Low back and leg pain

Low back and leg pain are very common general practice presentations. They represent a significant public health issue that results in a large fiscal societal cost, especially as it afflicts professions with repetitive physical work and uniformed personnel. Causation is mainly degenerative. Other aetiologies, such as trauma, oncological, vascular and infectious, require early exclusion. Pain generator identification is pertinent for successful management. Red flag history points, such as recent trauma, metastatic cancer, fevers and nocturnal rest pain, should mandate an urgent MRI and specialist review. Treatment principles for degenerative aetiologies require patient education, physiotherapy, healthy diet, cessation of smoking and, importantly, lifestyle modifications. If that were to fail, acute disc herniation or lumbar canal stenosis can then be treated with imaging‐guided corticosteroid injections. Surgery is considered if the patient suffers significant functional impairment leading to immobility, bladder and bowel difficulties or medically refractory pain.