The human spine is like a precious strand of pearls linked together by ligaments, muscles and connective tissues."The 21st Century Upright Woman was originally published by the San Francisco Bay view Newspaper on April 10, 2010, as an essay exploring the relationship between the anatomy and evolutionary anthropology of the spine, low back pain, lumbar degenerative disc disease and the spine health of the modern woman. It was inspired by a presentation and workshop on Women's Health I led that month at the University of San Francisco's Mission Bay Campus.This review details the conclusive body of anthropological evidence linking human evolution and the bipedal spine to the Global Pandemic of low back pain and lumbar degenerative disc disease.Occupational injury, strain and sports overuse, morbid obesity, poor posture and spinal malalignments, extended sitting, standing, sedentary lifestyles and poor nutrition contribute to the disabling impact of this most ancient-most common-human affliction.A mounting body of evidence based research supports the simple role of weight loss, lifestyle change, occupational impact mitigation and exercise in the treatment and prevention of chronic low back pain.