Letter to the Editor concerning “A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction” (M. Panjabi)

Abstract

In his article Panjabi gives a concise overview on the current knowledge and understanding of low back and neck pain [12]. He introduces the hypothesis that chronic back pain originates from subfailure injuries of three types of spinal ligamentous structures and their embedded mechanoreceptors: namely the spinal ligaments, the disc annulus and the facet capsules. These injured tissues then send out corrupted transducer signals to the neuromuscular control unit, and as a result corrupted muscle response patterns are generated leading to adverse consequences such as higher stresses, muscle fatigue, further injuries, and inflammation.While paying less attention to the central learning processes involved in chronic back pain [5, 6,19], this model focuses mainly on the structural mechanisms of pain generation. We are appreciative about the value of the hypothesis within this structural field and are optimistic about its successful application to the understanding and treatment of many cases of back pain. While we agree with the basic hypothesis and its emphasis on the transducer (mechanosensory) function of ligamentous tissues, we suggest to refine the model in terms of an inclusion of the thoracolumbar fascia (TLF). We present evidence that the TLF is significantly involved in all three levels of the hypothesis concerning spinal ligamentous structures: the transducer function of these tissues, their structural spinal function, and their proneness for subfailure injuries.

Lower limb involvement in spinal function and low back pain

“…Contraction of the abdominal muscles will increase tension in the lumbodorsal fascia (LDF), whilst contraction of the gluteals influences tension in the ilio-tibial band. The LDF links the spine and pelvis and has been incriminated in LBP though its role remains poorly understood, mechanoreceptors have been indentified in its structure suggesting a role in motion and control [21]. In addition it is believed that the LDF assists the spine in lifting; there is no consensus on the mechanism involved [9,10,12,18,25].…”

Systematic review/Meta-analysis The relationship between low pH in intervertebral discs and low back pain: a systematic review

“…In recent years, several hypotheses have been proposed to explain the pathogenesis of low back pain and most of them focus on the dysfunction of the spinal column and its components, such as injury and clinical instability [5–7], spinal column degeneration [8], inferior facet-tip impingement on the lamina [9], and Schmorl's nodes [10] and facet joint injury [11]. Other hypotheses focus on subfailure injury of the spinal muscles and ligaments and propose that spinal ligaments, disc annulus, facet capsules and thoracolumbar fascia may cause chronic back pain due to muscle control dysfunction [12–16]. In addition, the pain adaptation and pain-spasm-pain hypotheses have been proposed [17–19].…”

New hypothesis of chronic back pain: low pH promotes nerve ingrowth into damaged intervertebral disks

“…In addition, pain adaptation and pain–spasm–pain hypotheses have been proposed, while Panjabi and Schleip et al. speculated that subfailure injuries of ligaments (spinal ligaments, discannulus facet capsules, and thoracolumbar fascia) may cause chronic back pain due to muscle control dysfunction …”