I went to my family physician last week for a problem I am having with almost constant low back pain that has been slowly worsening for several months. I have not injured myself recently and I believe I am in otherwise excellent health. She said that I have lumbar instability, and she recommended that I lose some weight and go see a chiropractor to protect my back not allowing further problems developing.
Do you have any idea what this lumbar instability is, and what a chiropractor might do to help me with this problem?
Thank you for any information or insight you can offer.
The term “spinal instability” is a rather general term used to describe abnormal or excessive movement between two spinal bones (vertebrae), and this movement is often associated with variable lower back pain depending on degree of movement and the location of sensitive nerve structures in relation to the abnormal movement when it occurs. When the term “lumbar instability” is used it is made more specific by indicating that the problem is in the lower or lumbar part of the spine near the waistline. Even so, the term does not really indicate what is causing this excessive or abnormal spinal bone movement.
Martha, think of your problem as something like when your car has a rattle because something is loose. In the car the loose part would rub against other parts and cause damage to the general area, as well as making a lot of noise. In the body the spinal bones are not holding together as firmly as they should and this can cause wear on the tissue, as well as cause pain. This is a serious problem not only because of the lower back pain you are having now, but because of what other problems might develop over time if left untreated.
Lumbar instability usually occurs when the lower back ligaments, tendons, discs and joint capsules that support and hold together the bones of the spine are damaged. When this happens the relationship of the various spinal bones can shift out of normal alignment and cause them to not meet correctly during the common and frequent flexion or extension movement the low back goes through all day long. This unstable and abnormal spinal movement and alignment can pinch nearby nerves and result in pain in the low back and legs, and if extensive enough can sometimes even lead to leg weakness.
This instability can be detected easily by taking x-rays of the spine during the end points of forward flexion or backward extension to see if the bones hold together correctly during these extreme ranges of movement. If the doctor is especially skillful in the art of spinal palpation it is possible to feel the spine while the patient bends forward and backward, or even rotates the spine, in order to feel abnormal movement of the involved vertebrae with the fingertips as it is occurring; this is the way that most chiropractors examine the spine to see if spinal instability is present in a painful area of the spine.
Lumbar instability can also occur if there are pathological changes in the lower spine that can cause or contribute to abnormal spinal movement. For example, a lumbar spinal fracture, if left untreated could result in movement beyond the normal physiological limit of spinal motion. Excessive motion of lumbar instability can also be caused by spinal tumors, infection, advanced arthritis, disc degeneration, scoliosis or even osteoporosis that when severe can weaken the spine architecture and compromise stability. Obviously, your doctor has ruled out the possibility of outright pathology causing your loc back pain because she referred you to a chiropractor for additional care. But keep in mind that the excessive motion caused by spinal instability will eventually lead to damage or inflammation of the nearby nerve roots or worn joints due to the effects of repetitive motion. This is why you want to guard your spine from becoming further unstable or staying unstable longer than can be prevented.
You ask what the chiropractor might do to correct or prevent your spinal instability from advancing further. Unfortunately I cannot answer that question because I would need to know the exact reason your spine is unstable in the first place, in order to tell you what can be done to correct the problem. Having admitted I cannot give you a specific answer how your spine might be made more stable, I can speculate on a few general ideas that might possibly be helpful to you:
1. Provide a detailed exercise program for you to do to strengthen weak muscles and tone ligaments in the area of your instability.
2. Correct any spinal misalignment that is contributing to the excessive movement going on in your low back.
3. Use a variety of techniques within the discipline known as Applied Kinesiology to strengthen weak muscles, increase flow of lymphatic fluid out of the area of involvement, as well as tone ligaments in the area of your lumbar instability.
4. Use trigger point therapy or acupuncture if indicated to help tone muscles and related supporting soft tissue structures of the low back.
5. Dietary and exercise advice for your weight loss program that would be helpful in most any case in which lumbar instability is an issue.
Please let me know what happens when you get back from the chiropractor. I will be interested in what you learn and what steps are being taken to help your recovery. DL