity, stress, and psychiatric comorbidities
  • history of prior lower back pain
  • history of prior treatment
  • pain radiation does not extend beyond the knee
  • absence of red-flag symptoms
  • absence of fever, fluctuance, exquisite tenderness to palpation
  • sensory, motor, and deep-tendon reflex examinations within normal limits
  • negative straight- or crossed straight-leg raise test

Other diagnostic factors

  • dull, gnawing, tearing, burning, or electric pain associated with muscle spasms
  • lack of pain on flexion or relief on extension
  • scoliosis or kyphosis
  • negative FABER, Gaenslen's, or Schober's testing

Risk factors

  • obesity
  • family history of degenerative disc disease
  • poor musculotendinous flexibility and abnormal posture
  • stress and psychiatric comorbidities
  • increasing age, up to 60-65 years
  • female sex
  • heavy physical and occupational activities
  • tobacco use

Diagnostic investigations

Investigations to consider

  • lumbar spine x-ray
  • lumbar spine MRI
  • lumbar spine CT
  • myelography
  • FBC
  • ESR
  • C-reactive protein (CRP)
  • urinalysis and culture
  • blood cultures
  • radionuclide bone scan
  • EMG
Full details

Treatment algorithm


Professor and Vice Chair

Department of Physical Medicine & Rehabilitation

University of Miami Miller School of Medicine




AS declares that he has no competing interests.

Dr Andrew Sherman would like to gratefully acknowledge Dr Robert W. Irwin, Dr Louise Thwaites, Dr Karen Walker-Bone, Dr Joanne Borg-Stein, and Dr Philip Chiou, previous contributors to this topic. RWI, LT, KWB, JBS, and PC declare that they have no competing interests.

Peer reviewersVIEW ALL

Staff Physiatrist

Orthopedic and Arthritis Center

Brigham and Women's Hospital

Chestnut Hill



JB declares that she has no competing interests.

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic




AGC declares that he has no competing interests.

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