Low back pain
Assess for red flags, limit imaging, and focus on active recovery.
Last reviewed January 5, 2026
Red flags
- Progressive neurologic deficit, saddle anesthesia, or bowel/bladder changes.
- History of cancer, significant trauma, or systemic infection signs.
Diagnosis
- Classify as non-specific, radicular, or specific cause based on history and exam.
- Perform neurologic exam when radicular symptoms are present.
Initial workup
- Imaging is not needed without red flags; focus on functional assessment.
- Screen for occupational, psychosocial, or mental health contributors.
First-line management
- Encourage staying active, gentle mobility, and return to normal activities.
- Consider a short course of NSAID only when appropriate after safety checks; individualize exercise/physiotherapy and reassess function.
- Provide reassurance and self-management education.
Referral triggers
- Persistent disabling radiculopathy or functional impairment may warrant specialist assessment; duration alone does not mandate imaging unless it will guide a specific intervention or serious pathology is suspected.
- Suspected spinal stenosis, fracture, infection, or malignancy.
References
- Choosing Wisely Canada Spine recommendations (opens in a new tab)
- HealthLink BC Low back pain (opens in a new tab)
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