Wednesday, June 18, 2014

Wisdom Wednesday: Ilio-Transverse Ligaments

The last six steps in the QA protocol involve assessment and treatment of the spine and extremities. This is the cornerstone of chiropractic care and most of you are familiar with spinal and extremity manipulation. However, the evaluation and treatment sequence of QA are what revolutionized my musculoskeletal practice.

Virtually every chiropractor has a core of patients with chronic low back problems. We treat these patients monthly, weekly, or sometimes even daily. In most cases, we are able to provide some measure of temporary relief. The patients are pleased because their pain has been reduced, but they are always vulnerable, seemingly going from one episode of back pain to the next.

My practice had that core. It was the most dissatisfying aspect of my job. All of that changed with QA. As soon as I learned how to reset the neurological patterns that drive most low back pain cases, my chronic patients began to stabilize. With their vulnerability resolved, activities of daily living – arising from bed, walking, sitting, bending and lifting no longer stimulated episodic low back pain.

The key is a pair of ligaments that attach the transverse processes of the L5 vertebra to the inner crest of the ileum bilaterally. Forty years ago, when I was a student, we were taught that the ilio-lumbar ligaments were comprised of proprioceptive fibers. That is, they sense position, and send that information to the brain. So if you are swinging a golf club, those ligaments tell your brain how the pelvis is rotating. However, we now know that only half of the fibers of the ilio-lumbar ligament are proprioceptors. The remainder are nociceptors – they elicit pain.

When stimulated, the ilio-lumbar ligaments send pain signals to the brain that result in low back spasm, restricted range of motion, and, of course, a sense of back pain. This is a protective reflex designed to prevent low back injury. However, when stimulated repeatedly, these ligaments fire spontaneously creating ongoing chronic low back pain and instability.

In my clinical experience, this neurological pattern of pain stimulation is the key factor in almost all cases of chronic low back pain.

Thirty-eight years ago, during my first year in practice, I quickly learned that if I could elicit pain on palpation of the ilio-lumbar ligament, that patient was not stable. Even if they were pain free at the time of examination, they would soon be back with another episode. Unfortunately, I just didn’t know how to correct the problem.

Four years ago, when I began to test and treat the ilio-lumbar ligaments, 95% of my chronic low back patients stabilized within 3-4 visits and no longer required constant care. The remaining 5% are victims of FBSS (failed back surgery syndrome) or have significant neuropathy that limits healing.

When patients have acute low back pain, these ligaments are typically firing constantly. However, in more chronic cases, the ligaments often fire only when the patient is seated as sitting increases weight bearing on the low back ten fold. In the worst case scenario, I can reboot this reflex with the patient lying on their stomach and it will fire again as soon as they sit up. Unless rebooted again while seated, the reflex will continue to fire and create low back instability. This is the patient that “never holds an adjustment” and returns repeatedly for treatment. However, when treated over the course of 3-4 visits, the threshold continues to rise, the ligaments fire less and less often, and eventually the low back stabilizes.

Clinically, I find little or no correlation between the degree of disc damage (herniation, protrusion, prolapse, or rupture) and the response to treatment. As noted previously, nerve damage and previous low back surgery are the significant limiting factors.

If you suffer from chronic low back pain, please seek the help of a qualified QA practitioner. You can visit to find a physician in your area.