Lumbar disc herniation is a common cause of lower back pain. It may occur spontaneously or as the result of a strain type injury. This is usually caused by a movement involving forward bending and twisting but it may be as simple as prolonged sitting at work or while traveling. The disc is a functional spacer between spinal vertebra and contains a central core of gel. If the outer fibers of the disc that contain the gel are disrupted (torn) the gel migrates from its central position and the disc can change shape or bulge. The pain associated with a lumbar disc herniation can be severe and is often accompanied by muscle spasms. In the most severe cases the bulging disc applies pressure to an adjacent nerve root and causes leg pain.

Lumbar spinal stenosis is most often the result of advanced degenerative spinal arthritis which causes a narrowing of the spinal canal. This can lead to pressure on the spinal nerves in the lower back which causes radiating or aching pain in the legs, cramping or numbness. Someone with lumbar spinal stenosis may develop pain when walking that is relieved by bending forward, walking uphill or pushing a shopping cart. This is a chronic deteriorating condition. If symptoms cannot be controlled with conservative measures or neurological symptoms develop (e.g. lower extremity weakness, bowel or bladder incontinence) then surgery becomes a consideration. Patients with uncomplicated spinal stenosis are good candidates for flexion distraction manipulation.

Lumbar facet syndrome can be the cause of either acute and chronic lower back pain. Acute situations are usually the result of an injury and occur in a younger patient. It may also occur in a younger patient with sway back deformity, anterior pelvic tilt, scoliosis or other postural weaknesses. Chronic lower back pain in an older patient, that is attributed to lumbar facet syndrome, is usually related to degenerative arthritis.​ Back bending and side bending positions are usually provocative and painful. Flexion distraction manipulation provides a comfortable separation or decompression of the facet joint that can be particularly effective in relieving pain and improving joint function. Knee chest exercises can be a good home exercise for this condition.

Lumbar spondylolisthesis can be a source of chronic lower back pain. ​An x-ray is required to diagnose this condition which is usually seen as a forward slip of one vertebra. There are several different types and grades of spondylolisthesis. A stress fracture of the vertebra or degenerative arthritis are common causes. Genetics, sports like football and gymnastics, arthritis and being overweight are risk factors. The forward slippage of a vertebra can cause local pain in the lower back or radiating leg pain if a spinal nerve is compressed. Management of spondylolisthesis depends on the type and grade but can usually managed conservatively with flexion distraction manipulation and exercise.

The sciatic nerve is a single nerve that runs down the back of the leg. Many nerve roots from the lumbar spine join together to form the sciatic nerve which is about the size of your index finger. Sciatica is a term that describes radiating leg pain along the path of the sciatic nerve. It is usually the result of the nerve being compressed by a bulge in a lumbar spinal disc but it can also occur with degenerative arthritis and spurs that pinch the nerve or a tight muscle that entraps the nerve along its course through the pelvic region. Spinal manipulation, flexion distraction manipulation, soft tissue release techniques, stretching, exercise and heat or ice produce good results for the majority of people who experience sciatica. ​

Failed back syndrome is a condition of chronic lower back pain that occurs in some patients following back surgery. The pain may be local to the lower back or may, at times, be associated with radiating leg pain. Conservative options to manage the individual's pain should not be limited to analgesic medications. Rather, exercise, stretching, flexion distraction manipulation and a healthy anti-inflammatory type diet (i.e. Mediterranean diet) can help maintain function and control pain. Smoking and exposure to second hand smoke should be strictly avoided to improve outcomes.