It is hypothesized that, in a large number of cases of aspecific low back pain, the primary cause of the pain is a fracture of the vertebral endplate caused by compression forces. Clinical studies have shown that, in many low back pain patients, damage of the vertebral bodies and or the intervertebral disc is present. In vitro studies reveal that the most likely type of failure of this anterior part of the spine is a fracture of the endplate as a result of compression. The high incidence of aspecific low back pain concurs with the likeliness of compression fractures of the endplate to occur in everday life. Furthermore, epidemiological findings and the natural history of low back pain appear to be in line with the proposed hypothesis.