Acute low back pain is a very common presentation in primary care. In the vast majority of patients, it is benign and will run an indolent course. There are multiple causes, of which most are structural. Back pain can be isolated as well as present with sciatica, which is usually unilateral. Provided there are no signs or symptoms that might suggest a more sinister cause, further investigation is rarely helpful, and patients will improve with time and simple analgesia. Education is important to alter abnormal health beliefs, and a multidisciplinary and biopsychosocial approach is ideal.