From the Guidelines

Severe Low Back Pain (LBP) should initially be managed conservatively, without imaging, unless red flags are present.

A focused history and physical examination should be conducted to categorize patients into nonspecific LBP, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause 1.
The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain 1.
Initial treatment should include reassurance, initial pain management medications if necessary, and consideration of physical therapies without routine imaging in patients with nonspecific LBP 1.

Imaging is not warranted in patients with acute uncomplicated LBP, with or without radiculopathy, unless red flags are present or there is little or no improvement after 6 weeks of medical management and physical therapy 1.
MRI of the lumbar spine is the initial imaging modality of choice for patients with subacute or chronic LBP who have failed conservative therapy 1.
CT myelography and radiography may be useful in specific situations, such as assessing the patency of the spinal canal or evaluating spinal deformity 1.

Red flags, such as cauda equina syndrome, malignancy, fracture, or infection, should be evaluated promptly with imaging 1.
Patients presenting with red flags should be imaged immediately to identify potential underlying conditions that require urgent attention 1.

Most patients with acute LBP have nonspecific LBP that cannot be attributed to a specific disease or spinal abnormality 1.
Imaging abnormalities are common in asymptomatic individuals, and imaging may not be beneficial in patients with nonspecific LBP 1.
A practical approach to assessment is to conduct a focused history and physical examination to determine the likelihood of specific underlying conditions and measure the presence and level of pain 1.

From the Research

Low back pain (LBP) is a symptom and not a specific disease, with a large number of potential causes 2.
The vast majority of patients with LBP have a musculoskeletal cause, and 90% of patients with acute low back problems recover within a month with conservative treatment 2.
LBP is extremely common, with 15% to 20% of the population in the United States experiencing back pain each year, and approximately half of working-age adults admitting to back pain each year 2.

The presence and dominance of patho-anatomical, physical, neuro-physiological, psychological, and social factors that can influence the disorder is different for each individual 3.
Age-related physical and psychosocial changes, such as spinal degeneration, comorbidities, physical inactivity, and age-related changes in central pain processing, may affect the prognosis and management of LBP in older adults 4.
Predictive factors for development of LBP include poor back muscle endurance, perceived disability, depression/anxiety, fear avoidance, catastrophizing, and illness perception 5.

Classification of chronic low back pain (CLBP) disorders into sub-groups, based on the mechanism underlying the disorder, is considered critical to ensure appropriate management 3.
Physiotherapy interventions that are specifically directed and classification-based have the potential to impact on both the physical and cognitive drivers of pain, leading to resolution of the disorder 3.
Exercise is often considered a safe and effective treatment for LBP, and the older adult benefits from exercise in general, with no clear superior exercise paradigm for the older adult with LBP 5.
The biopsychosocial model and matched care for patients with LBP are highlighted as important considerations in primary care 6.

Older adults are more likely to develop certain LBP pathologies, such as osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis 4.
Age-related changes, such as dementia, may affect the assessment and treatment of older adults with LBP 4.
Exercise prescription for older adults with LBP must be extrapolated from the available literature, and considerations such as poor back muscle endurance and perceived disability must be taken into account 5.