Hi,
Ok so you’re probably going to be told the standard stuff when it comes to this. IE: You need to stretch, fix your posture, change your Deadlift form, get an MRI scan because there’s absolutely no Orthopedic test on earth that can tell you what you’ve hurt, and a whole slew of other completely irrelevant untrue stuff that is parroted on these forums. If you’re unlucky someone might start talking about the pain neuromatrix theory soon.
Here’s the low down. The lower back just like every other joint in the body, is held together by ligaments. The muscles of the lower back are attached to the bones by the tendons. The muscles are attached to eachother by way of the fascia. Most people who give you the advise in the previous paragraph most likely do not know anything about spinal anatomy. In fact if you’re in the UK chances are your GP won’t know either, although he will know where to google it.
You’re not in front of me so I can’t perform any orthopedic tests to see what you may have sprained, strained, or herniated, fractured (in the case of spondylolisthesis etc). MRI’s should only be used to A. confirm what your physician already knows, and B. because you’re going to have surgery. If you’re not going to have surgery then it is sort of irrelevant because the treatment options remain the same.
At any rate let me just give you a quick anatomy low down, before you go through the pain and torment that is the NHS. Bear in mind no surgeon will ever accept that the lower back can suffer strains and sprains because this is not something that they know how to or will operate. No surgeries exist for this yet, if they ever will. Unlike the knee where ACL autografts are common, if you avulse your Iliolumbar ligaments from the enthesis there’s nothing they can do for you.
The anatomy. The “lower back” consists of the five lumbar vertebrae. These are L1 to L5. These connect and articulate with the Ilium, and the Sacrum. The Sacrum articulates with the Coccyx.
The ligaments of the spine that are of particular relevance when it comes to injury are the Supraspinous and the interspinous ligaments, the facet capsules, and the intertransverse ligaments to a lesser extent. The supraspinous ligaments attach the superior and inferior spinous processess the interspinous ligaments lie deep to the supraspinous ligaments.
Moving down towards the sacrum and ilium you have the iliolumbar ligaments which run over the inner lip of the ilium and attach onto the transverse processess of L4 and L5. Further down you have the short posterior sacroiliac ligaments, deep to them you have the interossesus sacroiliac ligaments. Once you reach the posterior superior iliac spine you have the long posterior sacroiliac ligaments which attach onto the inferior lateral sacrum just above the superior lateral coccyx.
Without going further into the ligament side of injury, because there’s a lot more I could write, I’ll just write about the tendons real quick. You have the erector spinae, which is also refered to as the sacrospinalis. These are three muscle groups which run down the length of the spine.
The tendons of the longissimus dorsi and the iliocostalis lumborum attach onto both the illium and the sacrum as well as the spinous processess of the lumbar vertebrae. The multifidis runs lateraly onto the spinous processess and onto the sacrum. Then you have the glute maximus medius minimus, these originate from the ilium.
That write up is pretty sloppy but that is a boat load of structures to consider, any of which can become chronically injured, although tendons are secondary generally speaking.
The discs of the spine are ligamentous in nature. The annulus of the disc is ligament based. Also a herniation can be classed as three types, buldge, protrusion and extrusion. Buldges and protrusions are common and actually many asymptomatic people have them, with no pain or dysfunction. Consider this, to create a herniation in an animal during studies they destroy the interspinous ligaments and let the animal walk around, later on herniations appear. This should tell you something about your own anatomy.
Anyway maybe that’s a lot to take in, there are a lot of posts on here about lower back injuries and what to do. It’s very individual based and I’m certain most people here just don’t have a clue about these things, with neither the experience or knowledge to help. I can’t PM yet but as you’re in the UK drop me a PM or email or something I can send you a list of Dr’s who I’d recommend as being able to actually diagnose and work to fix the issue, although I don’t want to go into treatment options here.
Good luck with whatever you choose to do.
