Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Low back painMechanical low back painLumbar sprain ++ 724.2 Lumbago847.2 Sprain of lumbar ++ M54.5 Low back painS33.5 Sprain of ligaments of lumbar spine ++ Pattern 4F: Impaired joint mobility, motor function, muscle performance, range of motion, and reflex integrity associated with spinal disorders1 +++ Description ++ Iliolumbar ligament runs from transverse process of L5 vertebra to iliac crestStrain can be unilateral or bilateral depending on mechanism of injuryTenderness along line of ligament or at attachmentsPain over ligament that does not radiateMost episodes are self-limiting +++ Essentials of Diagnosis ++ Diagnosis made by clinical examinationUse of treatment- or impairment-based classification system is useful to determine evidence-based treatment planReproduction of symptoms in specific postures and activitiesRule out systemic disease (red and yellow flags) +++ General Considerations ++ Presentation may vary significantly based on anatomical structures and psychosocial factorsOften difficult to determine patho-anatomical cause of painPoor spinal alignment can cause irritation of ligament by altering the length-tension ratio +++ Demographics ++ Athletes and younger populations that are prone to extreme spinal movements +++ Signs and Symptoms ++ Pain in lumbar or sacral area that can be mechanically reproducedUnilateral or bilateral pain along length of ligament or attachmentLumbar segmental hypermobility may be present and indicate instabilityOften associated with poor body mechanics, core-muscle weakness, and postural deviations +++ Functional Implications ++ May impede ability to perform ADLs/IADLsMay impede participation in sports and other social activities +++ Possible Contributing Causes ++ Occupational factorsCongenital anomaliesPhysical conditionSmokingObesitySocioeconomic factorsPsychosocial and behavioral factorsPostural changesWeakness of core musculatureTightness of hip flexors, hip external rotators, hamstrings +++ Differential Diagnosis ++ Facet joint dysfunctionMalignant spinal tumor or metastasisReferred pain from visceral structuresSystemic auto-immune disease (rheumatoid arthritis, Reiter’s syndrome)SpondylosisSpondylitisSpondylolisthesisSpinal misalignmentSacral dysfunctionErector spinae muscle strainMyofascial pain syndromeHerniated disc +++ Imaging ++ Not necessary in most cases; only with persistent symptoms not responding to conservative management or if red/yellow flags are presentMRI helpful in diagnosis to visualize structure of ligament, compressed or inflamed nerve root, or disc pathology2X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)3CT to show ligament structure, herniation compressing the spinal canal/nerves, or to rule out abdominal pathology3Electrodiagnostic/nerve conduction testing can help determine specific impaired nerve function4Doppler ultrasound to examine vascular functionDiagnostic ultrasound to analyze fiber orientation ++ Negative nerve-conduction testsInflammation on MRI ++ To hospital for imagingTo physician for surgical consult if ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth