Sprain, iliolumbar ligament

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

• 724.2 Lumbago
• 847.2 Sprain of lumbar

• M54.5 Low back pain
• S33.5 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 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

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 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

Imaging

• 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

• Negative nerve-conduction tests
• Inflammation on MRI

• To hospital for imaging
• To physician for surgical consult if ...