Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Epidemiologic studies found mechanical low back pain to be the fifth most common reason for visiting a physician. Proteoglycan production is altered with the age of the host and may explain the development of degenerative disk disease. Important clinical low back pain entities reviewed in the literature include exercise-associated degenerative disk disease, sciatica in adults less than 21 years of age, fibromyalgia, apophyseal and sacroiliac joint pain, and sacral insufficiency fractures. No consensus exists among physicians concerning appropriate therapy for low back pain. Return to usual activity is the most effective therapy, according to a recent study. The first decompression operation for spinal stenosis has the best opportunity for a good outcome. Chiropractors are the most expensive health care providers for low back pain patients.