Have you ever felt like you moved too fast for your spine to catch up? Or that any quick movements will cause a sharp sensation in your back? It could very well likely be from a lumbar instability. Where the muscles around the spine are not able to prevent a shearing like sensation. And it can be rather painful.
Stability of the spine is built around three things:
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The passive system: vertebra, discs, ligaments, and joint capsules.
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The active spinal stabilizers: all the musculature and tendinous structures
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The neural system: neural network coordinating motor control and proprioception.
So what is it? It is a excessive lumbar vertebrae translation and rotation in the sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP).
What Causes this?
When all systems are working properly, the bony structure isn’t compromised from degeneration, trauma, arthritis or fracture, the muscles work in sync to maintain vertebral position, allow movement and control.
When structural integrity is decreased due to OA, trauma, fracture, disc herniation, or cancers, the ability for biomechanical balance is diminished greatly.
Degenerative Cascade (Most Common):
- Phase 1: Dysfunction. Early disc degeneration leads to tears and ligamentous strains.
- Phase 2: Instability. The intervertebral disc loses height, shifting the load to the facet joints, causing facet arthropathy, capsule laxity, and a “looser” segment.
- Phase 3: Restabilization. The body attempts to compensate by creating bone spurs (osteophytes) to tighten the segment, often leading to spinal stenosis.
- Loss of Passive Stability (the Structural integrity failure): Damage to ligaments (especially facet capsular ligaments) and facet joints allows for excessive movement.
- Active Subsystem Weakness (the muscular integrity failure): The deep stabilizer muscles, specifically the multifidus and transversus abdominis, fail to provide stiffness and control segmental movement.
- Neural Control Dysfunction: The nervous system fails to coordinate muscle activation, leading to delayed muscle firing during movement.
How can you learn if you have this issue?
A major point of findings here is that the spine can be painful to move if there is poor spinal stability. The tests themselves show a difference in pain when braced verses not braced.
The tests to rule in or rule out Clinical Lumbar Instability: great predictor if 2-3 tests are positive.
- Apprehension sign
- Instability Catch
- Painful catch
- Prone instability
Additional tests that come to mind to help show odd patterns of movement and or breathing patterns.
- Janda Breath test
- Functional Capacity Evaluation of low back
So how is this treated?
Where treatment from a chiropractor isn’t just an adjustment. The condition of lumbar instability needs stability training and not more mobility. The objective with an adjustment is to restore normal movement to a joint segment(s). We are in a different territory here. Where the condition needs duct tape, not WD-40. Where some treatments are for a tension line, or chronic poor quality tissue, this is more about reteaching the muscles how to be strong. Both through the nervous system and the muscular stability system.
Where changes to the passive system are slow we have to apply energies toward the muscular and neurological system.
This is one of the times where a joint manipulation is less likely to happen. Again we use joint manipulation as the WD-40 for the joints. A Lumbar Instability is the time we apply exercise therapies to help build up or bolster the lumbar spine muscles. Exercises are taught to help strengthen the spine from unwanted shifting both front and back and side to side.
Rehab: Phase 1
Phase 2
If a person is willing to manage their exercises on their own that is fine, but it is 8 weeks of 2-3x/week for stability exercises before full expected results.
Building up strength in the three planes of motion is beyond helpful than just addressing the sagittal plane. We want to make sure that there is strength surrounding the spine. So sagittal, frontal and transverse need to be addressed.
Who gets this? Occurs in 13-33%of all low back pain. Where back pain in general is the most common musculoskeletal problem, within it, potentially ⅓ of people with low back pain is caused from some form of a disability.
Luckily this condition tells us quickly whether we should be adjusting for movement, or training stability.
If you are experiencing low back pain and you can not figure it out on your own then come in for an assessment. We know what we are looking for.
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