By Chris Faubel, M.D.
ICD 10 code: M46.06 (lumbar spine enthesopathy)
Cause
- Soft tissue injury to the iliac insertion of the ligament.
- Can be from direct trauma, a fall in which the ligament is pulled at that iliac crest insertion site, or a lifting injury
Location of the ligament
- Located typically 1-inch cephalad and 1-inch lateral from the ipsilateral posterior superior iliac spine (PSIS)
Presentation
- Usually chronic or recurring, unilateral low back pain with a tender point at the posterior iliac crest
- The patient points to the most painful spot, which is lateral to the more midline facets.
- Worse with prolonged sitting or standing
Physical Exam
- Said to be frequently painful with the FABERs/Patrick test, though I have not seen this.
- Tender point(s) along the posterior iliac crest — must cause concordant low back pain when pressed, otherwise it is just soft tissue pain from overzealous pressure by the examiner.
- NOT painful with facet loading (as facetogenic pain would be)
Treatment
- Acute cases may resolve with relative rest, ice, and analgesics.
- Friction massage along the ligament may also be tried (see video link here)
- Chronic cases frequently need injections of local anesthetic (and sometimes steroid) along that posterior iliac crest. (INJECTION TECHNIQUE HERE)
Great information on this website. It really explain what the procedures are for treating different pains of the body.