Lower back pain is the second greatest cause of disability in western countries and therefore large amounts of health resources devoted to this problem.
Lower back pain can be split up into “specific lower back pain” and “non-specific lower back pain”. Making up 8-15% of lower back pain cases, specific lower back pain patients have an identified patho-anatomical diagnosis, ie. A cause for their pain that can be shown from an x-ray or scan.something that is a recognized specific cause of back pain. This includes spondylosisthesis, fracture, etc. The remaining 85-92% majority of cases are “non-specific” which includes lower back muscle strains, disc injuries, facet injuries, etc.
Without thorough discussion and education, to their horror, people often report they have been told that their spine is unstable, have instability, have hypermobility, or have slippage. This potentially can raise concern about the function of their back, the future of their back, the possibility of nerve injury, among other things. There are differences in these terms and these terms have been criticized for their use because they may in itself alarm the person who is given the diagnosis.
ANATOMY
The lumbar spine exists of five moveble vertebrae, called by L1 to L5. These strong vertebrae are linked by multiple bony elements connected by joints capsules, flexible ligaments/tendons, large muscles, and high sensitive nerves. The lumbar spine is intended to be very strong, so it can protect the sensitive spinal cord and spinal nerve roots. But, it’s also highly flexible for mobility of the back (flexion, extension, side bending and rotation). Flexion and extension the main motion directions.
Each level of your spine functions as a three-joint complex. There are two facet joints in the back and a large disc that acts as a joint in front. This tripod creates great stability, supports the weight above each level and provides support for movement in all directions.
THE MANY KINDS OF INSTABILITY
Spondylolisthesis is the diagnosis where the term “slippage” is mostly used. This is where there is a shift forward of one lumbar vertebra in relation to the vertebra below. Research has shown that spondylolisthesis usually occurs before adolescence and is a spinal variation rather than a spinal disorder. Only some cases of spondylolisthesis may develop pain at some stage in a persons like or may not develop pain or symptoms at all. If you’re given a diagnosis of spondylosithesis, it’s important to consult with your physiotherapist to get a clear explanation and discuss a management plan if needed.
Hypermobility is the term used to describe people who have global joint flexibility unusually more than normal. There are some cases where people who have hypermobility can develop symptoms such as pain and stiffness in the joints and muscles, clicking joints, joints that sublux, fatigue, digestive problems, dizziness, fainting, fragile skin. For those who develop such symptoms this is
called hypermobility syndrome. Hypermobility is often hereditary (runs in the family). One of the main causes is thought to be an alteration in the genetic blue print for the body’s production of collagen. Collagen is found throughout the body and forms the structure for most tissues (skin, ligaments, joints). People with hypermobility syndrome often benefit from a combination of controlled exercise and physiotherapy to maximize function and minimize pain.
Clinical Instability Pattern is the term used to describe a person who has non-specific lower back pain which is non-threatening and has features of a decreased ability to control micro-movements of the joints. Micro-movements can be likened to the periodic little shifting one does on their seat when sitting on an office chair. People with a clinical instability pattern have a lumbar spine that is inherently strong and robust but due to the decrease of micro-movement control they report difficulty maintaining prolonged postures, painful arc of movement, catching sensations, and difficulty lifting loads. Usually, this kind of back pain can be managed successfully with the physiotherapist. Treatment could include manual therapy, education, and exercise technique.