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124: ILIOLUMBAR LIGAMENT SPRAIN

Eric Shamus, PhD, DPT, PT, CSCS; Arie J. Van Duijn, EdD, MSc, PT, OCS; Kristie Centner, DPT

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

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1

PATIENT PRESENTATION

A 15-year-old girl presents with complaints of unilateral pain along the left iliac crest up to the L5 vertebra. The patient states she has just recently joined a gymnastics team and has had this nonradiating pain since her last practice 5 days ago. She vaguely remembers feeling pain in this area of her left low back after landing a spotted back handspring incorrectly. The patient states she is unable to practice or sit for periods of 30 minutes or longer due to pain and a feeling of instability. Upon palpation, the patient complains of point tenderness along the left iliac crest running up to the transverse process of the L5 vertebra. Passive intervertebral motion testing indicates hypermobility at the L5-S1 segment. Manual muscle testing of lumbar extension and trunk flexion are both 3/5. The patient tests negative for the straight leg raise test and X-rays are negative for fractures.

KEY FEATURES

Description

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

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

  • Tenderness along the line of ligament or at attachments.

  • Pain over the 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 pathoanatomical cause of pain.

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

Demographics

  • Athletes and younger populations who are prone to extreme spinal movements.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

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

  • Unilateral or bilateral pain along the length of ligament or attachment

  • Lumbar segmental hypermobility may be present and indicates instability.

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

FIGURE 124-1

Tests at the hip and SI joint. (A) Straight-leg-raising test: The examiner lifts the supine patient’s lower limb when the knee is held in extension. (B...

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