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Loose Ligaments:
The Key to Solving Back Pain
When back pain is due to loose
ligaments, a very characteristic behavior of pain is
observed. A patient with
loose ligaments of the
lumbar spine or
pelvis will experience recurring dysfunctions at the intervertebral
joint (degenerative
disc and possible nerve compression), at the
facet joints
(locking in flexion or extension), and at the
sacroiliac joints. In
other words, the low back pain can be due to an unstable disc
problem, facet joint locking, or sacroiliac dysfunction.
However, the
low back pain
can originate in the
ligaments
themselves. The
ligaments
in the lower back contain an abundant supply of small nerve endings.
Good and strong
ligaments
will stretch very little when a load is applied to them. When the
ligaments
are weak, an excessive
stretching
will occur with the same load. The
greater the
ligament laxity, the faster the ligament will elongate or
stretch. This exaggerated elongation of the weak and overstretched
ligaments allows excessive pull on the non-stretchable nerve
endings. As a result, pain and/or numbness is felt locally over the
ligaments or
referred distally in the
buttock or in the legs,
following a specific pattern for each ligament.
Ligament injury is very painful. This is, in part, because
of the nerves in the
ligaments, but also because ligament injury typically occurs
where the ligament attaches to the bone, an area called the
fibro-osseous junction. The outside of the bone, where the ligament
attaches (the periosteum), is also full of nerve endings. The most
sensitive structures that produce pain according to Daniel Kayfetz,
M.D., are the periosteum and the ligaments. It is important to note
that in the scale of pain sensitivity (which part of the body hurts
more when injured), Dr. Kayfetz explains that the periosteum ranks
first, followed by ligaments, tendons, fascia, and finally muscle,
respectively. (Kayfetz, D. Occipital-cervical (whiplash) injuries
treated by
Prolotherapy. Medical Trial Technique Quarterly. 1963;
June: 9-29.) When a
ligament is injured, pain will be elicited from both the
periosteum and the ligament. This is why
ligament injury
can and does cause severe pain. This also explains why ligament pain
can come and go. The ligament will not be overstretched in certain
positions, therefore no pain is felt at that time.
A patient with
loose ligaments of the
lumbar spine and pelvis will often complain of not only
nagging low back pain, but also of an inability to maintain the same
position for a long period of time. If the same position is held for
a long time period, this will stretch the already injured ligaments
with sensitive nerve endings. The patient will find relief by
changing posture or position because the nerve endings are no longer
being stretched. This relief is only temporary. As the new posture
is maintained, the weak ligaments gradually start to give and the
small nerve endings are again stretched, and the pain recurs.
Here are some typical pain patterns experienced with
ligament injury to the lower back:
Lying Down
When lying in bed, position must be changed repeatedly to get
comfortable
Sleep
is poor, and often disrupted because of the recurring back
pain
Arising out of bed and walking around often gives some relief of the
pain
Morning
The pain is more intense in the morning
After lying down for 5 or 6 hours, the athlete gets out of bed early
(5 or 6 a.m.) because
of the pain
Stiffness and pain in the lower back upon rising in the morning
Standing and Sitting
Standing too long aggravates the pain (like standing and watching a
sporting event, standing too long at a cocktail party, or in line at
the grocery store or bank)
Sitting too long aggravates the pain (observing a sporting event,
sitting at the theater, taking a long drive, or watching a movie)
Walking around after standing and sitting too long helps decrease
the pain
Anyone who has pain characterized by the above, needs to
consult a physician with special training in the diagnosis and
treatment of ligament problems. |
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