Lumbar instability is loss of structural integrity between two adjacent vertebrae, resulting in increased movement between those segments. It is also known as segmental instability.
This loss of the normal pattern of spinal movement, cause pain and neuronal compression. Lumbar instability usually causes limitations in many cases. It is a degenerative pathology that can appear from an early age, although it is more common in adults.
Patients with lumbar instability are usually patients with chronic pain in that area, which gradually increases.
The primary forms of degenerative lumbar instability are: the spondylolisthesis and the scoliosis degenerative.
Its early detection can significantly help patients. In this article we will introduce you to the types, most frequent symptoms, Causes, diagnosis and treatments that can help improve lumbar instability.
Index
Types of lumbar instability
Lumbar instability can be classified mainly into two types: functional instability (clinic) and structural instability (radiographic). Although it is also possible to have both, in this case we would be in the presence of a combined instability.
Functional instability (clinic)
Functional instability is the loss of neuromotor ability, that controls segmental movement. This causes pain despite the absence of radiological abnormalities.
Structural instability (radiographic)
Structural instability is the alteration of passive stabilizers, limiting the excessive range of motion of the segmental end.
Symptoms of lumbar instability
Uno de los principales síntomas de la inestabilidad lumbar es un “arco doloroso” en la flexión. Se lo conoce como la “espalda de caña rota” ya que la espalda se siente rígida. Usually occurs while standing and during a forward bend, in this case the patient feels pain. In addition to this they can be presented:
- Engagement in a moving segment during changes of position of the lumbar area
- Segmental changes
- Vertebra movement, with feeling of pain in flexion or deflection
- Excessive intersegmental movement
- Local pain in the lower back, during position changes
- Loss of postural control
- Abnormal sensation of movement in the lower back
- Presence of painful arc
- Disruption in contraction patterns, balance and reflexes
- Gowers signs
Causes of lumbar instability
Lumbar instability is most often caused by spondylolisthesis. Spasticity or severe lumbar strain can also cause elements of lumbar instability.. What's more, It can also be generated by degenerative pathology that increases over the years.
Other major causes include repetitive stress and trauma., spondylosis, facet joint syndrome, osteoporosis, sciatica, Rheumatoid arthritis, degenerative disc disease, among others.
Lumbar instability diagnosis
The diagnosis of lumbar instability is made through images, where abnormal spinal movement is observed. Lumbar instability is mainly multidirectional, but the resulting displacement is evaluated in a plane.
Sagittal and coronal displacements are evaluated with radiographs, displacements in the axial plane are assessed with computed tomography (TC) or resonance. In a good diagnosis of lumbar instability, several tests intervene, between them we have:
- X-ray imaging (neutral radiography, functional radiography)
- Physical exam: range of motion and palpation (stork test)
- Magnetic resonance
- Intraoperative measurement system
- Computed tomography
- Quantitative stability index
Treatments
Treatments for lumbar instability will be determined by the degree of severity of the pathology. These can range from rehab exercises to surgery., according to the case.
Medical treatment and surgery are most often recommended in cases of chronic instability.. When there is no direct risk, the first medical treatment should be physical therapy.
Another part of medical treatment is medication. Depending on the patient's complaints and the physiological indication, pain relievers may be prescribed, anti-inflammatories and muscle relaxants.
Rehabilitation exercises and physical therapy
Physical therapy for lumbar instability focuses on exercises designed to improve the stability of the spine.. They are based especially on the strengthening of the lumbar muscles.
It has also been proposed that the abdominal muscles, particularly the transverse abdomen and oblique abdominals, play an important role in stabilizing the spine.
Rehabilitation exercises to stabilize the mobile segments are an essential part of the treatment. Manual therapy can significantly help the patient's quality of life, in cases of minor lumbar instability. Among the most important we have:
- Acupuncture
- Hydrotherapy
- Massages
- Ice and rest
- Proprioceptive training
- Electrotherapy
Surgery
There are different methods to perform spinal segment fusion, as they are: anterior approximation, combined approach, Instrumented Fusion and Non-Instrumented Fusion.
The operation should be reserved for patients with severe symptoms and radiographic evidence of excessive movement., those with more than 5 translation mm or 10 Rotation, that do not respond to nonsurgical treatment.
Exercises to improve lumbar instability
There are different exercises that can help improve lumbar instability. These strengthen the back muscles and provide balance. Here we will describe you 3 examples that you can practice in the comfort of your home.
Lumbar bridge
Lying on your back on a flat surface, arms stretched down and knees bent. In this initial position, you begin by lifting your pelvis as much as possible., and then return to the starting position.
Do several repetitions for a minute.
Cat pose
Get on all fours with your palms and knees on the floor.. The spine must be completely straight in its initial position. Begin by lifting your chin and arch your spine inward., hold that position 5 seconds. Next, bring your chin to your chest and arch your spine out through 5 seconds.
Makes 5 repetitions of each.
Lateral back stretch
Lying on your back, we bend our legs bringing our knees to our chest and stretch our arms to the sides. We rotate the legs to the right side and the head to the left, then we rotate the legs to the left side and the head to the right. You must maintain both positions for 20 seconds.
Makes 5 repetitions of each.