The Effects of Sacralized L5 and Injection and Strength Training on Low Back Pain, Balance Performance, and Low-Back Fitness

Bertolotti (1917) first described unilateral or bilateral enlargement of the transverse process of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium. The clinical significance of a transitional vertebra has been frequently described. Its incidences in general population vary greatly, ranged from 4-24%, but were reported higher in back pain population, ranging from 16-30%. The incidences of a transitional vertebra were reported higher in patients with low back pain than in normal population. To date, there is no agreement as to how to treat these patients. For the entire upright human body, the center of mass (COM) lies just anterior to the second sacral vertebra. We assume that the COM performance be affected in the presence of LSTV, in which biomechanical alteration has been proposed between the most caudal lumbar vertebra and the sacrum or ilium articulated or fused. As a result, it is hypothesized that balance performance of patients with LSTV be altered accordingly. Balance performance may be measured as functional assessment in patients with LSTV. Hypermobility at the interspace above the transitional vertebra resulted in an increased risk of subsequent disc degeneration, suggesting the biomechanical strength of the IL ligament at the level immediately above the transitional vertebra. The IL ligament at the level immediately above the transitional vertebra was thinner and weaker than it was in cadavers without a LSTV. It is vulnerable to be sprained in terms of structural and biomechanical alterations and may be the target of treatment in low back pain patients with LSTV. In the crowbar model of the spine, the flexed spine (slouching) was compared with a crowbar which uses the IL ligaments as fulcrum and pivot. Subsequent malfunction of the fulcrum of the IL ligament may result in altered flexibility of spine, particularly in the degree of lumbosacral flexion. Slouching results in dorsal widening of the L5S1 intervertebral disc and strain on the IL ligament when protection from back muscle against lumbar flexion is absent. The IL ligaments are loaded in slouching. A significant increase of IL elongation was shown with simulated rectus abdominis muscle force. Adding erector spinae or multifidus muscle tension eased the IL ligaments. This loading mode may be prevented by controlling loss of lumbar lordosis with erector spinae and mutifidus muscle force. Intervention (local injection or ice massage to IL ligament) and strengthening of these low back extensors may compensate the function of the IL ligament, reducing IL ligament related low back pain, improving lumbar flexibility and finally enhancing balance performance of patients with LSTV. Purposes 1. To investigate balance performances, isometric strength and flexibility between control subjects and patients with LSTV. 2. To investigate the intervention effects of IL ligament sprain on pain control, balance performances, isometric strength and flexibility of patients with LSTV. 3. To investigate low back extensor strengthening effects on pain control, balance performances, isometric strength and flexibility of patients with LSTV.

Project ID:PC10107-0353
External Project ID:NSC101-2314-B182A-125