About one in ten Australian patients with lumbar radiographs has a lumbosacral transitional vertebra. Radiologists report fewer than a third of them. In a minority of these patients the transitional segment causes persistent low back, buttock or hip pain, often beginning in the twenties, that is treated for years as non-specific strain. Physiotherapists, chiropractors and osteopaths are the practitioners most people with low back pain see first and see most often.

This guide sets out what these practitioners need to recognise the condition and act on it. It covers what a symptomatic lumbosacral transitional vertebra is, why it concerns first-contact practitioners, and the presentation that raises suspicion once serious pathology has been excluded. It explains which imaging each profession can request under Medicare and what needs a medical practitioner's request. It describes the biomechanics of the transitional segment and what they imply for manual and exercise therapy, the evidence for treatment, and why high-velocity manipulation near the transitional articulation is a concern until the anatomy is defined. It sets out when and how to refer to the GP, with a letter template, and the practitioner's role after diagnostic injection or surgery.

Every clinical figure is drawn from the published evidence.