- Richard R. Fay, DC
Ligament Laxity and Spinal Stability
What is Ligament Laxity?
Ligaments have this incredible quality. They don't just break or snap, they stretch, they hyper-stretch. And when they hyper-stretch they cause laxity. For example, if you were to take the ring from a six pack and stretch it, it wouldn't break, but would deform. And in that deformation, you could never put the can back into it and you would not have a totally 100% functional ring.
Ligaments hold bones in alignment under movement. And when they are damaged, they can no longer hold the bones of the joint in alignment under movement. So we have what's called hyper mobility or excessive joint motion. And if we have excessive joint motion, we know it's due to the laxity in the ligament.
If the spinal motion unit angulates more than seven degrees greater than the next vertebral body angulation, we consider that to be hyper mobility in an angular pattern. The joints that are holding that unit together and prevent it from angulating are now lax. That is known as ligament laxity.You can have ligament laxity and not have it cause anybody any issues whatsoever.
Ligament laxity is benign as a condition. It just means that the ligament has somehow been damaged. It doesn't tell you how much damage it is. You could have ligament laxity that is severe, causing the vertebral bodies to move to the point where it causes cord compression or serious nerve compression.We don't know how much damage there is, so the term ligament laxity, doesn't tell you a lot. It doesn't tell you how lax the ligament is.
Today, as doctors, we know that ligament laxity is not symptomatic. When ligament laxity becomes symptomatic, the clinical term is spinal instability. The spinal motion units are held together by ligaments and when those ligaments become damaged and there's laxity in the ligaments. There is now excessive motion in the joint, and that causes a motor sensory or a pain problem. If a nerve is influenced negatively, it is called a spinal instability and it can cause the following:
weakness in the muscles
hypersensitivity in an area
pain associated in that area
Spinal instability by definition is excessive motion to the spine. The spine is designed to actually move in very specific, very minute movement patterns that all combine together. It’s both very complex, but very simple at the same time. The thing that holds all these spinal components, all these bones and joints in the right location for that movement pattern are the ligaments. When the ligaments are damaged, there's excessive motion. It’s that excessive motion allows the spine to now move in a way that it was not designed to move, which can irritate the nerve, which can cause pain and inflammation.
It Takes More Than Just an X-Ray or MRI
It's not something that you pick up on x-ray or on MRI alone. It's an entity that you pick up when you detect evidence of excessive motion. The best test for excessive motion is the flexion-extension x-ray. This is a stress radiology and a very accurate measurement of what are called translation and angular patterns.A board certified medical radiologist uses an advanced X-Ray measurement technology to accurately measure the exact abnormal intersegmental motion patterns that are associated with ligament laxity.
Dr. Fay can then easily correlate with the examination findings and determine the level and the severity of any spinal ligament injury and any spinal instability that has been left behind and now causing the patient a great deal of trouble. This of course leads to more accurate injury analysis and diagnosis so more responsive treatment can be promoted.
Once You Have a Spinal Instability, How Do You Get Rid of It?
The ligaments have already been damaged. There's already excessive motion. So, are you going to treat the excessive motion and make that go away? No, that's generally permanent. But the motor, sensory, or pain problems are not permanent. They can be transient based on the care. So, the care is gauged at rehabilitating the function of the nerve to not cause pain, not lose power or force as in a motor deficit, or to regain its ability to sense. A spinal instability is no longer a spinal instability when the patient becomes asymptomatic.
At DuPage Health and Physical Therapy Center ,we know that spinal instability is the number one cause of chronic pain and has often been the thing that is most undiagnosed in chronic pain patients. The proper diagnosis is extremely important. If the condition is not diagnosed correctly the chances of getting help are very slim.
Here at DuPage Health and Physical Therapy Center, we will provide conservative care to reduce symptoms, maintain joint mobility and improve quality of life.