Lower back pain can significantly affect someone's way of life as the simplest day-to-day activities are achieved through lower back mobility.
The iliolumbar ligament is part of the major network of nerves, muscles, ligaments, and tendons that work together to maintain the functionality of the lower back.
Iliolumbar ligament injections are typically performed using ultrasound guidance to guarantee the needle is accurately placed. As with all injections, patients must remember that the outcome is not variable, and they may not feel immense relief.
Lower back pain
The iliolumbar ligament is prone to tearing or damage because of how often it is used and where it is located. Spinal support is a significant function of this structure.
The ligament is surrounded by other soft tissue prone to injury too, and it is often overlooked as the source of lower back pain or decreased mobility.
However, iliolumbar ligament injections can benefit patients who suffer from chronic lower back pain.
The anatomy of the iliolumbar ligament
A connective tissue that binds bones together is called a ligament. Structures are held together and made sturdy by the ligaments.
Three ligaments connect the pelvis to the spine, the iliolumbar, sacrospinous, and sacrotuberous ligaments, with the iliolumbar being the most important.
This tendon has two ends, one on each side of the iliac bony crest, and they come from the lower back's vertebrae 4 and 5.
The iliac crest is located at the top of the pelvic bone and allows for practically all spinal motions, including twisting and bending,
Due to its angular attachment, it is vulnerable to damage. The nerve tissue present has a high degree of considerable pain perception and may hurt more than the imaging suggests.
Iliolumbar ligament pain and inflammation are critical symptoms of iliac crest pain syndrome (ILPS). Below we will explore some of the other symptoms that may point you towards receiving iliolumbar ligament injections.
The symptoms vary from one injury to another, and sometimes the injury can be mistaken for lower back soreness.
Lower back pain
Joint and muscle pain in the immediate surroundings
Tenderness or pain
People who spend a lot of time sitting or standing may experience a dull discomfort or searing sensation. It may be a long-term condition or a symptom of a specific movement.
If the initial injury is overlooked, it may lead to more serious conditions involving the 14 and l5 vertebrae. The areas become prone to degenerative processes that could lead to disc tearing, a herniated disc, or lower back root compression.
The symptoms may include motor problems or burning pain in the back of the legs.
What Causes Damage to the Iliolumbar Ligament?
There are several reasons for iliolumbar damage, resulting in a patient needing iliolumbar ligament injections.
Due to direct trauma, soft tissue injuries could happen where the ligament is pulled at the iliac insertion site. The ligament may be pinched or damaged if forced into an abnormal posture.
The various ways this could happen are by playing sports that involve a lot of twisting, such as tennis or golf, accidents, or heavy lifting.
Continuous ligament use by physically active people like athletes or workers relying on their physical strength can lead to faster deterioration of the ligament than other people.
Soft tissue deteriorates over time, which may cause inflammation and decreased support in the area. The decreased support leads to reduced mobility of the bones connected by the ligament.
4. Physical abnormalities
An abnormally placed bone or growing bone can cause ligament injury as it may dig into it. This could also happen if the ligament were formed unnaturally during growth.
Spinal deformation during growth could alter the tension on the ligament, increasing the likelihood of an injury.
The iliolumbar ligament exists deep under the epidermis, muscles of the erector spinae, and subcutaneous tissue. To closely detect the source of your discomfort, the doctor may perform several tests.
A physical exam
A doctor may use palpation or test the patient's mobility to observe the patient's response.
On palpation, the patient lies prone on their stomach with a slight hip joint extension. Finally, the transverse process of the L5 vertebra, which connects to the bone of the iliac bone, is subjected to pressure.
Mobility is tested through simple tasks such as walking, sitting, or rotating the hip joint through specific movements.
This form of imaging allows the doctor to see the structure of the connective tissue and identify where the injury could be and the extent of its damage.
The bone abnormalities that may be contributing to the injury are seen through x-ray imaging.
This identifies whether the connected members, like the spine and the pelvic bone, have any defects that may have caused the injury.
This method is not used for iliolumbar ligament tears because the x-rays go through the tissue, and only the bones can be seen.
Interacting with the lateral lumbar ligament, the ligamenta Flava, the interspinous and supraspinous ligaments, and the iliolumbar tendon support the spine. These ligaments maintain the core's strength and stability.
When these ligaments are damaged, the iliolumbar ligament may be strained. Therefore, a complete examination of the hip, groin, and lower back is required.
The doctor will suggest an appropriate treatment strategy in light of the diagnosis results. You need to know how serious the situation is and if it has escalated.
Ligament tears can heal over time as long as the patient reduces stress and strain on the particular area.
The doctor may suggest the patient sees a physiotherapist or advise on specific exercises that can help strengthen the muscles surrounding the iliolumbar ligament.
The muscles offer direct support to the back as the ligament heals, reducing strain on the ligament.
This is a final resort to a failed treatment plan, and it involves surgical procedures such as spinal fusion.
4. Iliolumbar ligament injection
Injecting the ligament with ultrasound guidance, treatment for iliolumbar ligament syndrome may be achieved.
It is possible to do this through:
The posterior (end) iliac crest is injected with a combination of local anesthetic and steroids to relieve pain. The anesthetic provides brief pain relief during the injection, while the steroids provide pain relief between 2 and 6 days following the injection.
Sometimes just a local anesthetic is administered as a diagnostic procedure. In this case, it is done to identify and isolate the root cause.
This kind of care offers ligament injury therapy that is less intrusive and uses the body's natural healing mechanisms. Aside from pain reduction, it focuses on repairing the ligament and preventing future degeneration.
As a person ages, the number of regenerative cells reduces, making it harder to recover from injuries. The regenerative cells can transform into other cell types such as nerves, cartilage, or muscle and rebuild the damaged areas.
A sample of the patient's blood and bone marrow is taken, and the regenerative cells are harvested to create a high-concentration injection. The injection is administered to the damaged area of the iliolumbar ligament using effective imaging to guide the injection accurately.
As an outpatient procedure, it will take a few hours, after which the patient can go home. The treatment effects take a while since it is biological, and the pain relief over time may begin after 3 to 4 weeks.
Stem cell injections
Stem cells may be derived from several organs and tissues in the body, including the bone marrow, fat cells, and red blood cells. They are processed and then reintroduced into the body through an injection.
The specific site of the damage is determined using MRI or ultrasound technology because the cells "call" other cells with healing abilities, injuries such as ligament tears may mend more quickly without the need for further assistance.
Platelet-rich plasma (PRP) injection
A blood sample is collected from the patient and spun in a centrifuge to separate blood constituents. After that, a concentrated platelet-rich plasma is collected and injected into the injured region to promote healing.
Platelets contain proteins and growth factors that speed up the healing process. Imaging is used to pinpoint the location of the damage and guide the injection.
Complications after receiving Iliolumbar ligament injections
Complications during the injection are pretty uncommon, especially if the injection is done using the precision needle placement method. Most severe effects are transitory and may be tolerated by the patient in most cases.
Even though major consequences are possible, they are quite infrequent.
Patient discomfort or pain during the treatment is possible regardless of whether they are under anesthetic. A nervous patient may be sedated before receiving the injection.
The most common side effects after treatment include the usual side effects of administered medicine, like
Cold therapy, such as using an ice pack, may control swelling or pain in the injection. It reduces blood flow to the region and nerve activity.
They are possible after the injection but are rare. This condition might be internal or external, and the patient must remain in the hospital for about one hour for careful observation.
Damage to the arteries around the ligament, like the branches of the iliolumbar artery, may cause internal bleeding around the area.
Bleeding at the injection site may occur, especially if the patient previously took blood-thinning medication, which makes blood clotting a bit difficult.
Infections may arise at the injection site or inside the body. It may be caused by germs on the patient's skin.
The injection area should be thoroughly cleaned before the injection, and the instruments used are sterile.
There are nerve trunks surrounding the ligament, so injury by the needle may lead to major consequences. It may go undetected because local anesthesia is used.
The patient may have nerve damage but may not know it. The nerve damage can be attended to if it is discovered early enough.
It may cause numbness or loss of feeling. The patient is also held for about an hour after the procedure to determine whether nerves are damaged.
Soft tissue abscess
This is the buildup of pus in the soft tissue surrounding the injection site. It is often caused by bacteria, leading to an infection.
Dr. Ordmond takes all the necessary precautions and follows strict guidelines to ensure that these complications don't happen!
What you can do at home
You could do some post-treatment exercises at home with the physician's advice.
Walking may seem out of the question, but it is efficient. It has a low inflammatory effect, with pain-free movement being sensitive at the start but getting better progressively.
Yoga exercises aimed to increase the mobility of the low back may be done about two weeks after the injection, with the physician's advice. This is because some stretches require a specific range of motion that can be found on assessment of the injury, which may lead to straining of the ligament.
With the motion assessment over time, you may address the mobility deficits using some of these exercises:
Knee to chest
Lower back rotation
The pain during the stretches should reduce, and the mobility should increase as you continue. This shows the success of the treatment.
Would you like to know more about iliolumbar ligament injection?
We urge you to contact Atlas Pain Specialists if you reside in the Phoenix region and have questions about Iliolumbar Ligament Injection.
We will carefully review your injuries and medical records to identify the best course of action for relieving your pain. Make a same-day appointment now!
About Dr. Ormond
Dr. Sean Ormond is dual board-certified in Anesthesiology and Interventional Pain Management. He completed his anesthesia residency at Case Western University in Cleveland, Ohio where he served as Chief Resident, followed by an interventional pain management fellowship at Rush University in Chicago, IL. Following fellowship, Dr. Ormond moved to Phoenix and has been practicing in the Valley for a few years before deciding to start his own practice.