Lumbar Ligament Injury and Non-Specific Low Back Pain
Most low back pain has no identified anatomical cause, which is why it is called non-specific. Lumbar ligament injury is one proposed explanation for some of that pain, particularly after trauma, but it is a hypothesis with mechanistic support, not an established diagnosis for most patients. After a car accident, the practical question is whether a specific injury can be documented. For some patients in Charlotte it can, and for many it cannot.
What Non-Specific Means
A 2017 Lancet review describes non-specific low back pain as pain without a known pathoanatomical cause. Management guidelines call for triage to find the rare cases caused by serious disease, which need a diagnostic workup or specialist referral. The review notes that the course of low back pain is often favorable and identifies overuse of imaging, opioids, and surgery as a widespread problem (Maher, Lancet 2017).
That last point applies to my own work. Imaging every patient with back pain after a crash is not justified by the evidence. Imaging is justified when it can answer a specific question raised by the exam.
Where Ligament Injury Fits
Panjabi proposed a mechanism focused on the low back: a single trauma or repeated small injuries cause subfailure damage to spinal ligaments and the mechanoreceptors inside them. The damaged receptors send corrupted signals, muscle control changes, and the resulting abnormal loading can lead to chronic pain (Panjabi, Eur Spine J 2006). He cited the poor healing capacity of spinal ligaments as part of why the problem could persist.
The paper is a hypothesis. It explains how a ligament injury could produce pain without a visible lesion, which matches the clinical picture of non-specific pain. It has not been confirmed step by step in patients. Treating it as proof would overstate what is known.
Why Imaging Findings Are Hard to Interpret
Lumbar MRI findings are common in people without pain. In a systematic review of 3,110 asymptomatic people, disc degeneration was present in 37% of 20-year-olds and 96% of 80-year-olds, and disc bulge in 30% and 84% (Brinjikji, AJNR 2015). A degenerative finding on a post-crash MRI does not identify the pain source.
A ligament injury that allows excessive motion is one finding that can be measured against a defined standard. The AMA Guides Sixth Edition sets lumbar angular motion thresholds of more than 15 degrees at L1-L2 through L3-L4, 20 degrees at L4-L5, and 25 degrees at L5-S1, compared with adjacent levels, and a translation threshold at L5-S1 of more than 6% anterior or 9% posterior, all measured on flexion and extension X-rays. A measured value over a threshold, at a level the exam identifies as painful, moves a case from non-specific toward specific.
When Motion X-rays Add Information
I order lumbar flexion and extension X-rays when the exam localizes pain to a segment, when pain is provoked by movement at that level, and when the result would change care or documentation. I do not order them for every patient with back pain after a crash. A normal study is a useful result. It lowers the probability of a ligament injury at that level.
What Persistent Back Pain Costs
In a 2008 US insurance claims analysis, patients with chronic low back pain had average total direct medical costs of $8,386 per year, compared with $3,607 for matched controls (Gore, Spine 2012). That study did not separate pain by cause, so the figure cannot be attributed to ligament injury. It shows what is at stake when back pain becomes chronic.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What is non-specific low back pain?
Non-specific low back pain is back pain without a known pathoanatomical cause. A 2017 Lancet review notes its course is often favorable and that imaging, opioids, and surgery are overused (Maher, Lancet 2017).
Can a car accident injure the ligaments in the low back?
It can. Panjabi proposed that trauma causes subfailure injury to spinal ligaments and their mechanoreceptors, leading to altered muscle control and chronic pain (Panjabi, Eur Spine J 2006). That mechanism is a hypothesis, not a confirmed diagnosis.
How is lumbar ligament instability measured?
On lumbar flexion and extension X-rays. The AMA Guides Sixth Edition flags angular motion of more than 15 degrees at L1 through L4, 20 degrees at L4-L5, or 25 degrees at L5-S1, compared with adjacent levels.
Do I need X-rays for back pain after a car accident?
Not always. Imaging is justified when it answers a specific question from the exam. Dr. Justin Dick in Charlotte, NC orders flexion and extension X-rays when the exam localizes pain to a segment and the result would change care.
How much does chronic low back pain cost?
In a US claims analysis, patients with chronic low back pain averaged $8,386 per year in direct medical costs, compared with $3,607 for matched controls (Gore, Spine 2012).
Where can I get a low back injury evaluated after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), evaluates low back injuries at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. PMID 27745712. LinkEvidence tier: Narrative clinical review
- Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15(5):668-676. PMID 16047209. LinkEvidence tier: Hypothesis paper (mechanistic reasoning)
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PMID 25430861. LinkEvidence tier: Systematic review
- American Medical Association. Guides to the Evaluation of Permanent Impairment, Fourth, Fifth, and Sixth Editions.Evidence tier: Expert consensus (impairment rating guideline)
- Gore M, Sadosky A, Stacey BR, Tai KS, Leslie D. The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine. 2012;37(11):E668-E677. PMID 22146287. LinkEvidence tier: Retrospective claims cohort
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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