Chiropractors commonly associate chronic recurring lower back pain with an underlying laxity, weakness or instability with the spinal and pelvic ligaments.

Understanding how ligaments work, why they are important and what role they play in low back pain is important for patients’ healing and recovery.

What are ligaments?

Ligaments are dense, fibrous cable-like tissues made up of a protein substance: collagen. Collagen makes up between a third and a quarter of the body’s protein. Aside from ligament tissue it is found in cartilage, tendons, bone and skin.

Ligaments, like tendons are known as connective tissues. Ligaments specifically surround joints connecting bones together to provide crucial stability and support. They are found within all peripheral (e.g. knees, ankles) and spinal joints.

Ligaments are flexible. They allow joints to stretch within their normal ranges of movement. Their intrinsic design enables joints to be put under ‘normal’ levels of mechanical stress, stretching to a natural limit. Once the mechanical stress removed, healthy, uninjured ligaments will return to their normal length.

What can go wrong?

Sudden, major traumatic stress/injuries (e.g. whiplash, a bad fall, twisted ankle) or repetitive micro injuries cause ligaments to stretch beyond their natural range. This ‘over-stretching’ causes multiple micro tears or “fraying” to the ligament fibres.

The immediate reaction to such injury is usually inflammation (the body’s normal healing mechanism) which causes localised or referred pain, swelling, warmth to the area and restricted joint movement.

The inflammatory process basically involves your body attempting to create and lay down new collagen tissue. During this process new threads tissue form and attach themselves to the already damaged fibres. It is thought that the scar tissue developed to further enhance ligament function is “biologically and biomechanically inferior to the tissue it replaces” (Frank 2004).

Efficient healing is dependant on many factors including the extent of injury, diet, age and genetic make up. Ligament tissue, unlike muscle, does not receive a large blood supply which it needs to replenish and heal. Generally, this means the healing time in comparison is much slower.

Poor or inadequate healing may cause chronic inflammation and pain. The resulting damage to the ligament is often termed as ‘ligament laxity’ because the ligament has not returned to its ideal length and strength causing it to be weaker. This can potentially lead on to repetitive injury.

Clinically, this can present as lower back problems that respond well to treatment but have a tendency to recur suddenly with or without a specific preceding trigger.

Movement of the involved joint will often be hypermobile and painful. The surrounding tissues frequently create “protective actions”: muscle tissue contracting and going into spasm in an attempt to pull the joint into its ideal position or stabilize it to protect it from further damage.

What can help?

• Hands on cross-friction techniques to re-promote tissue healing and break down scar tissue
• Chiropractic technique (non-manipulative) to promote joint cohesion
• Orthopaedic supports to provide stability
• Core stability training for rehabilitation and strength

Supplements

There is no one miracle supplement that will improve ligament healing and function. However, a combination of supplements that help maintain joint health, alleviate pain and reduce inflammation may help.

Some examples are:

	Herbs such as turmeric and ginger often used in cooking both have benefits towards joint health for their anti-inflammatory benefits. Enhance your diet - eat more curry! Curcumin is the active constituent in Turmeric. Not only is it responsible for the yellow colour but is it thought to combat the active components in the inflammatory process.
	Natural plant anthrocyanidins are another useful herb, found particularly in dark skinned fruits such as bilberries. Studies have found that the active components can “help reinforce and preserve collagen in the body” (Lamberts).
	Cherries. Anthocyanins, powerful antioxidants found in deep red cherries. Studies have shown an anti-inflammatory ability comparable to ibuprofen.

Specific supplements taken will be different for each individual injury and history. Please seek advice if you are thinking of taking or would like information on supplements that may be of benefit to you.

A combination of methods will usually help restore joints and ligaments to an optimum state.

This information is provided as guidance; each individual patient and injury is different thus the chosen technique and outcome will always vary.

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