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Low back pain has a lifetime prevalence of nearly 80%, and spinal disorders are the fourth most common primary diagnosis for office visits in the United States (1). Low back pain is also costly, accounting for a large and increasing proportion of health care expenditures without evidence of corresponding improvements in outcomes (2). In most patients, the specific cause of low back pain cannot be identified, and episodes generally resolve within days to a few weeks with self-care. Up to one third of patients, however, report persistent back pain of at least moderate intensity 1 year after an acute episode, and 1 in 5 report substantial limitations in activity (3). Because low back pain is common, can lead to substantial disability, and can become chronic, proficiency in evaluation and management is important.
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