Lower back pain is a common condition many people face on a daily basis. Sciatica/lower back pain is not always caused by bulging discs. At times the cause of such pain can be misdiagnosed and we take some time to assess a variety of other causes.
Sciatica / lower back pain is not always caused by bulging disc/s. It’s time to start focusing on the involvement of ligamentum flavum…
In a study conducted in 2015 by Munns & colleagues, they investigated how the ligamentum flavum can be involved with lower back pain and sciatica. The ligamentum flavum is a thick ligament that runs from the neck to the lower back. In the study, they examined 63 people’s ligamentum flavum in asymptomatic (a person with no symptoms of back pain) and chronic lower back pain of. In conclusion, they found that ligamentum flavum thickness was greater in patients with lower back pain. While traditionally the focus of discussion has been on the bulging of the disc leading to compression of the nerve, there is growing evidence that identifies ligamentum flavum thickness or hypertrophy as a pathologic feature of back pain and sciatica.
The image on the right best illustrates this idea. Evidently it illustrates:
- The spinal nerve can be effected by a bulging disc
- The spinal nerve can be effected by an osteophyte
- Finally, the spinal nerve can be effected by ligamentum flavum thickness / hypertrophy
At PROHEALTH PHYSIO, we take the approach of assessing both disc bulging and ligamentum flavum thickness. We do this to capture all information in the initial assessment, to avoid long-term physiotherapy treatments of the lower back and sciatica.
For further information, please refer to: Munns, J. J., Lee, J. Y. B., Espinoza Orias, A. A., Takatori, R., Anderson, G. B. J., An, H. S. & Inoue, I. (2015). Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects. National Institute for Arthritis and Musculoskeletal and Skin Diseases68(2), 134-140