Low back pain is the leading cause of disability worldwide, affecting an estimated 540 million people at any one time. Yet, a new Series of papers in The Lancet highlights the extent to which the condition is mistreated, often against best practice treatment guidelines.

Evidence suggests that low back pain should be managed in primary care, with the first line of treatment being education and advice to keep active and at work.

However, in reality, a high proportion of patients worldwide are treated in emergency departments, encouraged to rest and stop work, are commonly referred for scans or surgery or prescribed pain killers including opioids, which are discouraged for treating low back pain.

The global burden of disability due to low back pain has increased by more than 50% since 1990, and is due to increase even further in the coming decades as the population ages.