Iliolumbar Ligament Injury

The iliolumbar ligaments are crucial in supporting the lower lumbar spine; they join the 4th and 5th lumbar vertebrae (L4 and L5) to the iliac bone crest at the back of the pelvis. Injury to this area, fairly common among certain athletes due to the amount of frantic spinal motion involved in many sports, can develop into sacroiliac joint pain and associated problems. The sacroiliac joint is located in the pelvis and helps to keep the spine stable.

Symptoms

Pain is likely to arise in the lower lumbar spine and may be felt as occasional stabbing attacks. This can be exacerbated by physical activity involving the spine, e.g. twisting or bending, and long periods of sitting can also bring on the pain. The area can be tender to the touch and your back might feel weaker than usual. While these may be the primary symptoms if the injury is caught and treated early, iliolumbar ligament sprain or trauma can also lead to more serious conditions involving the 4th or 5th lumbar vertebrae. These areas can become weakened and prone to degenerative processes that can result either in persistent lower back pain, disc tearing, a herniated disc, or lower back nerve root compression (see our article for further details). Such conditions will cause harsher symptoms, such as burning pain in the back or legs, and motor problems.

Causes

Sports incorporating repeated spinal movements like bending and twisting often provoke iliolumbar injury, e.g. golf, tennis and many net sports. Direct trauma to the area can also cause the condition, such as a hard strike from a projectile or fellow athlete. Outside of sport, car accidents and other collisions can lead to these problems.

If the initial iliolumbar ligament injury is worsened, this is generally due to instability in the affected lumbar vertebrae that causes the 4th vertebra to slip and the 5th to move. This can lead to disc herniation.

Treatment

Your doctor will recommend suitable treatment based on their diagnosis; this will depend on the severity of the problem and whether the iliolumbar injury has developed into another condition. Conservative, non-invasive treatment is usually the first and most successful option, but depending on individual circumstances surgery may be required. In the meantime it is important, until the pain symptoms have desisted, to take a break from all activities that could put unneeded pressure on the spine. You can reduce pain and swelling by applying ice to the injured area at least 3 times per day to begin with, and by taking anti-inflammatory pain medication such as ibuprofen.

Rehabilitation

When you are pain free, consult your doctor or a physical therapist about an appropriate program of stretching and strengthening exercises for the buttocks and hips. This is crucial in building up strength and support for the lumbar spine in order to prevent similar future injuries, and for maintaining smooth movement in the injured areas. The doctor might also prescribe a course of medication for this purpose.