It's time we stop focusing on posterior disc protrusions
Monthly our team at Limp in Leap out Physiotherapy & Wellness in Belfield conduct blogs and articles.
It’s time we stop focusing on posterior disc protrusions …
Lower back pain is a common condition that affects many people, not only in the workforce, but also in everyday life activities. It is important to take note that nerve and lower back pain are not always caused by bulging discs.
As shown in the attached figure, nerve pain can also be caused by an osteophyte (or bone growth) compressing a nerve or swelling within the ligamentum flavum that compresses the spinal nerve.
This article will focus on swelling as a contributing factor. It’s time to start focusing on the involvement of ligamentum flavum…
The ligamentum flavum is a thick ligament band that runs from the neck to the lower back. In 2015, there was a study conducted that investigated how the ligamentum flavum is involved with lower back pain and sciatica. The study examined 63 subject’s ligamentum flavum in people with no symptoms of back pain and those with lower back pain.
The conclusion: the study found ligamentum flavum thickness was greater in patients with lower back pain. It is predominately thought that protrusions of the disc can lead to compression of the nerve, however there is growing evidence that also identifies ligamentum flavum thickness as a feature of back pain and sciatica.
Another study in 2015 also identifies that facet joint degeneration can cause leakage into and within the ligamentum flavum. Thus, as we age the ligamentum flavum can also naturally thicken and may be another reason for lower back pain and nerve pain.
During your Limp in Leap out Physiotherapy consultation, we take the approach of assessing both disc bulging and ligamentum flavum swelling. We capture all information in the initial consultation, and this can be with the use of scans (MRI, CT scans).
Reference: 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