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Updated: Oct 13, 2025

Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
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ACR Appropriateness Criteria® Low Back Pain: 2021 Update.

, Troy A Hutchins1, Miriam Peckham2

  • 1Chief Value Officer, Department of Radiology, University of Utah Health, Salt Lake City, Utah.

Journal of the American College of Radiology : JACR
|November 19, 2021
PubMed
Summary
This summary is machine-generated.

Acute low back pain typically resolves without imaging. Imaging is reserved for persistent cases or when red flags suggest serious conditions like cauda equina syndrome.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaDiagnostic imagingLow back pain (LBP)LumbagoLumbar painRadiculopathyRed flags

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Area of Science:

  • Orthopedics and Sports Medicine
  • Radiology
  • Public Health

Background:

  • Acute low back pain is a leading cause of disability in the US.
  • Uncomplicated cases are self-limited and do not require immediate imaging.
  • Imaging is indicated for persistent pain or red flag symptoms.

Framework:

  • Evidence-based guidelines from the American College of Radiology Appropriateness Criteria.
  • Annual review by a multidisciplinary expert panel.
  • Utilizes RAND/UCLA Appropriateness Method and GRADE methodology.

Implementation:

  • Guidelines inform imaging decisions for low back pain.
  • Imaging considered after 6 weeks of conservative management without improvement.
  • Imaging is also indicated for suspected serious conditions (e.g., malignancy, infection, fracture, cauda equina syndrome).

Implications:

  • Appropriate imaging use reduces unnecessary procedures and costs.
  • Ensures timely diagnosis for serious underlying conditions.
  • Supports evidence-based clinical decision-making for low back pain management.