Lower back pain can disrupt an individual’s way of life, as our lower backs are used in many day-to-day activities.
The number of nerves, muscles, tendons, and ligaments that work together in the lower back allows 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 is 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.
Anatomy of Iliolumbar Ligament
Ligaments are fibrous tissues that connect bones to other bones. Their main function is to stabilize joints and bones which prevents injury. The pelvis is attached to the spine using 3 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 most spinal motion, especially twisting and bending. It helps to stabilize the 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 allows 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 an iliolumbar syndrome, can surface with several symptoms:
- Pain in the lower back
- 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 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.
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 it is a part of 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.
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: 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: 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 the spinal structure is abnormal, 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.
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 can heal by themselves over time if the patient can 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 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 by 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 to improve stability in the spine. Spinal fusion surgery uses foreign objects such as screws, rods, and bone grafts to complete the fusion. There is 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 (3-12 months or more), and cost. It is considered major surgery and would only be considered if the ligament tear is affecting spinal stability greatly.
Most ligament tears do not require major surgery. 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.
A less invasive approach to healing iliolumbar ligament tears can be found in regenerative therapies. These include cell-based therapies and platelet-rich plasma (PRP) therapy. 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 by some of the other conventional treatment options, such as physical therapy. CELLAXYS offers two forms of therapy that involve a simple series of injections and have yielded very positive results.
Both forms of therapy work best when applied to soft tissue injuries, so they have a high potential of helping to heal a ligament tear. The available regenerative therapies are:
- Cell-based therapies: Many people call this treatment “stem cell therapies.” In these procedures, doctors can extract healthy cells from the patient’s adipose (fat) tissue or bone marrow. When they opt for the adipose tissue, it is called a Minimally Manipulated Adipose tissue (MMAT) transplant. Taking cells from the patient’s bone marrow is called Bone Marrow Concentrate (BMAC). These cells are processed and returned to the body at the injury site.
- Platelet-rich plasma (PRP) therapy: In PRP, the doctor extracts platelets from the patient’s blood plasma, processes them, and then returns them to the injury site. Platelets contain 10 Growth Factors and proteins that aid in the healing process. They also release chemical impulses to attract healing cells in the blood and produce fibrin, a web-like scaffolding that supports the development of healthy tissues. Increasing the platelet count in the injury site promotes healing.
Doctors use ultrasound or MRI to locate the precise location of the injury, where they then inject the cells. Cell-based and PRP therapies are outpatient procedures, meaning you can go home after the procedure. MMAT and BMAC usually take around 1.5 to 2 hours to complete, while PRP takes about 45 minutes.
Doctors who use regenerative therapies will often still recommend a physical therapy regimen to continue strengthening the muscles and ligaments around the tear so that it can be better supported as it heals.