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  • Low back pain
  • Mechanical low back pain
  • Lumbar sprain

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  • 724.2 Lumbago
  • 847.2 Sprain of lumbar

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  • M54.5 Low back pain
  • S33.5 Sprain of ligaments of lumbar spine

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Description

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  • 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

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Essentials of Diagnosis

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  • 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)

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General Considerations

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  • 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

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Demographics

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

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Signs and Symptoms

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  • 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

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Functional Implications

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  • May impede ability to perform ADLs/IADLs
  • May impede participation in sports and other social activities

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Possible Contributing Causes

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  • 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

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Differential Diagnosis

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  • 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

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Imaging

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  • 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 function4
  • Doppler ultrasound to examine vascular function
  • Diagnostic ultrasound to analyze fiber orientation

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  • Negative nerve-conduction tests
  • Inflammation on MRI

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  • To hospital for imaging
  • To physician for surgical consult if myelopathy suspected (see Lumbar Radiculopathy)
  • To physician for ...

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