Segmental Lumbar Instability

The lumbar spine is the clinical term for the lower back. When we think of low back pain, we are usually thinking of the pain of the lumbar spine. Low back pain is common among athletes and non-athletes. This is because low back pain can result from overuse, underuse, stretch injuries, and physical trauma (1). Most low back pain is mechanical- usually a lack of stability or hypermobility of the joint.

Unresolved ligament injuries attribute to pain in the lower back. These contribute to an unstable intervertebral joint and may predispose an individual to disc herniation (1). Ligament injuries and associated mechanical stresses continue to cause pain until they are resolved. Pain killers do not repair, they only mask the pain and make reckless injuries more likely.

The Lumbar Spine

Five stacked vertebrae (backbones) make up the lower back. Between vertebrae are the discs which act as a cushion between bony segments and provide limited movement. The vertebra is also held together by intervertebral ligaments- which connect one vertebra to another. Intervertebral ligaments provide segmental stability and mechanical support of the lumbar spine.

Ligament Injury and Laxity

Ligament injuries are a major cause of pain and dysfunction in the body. Furthermore, injuries to these are hard to diagnose as ligament microtears are not typically visible in MRIs or X-rays. Over time, unresolved injuries can lead to weak and lax ligaments.

Ligament laxity refers to a loose ligament. This is a problem because these structures hold the intervertebral joint and keep it in place. In addition, if the ligament is lax, the intervertebral joint moves excessively and leads to segmental instability of the spine.

Abnormal joint mechanics and rubbing of the bones damage nearby structures. As a result, these abnormalities can predispose one to disc herniations, bone degeneration, and spurs.

Segmental Lumbar Instability and Pain

Segmental instability is typically a result of lax ligaments from injury or degenerative disc disease (2). In the case of ligament injury, its incomplete healing makes it lose its tension and ability to hold vertebrae in place. Hypermobility of the joint leads to pain and the increased chance of injury to the area.

In lumbar degenerative disc disease, the discs (found between vertebrae) lose height and as a result, vertebrae move close to each other. Ligaments connecting two vertebrae together are left loose “like a rubber band” and cannot provide the same stability as before (2).

Prolotherapy Treatment

Prolotherapy injections which repair, stabilize, and strengthen ligaments should be the treatment of choice for lumbar segmental instability. Such injections do this by “tricking” the body into starting a new healing cascade via inflammation(1).

Injection treatments are minimally invasive, cost less, and have a quicker recovery than surgery. Consequently, case reports and studies on the use of prolotherapy for lumbar segmental instability associated with lax ligaments and degenerative disc disease show improvements ranging from 70% to 100% (1)(2). This includes improvement in function, stability, and long-lasting pain. In summary, patients usually return to normal life functions like lifting, bending, and recreational sports.

References-

1. Alderman, Donna. “Prolotherapy for Low Back Pain.” Practical Pain Management, www.practicalpainmanagement.com/pain/spine/prolotherapy-low-back-pain.
2. Inklebarger, James, and Simonon Petrides. “Prolotherapy for Lumbar Segmental Instability Associated with Degenerative Disc Disease.” Journal of Prolotherapy, 14 Dec. 2017, journalofprolotherapy.com/prolotherapy-lumbar-segmental-instability-associated-degenerative-disc-disease/.