What is ligament laxity?
Ligament laxity is a big key word, things that Doctors of Chiropractic are now looking at. Everybody thinks with ligament laxity.
Ligament laxity is just that. It’s where the ligament goes lax. Ligaments have this incredible quality. They don’t just break or snap, they stretch, they hyper-stretch. And when they hyper-stretch they cause laxity. For example, if you were to take the ring from a six pack and stretch it, it wouldn’t break, but would deform. And in that deformation, you could never put the can back into it and you would not have a totally 100% functional ring.
Ligaments hold bones in alignment under movement. And when they are damaged, they can no longer hold the bones of the joint in alignment under movement. So, we have what’s called hyper mobility or excessive joint motion. And if we have excessive joint motion, we know it’s due to the laxity in the ligament.
We have body conditions that cause all joints to be lax. They are very specific conditions and are rare. When we are talking about spinal ligament injuries and ligament laxity, we’re not talking about disease states or hereditary conditions. We’re talking about specific joints being damaged, the ligaments being damaged, and showing excessive motion.
Ligament laxity is benign. Ligament laxity occurs any time a spinal motion unit (two vertebra) move more than a millimeter in motion. If they slide back and forth more than a millimeter, we consider that to be a laxed ligament.
If the spinal motion unit angulates more than seven degrees greater than the next vertebral body angulation, we consider that to be hyper mobility in an angular pattern. The joints that are holding that unit together and prevent it from angulating are now lax. That is known as ligament laxity.
You can have ligament laxity and not have it cause anybody any issues whatsoever. Ligament laxity is benign as a condition. It just means that the ligament has somehow been damaged. It doesn’t tell you how much damage it is. You could have ligament laxity that is severe, causing the vertebral bodies to move to the point where it causes cord compression or serious nerve compression.
We don’t know how much damage there is, so the term ligament laxity, doesn’t tell you a lot. It doesn’t tell you how lax the ligament is.
Today, as doctors, we know that ligament laxity is not symptomatic. When ligament laxity becomes symptomatic, the clinical term is spinal instability. The spinal motion units are held together by ligaments and when those ligaments become damaged and there’s laxity in the ligaments. There is now excessive motion in the joint, and that causes a motor sensory or a pain problem. If a nerve is influenced negatively, it is called a spinal instability and it can cause the following:
- motor conditions
- weakness in the muscles
- sensory conditions
- hypersensitivity in an area
- pain associated in that area
Spinal stability says that ligament laxity has caused a clinical scenario and the providers that are doing spinal instability evaluations have taken that laxity off of an x-ray and said, “Great, that laxity is causing excessive motion, which is causing a motor sensory or pain problem at this level. It has now become a clinical entity called a spinal instability.”
How is ligament laxity shown?
It’s picked up in Stress Radiology. In injury work, stress radiology should be performed outside of the treating provider’s office. In other words, the treating providers should not do an excessive motion test on his own patient’s spine.
Why? Well, the simple answer to that is because the provider is biased, and the provider is looked upon in the market as bias. Ligament laxity that causes spinal instability measured on x-rays can cause the patient to have findings that are allowed within the presurgical authorization guidelines. With many insurers in the U.S., this can cause or trigger findings that are significant enough that allows the surgeon to get preauthorized based on the spinal fusion surgery guidelines to do spinal fusion surgery.
Now, would an insurer look at a spinal fusion surgeon that was doing his own ligament testing and always coming up with results that were allowing him to do spinal fusion surgeries? Anyone will look at that and say, that’s very suspect.
These findings of ligament laxity that lead to spinal instability and can lead to impairments of the spine and allow preauthorization for surgical fusions to occur. They can lead to a lot of different things, but they ultimately lead to the accurate diagnosis of the patient’s condition and then the treatment thereof.
These findings, such as disc herniation or excessive motion findings, should be done independent of the treating provider. That treating provider had ought to find the best place possible in order to get that testing done and then rely on that testing and know that that testing was done in an unbiased, independent manner so it can be relied upon. You are certainly not going to attack the provider and say, “Well, the provider’s bias. Provider didn’t do their study. The providers actually tried to over escalate the condition itself because they’re trying to get enriched.” None of those things can occur, which oftentimes they do in the injury market.
As I previously stated, ligament laxity is a benign thing. It just says that there is laxity in the ligament. It doesn’t mean that it’s clinically causing anything else unless the provider understands how to take ligament laxity and use the clinical findings, motor testing, sensory testing, and pain correlation findings to correlate it and to say that they now have an active spinal instability.
For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.
For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com
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