Low Back Pain

By Noah Volz

There are multiple causes of low back pain but in this article we will look at one common cause which is ligament injuries. By having a deeper understanding of how they occur, what the common symptoms are, and how to pinpoint the structure that has been damaged we can learn a lot about the treatment of pain in this area. 

What Are They?
Sprains are microtears in the ligaments that connect bone to bone and when they cause low back and hip pain they are most often found along the lumbar vertebrae from L1-L5 or along the sacral ligaments. Because of their structure they do not receive good blood supply and when damaged adhesive scar tissue will often form. Ligament pain is often considered to have a similar pain pattern as nerve pain. It is sharp, burning and powerfully painful. 
 
The three primary sacral ligaments are the iliolumbar, supraspinous and interspinous ligaments. Each one has a different pain pattern that has been established.

The Iliolumbar Ligament
The iliolumbar ligament attaches the ilium of the pelvis to the lumbar vertebrae. The most often part of the ligament that is damaged is where it attaches the L5 transverse process to the ilium. It is a large sheath that coordinates with many of the low back muscles. Sciatica is a very imprecise diagnosis as it only refers to pain in the sciatic nerve. As the sciatic nerve is the main nerve that goes down the leg any pain in the leg will be associated with this nerve. Possible locations of pain are around the buttock, groin, genital, thigh, lower leg, and foot in combination with the low back is usually an indication that this ligament is affected. Sometimes the low back doesn't even hurt.  Pain in these areas may indicate a ligament tear in the low-back region. This may be concurrent with disc indicators which should be assessed separately. 
Supraspinous and Interspinous LigamentsThese ligaments are more frequently sprained in two primary locations. One is between L4 and L5 and between L5 and S1. A clients pain pattern will depend on the precise location of the tears. The pain can be felt on one side of the back, both sides, or the center of the back. Ligament pain does not refer across the mid line. If there is pain that is experienced across the entire low back region this is usually an indication that both sides of the spine may be injured. 

How Serious is the Injury
When working with injuries to the ligaments the severity of the injury is indicated by the distance that the pain is referred down the body. If there is pain in the buttocks or thigh it is likely that the injury is not severe. If however the pain refers the lower leg then the injury is considered moderately severe. Anytime the pain is felt in any area of the foot the injury is very severe and will require a more complete intervention in order to mend the damaged ligaments.

The Cause of Ligament Tears
Pain in the low back and tissues below the waist can appear suddenly. Sometimes there is no apparent traumatic event that precipitated the pain pattern. Sometimes the cause of pain is associated with a fall, lifting a heavy object, a sports injury, or an automobile accident. Depending on the cause of the pain it may arise suddenly. If however it takes days for the pain to arise, such as in the case of a motor vehicle accident, then the ligaments are not giving off pain signals until the scar tissue begins to form. 

Sometimes through repetitive stress the pain in the low back or inferior areas may start slightly perhaps beginning with a a slight discomfort. If this ache intensifies over time then it may hit a crescendo and the person may be bedridden for a period of time. Often times activities as seemingly innocuous as sitting can lead to a persistent pain pattern. 

In most cases ligament pain is associated with gradual onset or a sudden experience of pain. This is because the ligaments are more likely to tear when they become fatigued from overwork. Oftentimes poor alignment is the primary contributor to this kind of ligament damage. The system works hard to re-calibrate the structural integrity of the body and when it is unable to balance the constant stress experienced in the body than the depleted circulation to the ligaments sets up the conditions for injury. By developing consistent exercise and dietary habits that support the bodies tissues through proper warm up and relaxed muscles then the scar tissue will not form and will not tear under stress.

How the Discs affect the Ligaments
When we awaken in the morning our spine has had time to lengthen and the discs between the vertebrae are spongy and filled with fluid. As we go throughout our day the compressive forces of gravity begin to squeeze the discs and small amounts of fluid return to circulation. This process causes a slight narrowing of the discs by the end of the day. When we sleep the disc's are restored to their optimal size. If however we have excessive muscular tension in the erector spinae muscles that hug the spinach cord then oftentimes the extra pressure of the hundreds of these small muscles will exert a force stronger than gravity and will deplete the fluid within the discs. The tension of the spinal ligaments is determined by the space between the bony protuberances that they attach to. If the disc space narrows then the taught ligaments become lax. When the ligaments slacken they are unable to maintain the structural integrity and they lose their strength. As strength is lost then the ligaments can become damaged more easily and more scar tissue is formed further weakening hte ligaments. 

A similar pattern of tension in the paraspinal muscles can occur if the person is under a lot of emotional stress as this can cause chronic contractions of the muscles. Also stress fighting hormones such as cortisol may contribute to the compromised healing process. When there is an overabundance of cortisol secreted because of excess stress this overabundance can become toxic and slow down the bodies natural mechanisms for maintaining balance.  

Injury Verification
Pain in the low back region can be caused by a variety of things, ranging from minor to serious. Some really serious conditions that cause low-back pain are spinal stenosis, spondylolisthesis and nerve root compression. Thankfully these conditions have definite signs and symptoms and when they are found it indicates a serious medical condition that needs to be addressed by a physician right away. 

• Continuous numbness or pins and needles in the legs or feet.
• Severe, debilitating pain in the low back region or legs.
• Atrophy of a leg muscle or significant weakness.
• Exceptional inability to perform movements below. 
• Incontinence of the bladder or bowel.
• Inability to move a limb.

The more precise the cause is determined the more quickly the pain and dysfunction will resolve. In order to detrmine if the pain is being caused by an injury to the ligaments there are a few tests that can be done. One way in which these tests differ is that they are passive. If a muscle is injured it will be painful when the muscle is activated against resistance. For example if a passive forward fold without resistance is performed with pain then it is likely that a ligament or other structure that does not initiate movement is to blame. This is called passive flexion and it should be noted where the pain was felt. Another test that can be performed is passive extension. This means that the client will doing a slight standing backbend. Agin note where the pain was felt. If pain was felt it is likely that supraspinous or interspinous ligaments are injured. Lastly you can do these tests to each side. This is called passive side flexion. Take note of the pain location as this is usually related to ilio-lumbar ligament injury. You can perform these tests by yourself, but for the best results it is best to have a well trained massage therapist assessing you during them.

Conclusion
Although ligament injuries are relatively common they can be often overlooked. By doing these simple self tests you can determine whether your ligaments may be injured and a massage therapist can palpate these ligaments to determine if there are adhesions or scar tissue within the tissues. In order to get relief consider scheduling an appointment for a massage today.