Lower back pain is the leading cause of disability globally but too often patients are let down by the treatment they are offered, say experts.
They have written a series of papers in The Lancet asking the worldwide medical profession to stop offering ineffective and potentially harmful treatments.
Strong drugs, injections and surgery are generally overkill, they say, with limited evidence that they help.
Most back pain is best managed by keeping active, they advise.
Recommendations that doctors follow in the UK are clear about what investigations and treatment patients should expect.
Some patients will require a scan to rule out underlying causes, but in most cases they are deemed unnecessary because they are likely to be inconclusive.
Signs that something more significant might be wrong include:
difficulty passing urine
feeling the needing to pass urine, when there is none there
impaired sexual function such as loss of sensation during intercourse
numbness or tingling in the genitals or buttocks
loss of bladder or bowel control
loss of power in legs
Most adults will experience back pain at some point.
Episodes are usually short-lasting with no consequence, but recurrence is common – about one in three people will have a recurrence within a year of recovering from a previous bout, according to the researchers.
UK guidelines recommend a mix of physical exercise, advice and support to help patients cope with symptoms and enjoy a better quality of life.
Health staff should not treat back pain or sciatica with equipment such as belts, corsets, foot supports or shoes with special soles.