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Condition/Disorder Synonyms


  • Low back pain

  • Mechanical low back pain

  • Lumbar sprain


ICD-9-CM Codes


  • 724.2 Lumbago

  • 847.2 Sprain of lumbar


ICD-10-CM Codes


  • M54.5 Low back pain

  • S33.5 Sprain of ligaments of lumbar spine


Preferred Practice Pattern


Key Features




  • Iliolumbar ligament runs from transverse process of L5 vertebra to iliac crest

  • Strain can be unilateral or bilateral depending on mechanism of injury

  • Tenderness along line of ligament or at attachments

  • Pain over ligament that does not radiate

  • Most episodes are self-limiting


Essentials of Diagnosis


  • Diagnosis made by clinical examination

  • Use of treatment- or impairment-based classification system is useful to determine evidence-based treatment plan

  • Reproduction of symptoms in specific postures and activities

  • Rule out systemic disease (red and yellow flags)


General Considerations


  • Presentation may vary significantly based on anatomical structures and psychosocial factors

  • Often difficult to determine patho-anatomical cause of pain

  • Poor spinal alignment can cause irritation of ligament by altering the length-tension ratio




  • Athletes and younger populations that are prone to extreme spinal movements


Clinical Findings


Signs and Symptoms


  • Pain in lumbar or sacral area that can be mechanically reproduced

  • Unilateral or bilateral pain along length of ligament or attachment

  • Lumbar segmental hypermobility may be present and indicate instability

  • Often associated with poor body mechanics, core-muscle weakness, and postural deviations


Functional Implications


  • May impede ability to perform ADLs/IADLs

  • May impede participation in sports and other social activities


Possible Contributing Causes


  • Occupational factors

  • Congenital anomalies

  • Physical condition

  • Smoking

  • Obesity

  • Socioeconomic factors

  • Psychosocial and behavioral factors

  • Postural changes

  • Weakness of core musculature

  • Tightness of hip flexors, hip external rotators, hamstrings


Differential Diagnosis


  • Facet joint dysfunction

  • Malignant spinal tumor or metastasis

  • Referred pain from visceral structures

  • Systemic auto-immune disease (rheumatoid arthritis, Reiter's syndrome)

  • Spondylosis

  • Spondylitis

  • Spondylolisthesis

  • Spinal misalignment

  • Sacral dysfunction

  • Erector spinae muscle strain

  • Myofascial pain syndrome

  • Herniated disc


Means of Confirmation or Diagnosis




  • Not necessary in most cases; only with persistent symptoms not responding to conservative management or if red/yellow flags are present

  • MRI helpful in diagnosis to visualize structure of ligament, compressed or inflamed nerve root, or disc pathology2

  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)3

  • CT to show ligament structure, herniation compressing the spinal canal/nerves, or to rule out abdominal pathology3

  • Electrodiagnostic/nerve conduction testing can help determine specific impaired nerve ...

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