An Uncommon Cause of Back Pain

Low Back Pain is common.  Uncontrolled or overloaded forward leaning is the most common cause.  In this group, a lumbar disc is often implicated as the site of injury.  These injuries tend to cause pain with leaning forwards, sitting, driving, and coughing / sneezing.  But what happens if the disc is not the cause of the pain?  QSMC Physios explored the potential explanations.

In a recent interesting clinical case, a client presented with back pain that did not fit the common discal profile of injury.  While leaning forward was part of the mechanism, there was a more specific area of pain associated with local swelling just to the side of the spine on one side.  There was no radiation of pain nor was there any discomfort with coughing and sneezing which is so typical of discal back pain.  The key aggravating factor was maintenance of slumped posture.

Further investigation and clinical reasoning implicated the ilio-lumbar ligament (ILL) as the site of pathology in this case.  The ILL is a broad, five part structure which binds the lowest two lumbar vertebrae to the pelvis.  Some parts of it are tightened in forward bend, and others tightened when leaning backwards.  While uncommonly injured, the structure is critical to the stability of the spine and pelvis.

The good news in this case is that with careful history taking and assessment, the correct management can be delivered.  Treatment of ILL sprains include manual therapy, taping and restriction of painful activities eg. slouched sitting.  With less than a week of treatment there was a drastic reduction of symptoms.  In six weeks, there was a complete return to normal activity.

If you or someone you care for is troubled by single sided low back pain which is irritated by slouched sitting and yet doesn’t hurt with coughing or sneezing, maybe the Ilio-lumbar ligament is involved.  Ask your physiotherapist about it today.