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Low Back Pain Care Pathway

Date of last update: February, 2024

Diagnosis for Non-specific Low Back Pain (NSLBP)

Clinical Cornerstone:

  • Diagnosis is primarily clinical, relying on patient history and clinical examination, and aims to exclude identifiable pathologies.

  • Definition: LBP not attributable to a discernible, specific pathology (e.g., infection, tumor, osteoporosis, lumbar disc herniation).

  • Prevalence: Approximately 90% of all LBP cases.

  • Risk Factors: Include low physical activity levels, smoking, obesity, and high physical stress at work.

  • Pain Location: Localized below the costal margin and above the inferior gluteal folds, with or without leg pain.

  • Duration: Pain can be acute (lasting less than 6 weeks), subacute (6 to 12 weeks), or chronic (more than 12 weeks).

  • Signs and Symptoms:

    • Pain can be sharp, dull, shooting, or aching.

    • Pain intensity can vary from mild to severe.

    • Pain may be aggravated by specific movements, postures, or activities and relieved by others.

    • There may be associated muscle stiffness or spasms.

    • Referred pain into the legs may or may not be present but does not commonly extend below the knee

  • Neurological Examination: Typically, there are no neurological deficits. If present, they are mild and do not follow a specific nerve root distribution.

  • Response to Conservative Management: Often responds to conservative treatments such as education, exercise, and manual therapy.

  • Psychosocial Factors: Consider psychosocial factors (yellow flags) that might influence pain perception and recovery (e.g., beliefs about pain, fear of movement, catastrophizing).

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

Non-specific LBP or LBP with radiculopathy:

  • Education

  • Self-care

  • Exercise

  • Manual therapy

  • Medicines

  • Psychological therapy

  • Social support

  • Mind-body interventions

  • Needling therapies, electrotherapies*

  • Mobility assistive devices

  • Multicomponent biopsychosocial care

  • Topical ceyenne pepper

Additionally for LBP with radiculopathy:

  • Medical/surgical consultations

Other specific LBP:

  • Refer to appropriate emergency or healthcare provider

Major symptom/sign change

Goals not achieved


Adjust treatment and management plan or refer

References or links to primary sources

Contact information for further inquiries or feedback


These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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