Unraveling the Mystery of Low Back Pain #3: Iliolumbar Ligament Sprains
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1 Unraveling the Mystery of Low Back Pain #3: Iliolumbar Ligament Sprains Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. 1
2 SPONSORED BY: Over 30 years of experience building the finest portable treatment tables and accessories. Products that are visually stimulating, ergonomically supportive, and incredibly comfortable. The superior design and engineering capabilities merge to create the ultimate experience for you and your clients SPONSORED BY: Mattes chair Side-lying position system Webinar Goal Explore the assessment and treatment of the iliolumbar ligament, one of the most common low back injuries. 2
3 Pretest 1. Pain on the upper border of the iliac crest usually comes from a quadratus lumborum muscle strain. True or False? 2. Pain felt while bending the trunk to the side only is usually caused by strain to the sacrotuberous ligament or gluteus medius muscle. True or False? 3. Pain into the genital area can be caused by a strain of the iliolumbar ligament. True or False? 4. The iliolumbar ligament is attached to the L4 transverse process. True or False? 5. The iliolumbar ligament primarily stabilizes the pelvis in forward and backward movements. True or False? Anatomy Anatomy of the Iliolumbar Ligament Attaches the transverse process of the 5th lumbar vertebra (and occasionally the 4th) to the iliac crest Lower slip attaches to the anterior sacroiliac ligament Stabilizes the pelvis in side-bending 3
4 Anatomy of the Iliolumbar Ligament Beneath and blends into thoracolumbar fascia and part of quadratus lumborum Palpation alone is not reliable Assessment Test 1a: Side-flexion 4
5 Test 1b: Side-flexion in slight forward flexion Test 1c: Side-flexion in slight extension Test 2: Resisted side-flexion 5
6 Resisted testing: Ruling out muscles Muscular injury: pain on resisted testing Ligament injury: no pain on resisted testing Test 3: Flexion Test 4: Extension 6
7 Theory Assessment Test Results for Iliolumbar Ligament Injuries Pain on side-flexion Sometimes pain on flexion and extension as well No pain on resisted sideflexion (unless the muscles are also injured) Local pain on palpation Pain Patterns for Iliolumbar Ligament Injuries Referred pain: Low back Buttock Lower abdomen Groin Upper lateral thigh Genitals 7
8 Pain Patterns for Iliolumbar Ligament Injuries Both ligaments may be affected: Often caused by compensation patterns Leads to pain on both sides or straight across the back Other ligaments may also be involved. Causes of Iliolumbar Ligament Injuries Sudden trauma Routine activities that involve lifting and twisting Treatment 8
9 Friction Therapy Watch the video at the end of the Webinar Myofascial Therapy Massage Therapy 9
10 Therapeutic Exercises Place tension on the ligaments Prevent the adhesive scar tissue from re-forming Help the tissues to heal in the presence of movement Should not cause any pain or discomfort Exercise #1: Sitting Forward Bends Exercise #2: Standing Forward Bends 10
11 Exercise #3: Leg-Up Forward Bends Active Isolated Stretching & Strengthening Referrals Movement problems: Alexander Technique or Feldenkrais practitioner Limited flexibility or strength: AIS practitioner Stretched out ligaments: prolotherapy (Ongley Institute: 11
12 Questions Clinical Reasoning Question for you If passive movements test for injuries to ligaments and joints And resisted testing primarily assesses injury to muscles and tendons Why are active tests not as useful? The answer is contained in the question. Questions Facebook.com/DrBenBenjamin 12
13 Post-test 1. Pain on the upper border of the iliac crest usually comes from a quadratus lumborum muscle strain. True or False? 2. Pain felt while bending the trunk to the side only is usually caused by strain to the sacrotuberous ligament or gluteus medius muscle. True or False? 3. Pain into the genital area can be caused by a strain of the iliolumbar ligament. True or False? 4. The iliolumbar ligament is attached to the L4 transverse process. True or False? 5. The iliolumbar ligament primarily stabilizes the pelvis in forward and backward movements. True or False? 13
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