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ObjectiveTo describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain.DesignA descriptive, cross-sectional analysis of baseline data from a prospective cohort study.Setting and participantsA study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted.Outcome measuresDiagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes.ResultsOf all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care.ConclusionThere is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.