Low Back

Iliolumbar Ligament Tears: Avoid Surgery With Regenerative Therapy

By August 28, 2019 September 16th, 2019 No Comments

Lower back pain can disrupt an individual’s way of life, as our lower backs are used in many day-to-day activities.

The amount of nerves, muscles, tendons, and ligaments that work together in the lower back allow for many potential injuries that could contribute to back pain. A major part of this network, though one that often flies under the radar, is the iliolumbar ligament.

It is a major source of support for the spine.

This ligament flies under the radar because it is surrounded by other soft tissue that are more likely to be damaged, but should be considered when attempting to find the source of lower back pain or decreased mobility.

Unfortunately, due to its frequent use and precarious location, the iliolumbar ligaments are prone to tears or injury. This article will review the anatomy of their structure, symptoms of iliolumbar ligament tears, causes, how they are diagnosed, how they are conventionally treated, and alternative treatment methods which may offer a more pleasant treatment experience.

Anatomy of Iliolumbar Ligament

Ligaments are fibrous tissues that connect bones to other bones. Their main function is to stabilize joints and bones which in turn prevents injury. The pelvis is attached to the spine using three major ligaments; the iliolumbar ligament, the sacrospinous ligament, and the sacrotuberous ligament.

The iliolumbar ligament originates on lumbar vertebrae 4 and 5 (L4 and L5) and attaches to the back (anterior) side of the iliac bone crest. The iliac bone crest is at the top of the pelvis bone. This location allows the spine to be supported during almost all spinal motion, especially twisting and bending. It helps to stabilize spinal movement by restricting the amount of motion in the surrounding bones and muscles. It also holds the vertebrae in place so that they don’t slip.

The sacrospinous and sacrotuberous ligaments are located lower on the pelvic bone and also help support spinal movement and function by stabilizing it.

The placement of these ligaments allow them to be protected to an extent, but damage can still occur under the right conditions.

Signs and Symptoms

A tear of the iliolumbar ligament, also known as iliolumbar syndrome, can surface with several symptoms:

  • Pain in lower back
  • Inflammation
  • Soreness or tenderness
  • Painful movement
  • Reduced mobility
  • Pain in joints and/or muscles in the surrounding area

The severity of symptoms can vary from one injury to the next, and may not necessarily feel like an injury at first. Pain that is experienced can have a range of being a dull ache to a sharp, stabbing pain. It can occur only during certain movements or be chronic. Some individuals are at a higher risk of this type of injury, but a ligament tear can occur in anyone at any time.

Causes

Damage to ligaments occurs for several reasons:

  • Injury: if a ligament is forced into an unnatural position, it can become pinched or torn. This can include injury during lifting or moving, performing sports that involve twisting such as golf, an automobile accident, or a fall.
  • Deterioration: soft tissues in the body naturally deteriorate over time. If a ligament is deteriorating, it can cause pain and inflammation as well as decreased support in its area. This lack of support can also lead to a decrease in mobility.
  • Overuse: people who use certain ligaments more than others, especially those who are physically active, can be more prone to ligament injury as overuse can lead to more rapid deterioration. This can apply to athletes and people who are using these movements in their job, such as construction workers or movers.
  • Physical abnormalities: in some cases, a bone that has formed abnormally can cause ligament injury as it may be digging into it, or the ligament could have been formed improperly during growth. Spinal deformities can alter the amount of tension on the ligament as well, which could lead to a higher likelihood of injury.

It is difficult to diagnose a tear in the iliolumbar ligament because the network of which it is a part has many potential causes of injury. Many other ligaments, muscles, cartilage, nerves, and bones exist in the area that could be tested as potential causes before doctors even consider the iliolumbar ligament. This means that without the proper diagnostic techniques, it may be overlooked as a cause of pain and inflammation.

Diagnosis

Proper treatment of any injury begins with an accurate diagnosis of the issue. In the case of a tear in the iliolumbar ligament, doctors may perform several tests to determine the exact cause. These include:

  • Physical examination: doctors will often begin by simply testing the range of motion that a patient has. This includes watching them walk, sit down, and perform specific movements that may indicate the location of the injury. Doctors may also test for tenderness or soreness by lightly touching the area to observe the patient’s response.
  • MRI imaging: this form of technology helps doctors to see the structure of tissues in the body, which can help with identifying the location and extent of damage to the ligament.
  • X-Ray imaging: allows doctors to spot abnormalities in the bone that may be causing or contributing to an injury. For iliolumbar tears, this is not often used because it is an injury in the soft tissue which cannot be seen on X-Rays. If there is an abnormality in the spinal structure, an X-Ray would be able to identify it.

Depending on the results of diagnostic tests, doctors will help to create a treatment plan that is specific to every patient.

Conventional Treatment

There are several stages of conventional treatment that doctors will consider depending on the type of injury and severity. These include:

  • Rest: many ligament tears have the ability to heal by themselves over time if the patient is able to reduce the amount of stress to the injured area. This form of treatment is typically accompanied by over-the-counter anti-inflammatory medications, such as Naproxen or Ibuprofen, and intermittent application of ice.
  • Steroid injections: these can help with pain in the short-term, but many studies have concluded that these types of injections can actually cause damage to soft tissues over time.
  • Physical therapy: certain exercises can help to strengthen the muscles surrounding the iliolumbar ligament, which will provide support for the back as it heals.
  • Surgery: if none of the above treatments are helping to stop pain caused from injury, doctors will discuss a surgical option with patients. A cure for spinal instability that some doctors turn to is called Spinal Fusion. This form of surgery is highly invasive and involves essentially fusing two vertebrae together to improve stability in the spine. Spinal fusion surgery uses foreign objects such as screws, rods, and bone grafts to complete the fusion. There are a myriad of risks associated with this operation, including infection, blood clots, rejection of foreign objects or anesthesia, and many more. Spinal fusion surgery has received some speculation as of late because of its relatively low success rate, long recovery time (three to twelve months or more), and cost. It is considered a major surgery and would only be considered if the ligament tear is affecting spinal stability greatly.

Most ligament tears do not require major surgery. The option is somewhat far-fetched since it is such a drastic solution. If the conventional treatments leading up to surgery are not working, patients should consider alternative medicines and therapy before making the potentially life-altering decision to undergo surgery.

Regenerative Therapy

A less invasive approach to healing soft tissue injury can be found in regenerative therapies. Both therapies available with CELLAXYS involve a simple series of injections and have yielded very positive results. Both forms of therapy work best when applied to injuries of the soft tissue, so they have a high potential of helping to heal a ligament tear. The available regenerative therapies are:

  • Stem Cell Injections: doctors are able to get stem cells out of parts of the body such as blood cells, fat cells, or bone marrow. The stem cells are processed and returned to the body via injections. Doctors are able to use ultrasound or MRI imaging to locate the precise location of the injury where they then inject the stem cells. The cells are able to call to other cells in the body which contain healing properties; because of this, injuries to soft tissue (such as an iliolumbar ligament tear) can heal much faster than they would without the extra help.
  • Platelet-Rich Plasma Injections: blood is extracted from the patient in the form of a blood draw. It is then put into a centrifuge where the platelets are separated from the plasma. Platelets contain growth factors and proteins that aid in the healing process – they are then injected into the injury site to help repair it. Similarly to stem cell injections, doctors can use imaging technology to locate the injury site accurately.

Both of these forms of therapy are essentially taking healing properties that already exist in the body, concentrating them, then reapplying them to an injury site. These can also be accompanied with some of the other conventional treatment options such as physical therapy. Doctors who use regenerative therapies will often still recommend a physical therapy regimen to continue to strengthen the muscles and ligaments around the tear so that it can be better supported as it heals.

These forms of therapy are not only minimally invasive, they also have a much shorter recovery time than surgery – patients usually begin to see results in only a couple of weeks. They also can be more cost-effective, as surgery can be very expensive when not covered by insurance. Spinal fusion surgery is almost always considered an elective surgery, so it is most often not covered. Coupled with a low risk and high success rate, these forms of treatment should not be left out of the conversation about healing a torn ligament or other soft tissue.

Conclusion

The complex network of support at the bottom of the spine is at a risk of becoming injured due to its important location and frequency of use. A major portion of spinal support comes from the iliolumbar ligaments which should be monitored especially if they are being used often or have been placed at risk due to injury or abnormality.

Lower back pain can disrupt an individual’s way of life because it is so vital to daily activities. When conventional treatments fail, alternative regenerative therapies should be in the conversation because of their potential to heal an injury without further disrupting one’s way of life.

Dr. Pouya Mohajer

Dr. Pouya Mohajer

Director of Spine & Interventional Medicine
Board certification in Anesthesiology and Interventional Pain Medicine
Fellowship-trained from Harvard University
UCLA Alumni