Ligamentum Flavum Hypertrophy: Safe Care Options
Ligamentum flavum hypertrophy means thickening of a ligament at the back of the spine that helps guide movement and maintain alignment. When this ligament thickens or loses flexibility, it may reduce space within the spinal canal and influence how nearby nerves respond during daily activity.
Thickening of the ligamentum flavum rarely occurs alone. It is often seen together with degenerative disc changes (worn spinal discs) and related disc conditions such as bulges, protrusions, prolapse, or extrusions, as well as facet joint enlargement. When these structures are involved at the same level, the way the spine handles load and movement may change.
Signs can include stiffness, reduced movement, or sensations that travel into the arms or legs. These may vary with posture, sitting, standing, or walking.
Understanding how discs, joints, and ligaments work together helps guide safe, non-invasive care. For those exploring ligamentum flavum hypertrophy care, including in Kuala Lumpur (KL), a structured assessment can help identify what is involved and how best to approach it.
Key Takeaways: Ligamentum Flavum Hypertrophy
- Ligamentum flavum hypertrophy refers to thickening of a spinal ligament that may reduce space around nerves
- It often develops together with disc changes such as disc bulges, herniations, or reduced disc height
- Facet joint enlargement and ligament thickening commonly occur at the same spinal level
- Signs may include stiffness, reduced movement, or sensations that travel into the arms or legs
- Symptoms may change with posture, walking, or prolonged sitting
- Imaging findings may not always reflect how the spine behaves during movement
- Non-invasive care is typically structured to address discs, joints, ligaments, and movement patterns together
- A structured assessment helps determine which structures are involved and how they interact
Ligamentum Flavum Hypertrophy & Its Role in Pinched Nerve Issues
Ligamentum flavum hypertrophy is a common contributor to spinal canal narrowing, especially in the lumbar region. As this ligament thickens, it may encroach into the spinal canal or neural foramen, reducing the space available for nerve roots to pass. When this happens, the result can be mechanical compression often referred to as a pinched nerve.
According to peer-reviewed studies, degenerative thickening of the ligamentum flavum is frequently observed in individuals with spinal stenosis and chronic nerve-related symptoms like numbness, tingling, or shooting discomfort down the legs (Zhao et al., 2019; Moon et al., 2013). These symptoms tend to worsen with prolonged standing or walking and may be relieved with sitting or leaning forward, which temporarily opens the spinal canal.
If you’re experiencing signs of nerve involvement alongside ligamentum thickening, understanding the connection between the two is key. Our non-invasive approach focuses on spinal decompression, posture correction, and physiotherapy-guided rehab strategies to reduce structural pressure and promote healthier nerve function. Learn more about Pinched Nerve causes and care options here.
What Is the Ligamentum Flavum and What Does It Do?
The ligamentum flavum is a strong, elastic band that connects the bones of the spine along the back of the spinal canal. Its main role is to help guide movement, maintain alignment, and support stability as the spine bends, extends, and returns to its resting position.
Because of its elastic nature, this ligament helps the spine move smoothly while preventing excessive motion between spinal segments. It also plays a role in maintaining space within the spinal canal where the nerves travel.
Over time, changes in movement patterns, posture, or load distribution across the spine may affect how this ligament behaves. In some cases, it may become thicker or less flexible, which can influence how the spine moves and how nearby structures respond.
These changes are most often seen in the lower back, where the spine handles higher levels of load and movement.
How Elastin Supports Ligament Flexibility
Elastin is a key structural protein that allows ligaments to stretch and return to their original shape after movement. In the spine, elastin plays an important role in maintaining flexibility while helping control how each segment moves.
The ligamentum flavum contains a high concentration of elastin. This gives it the ability to support bending and extension while helping the spine return to a neutral position. It also contributes to maintaining space within the spinal canal during movement.
Over time, changes in posture, movement patterns, or load distribution may influence how this ligament behaves. When the balance between elastin and other structural components shifts, the ligament may become less flexible and more prone to thickening.
Because the ligamentum flavum works closely with discs and joints, these changes are often seen alongside other structural variations within the same spinal segment.
Common Signs When Ligamentum Flavum Is Involved
Changes in the ligamentum flavum often develop alongside disc and joint changes. Because these structures work closely together, the signs may overlap with those seen in facet joint conditions.
A commonly observed pattern includes:
- Stiffness after sitting: Getting up after prolonged sitting may feel slow or restricted, especially during the first few steps
- A slightly bent or guarded posture initially: Some individuals may feel temporarily hunched or unable to fully straighten before movement improves
- Improvement with continued movement: Walking for a short distance may help the spine feel more mobile and less restricted
- Reduced tolerance for standing or walking in some cases: Symptoms may increase with longer periods of upright activity, depending on the level involved
- Nerve-related sensations when space is reduced: Tingling, numbness, or weakness may occur in the arms or legs when nearby nerves are affected
Because ligamentum flavum changes are often seen together with disc changes, some individuals may also notice symptoms influenced by pressure changes, such as increased discomfort with coughing or sneezing.
These patterns can vary depending on the spinal level involved and how discs, joints, and ligaments are functioning together.
What Commonly Leads to Ligamentum Flavum Thickening
Ligamentum flavum thickening usually develops over time as the spine adapts to changes in movement, posture, and load distribution. These changes often occur gradually rather than from a single event.
Common contributing factors include:
- Changes in spinal discs: Reduced disc height or structural changes may alter how load is shared across the spine
- Repeated mechanical stress: Frequent bending, lifting, or prolonged sitting can increase strain on spinal ligaments
- Posture-related loading: Long periods in fixed positions may affect how stress is distributed across spinal structures
- Age-related changes in connective tissue: Ligaments may become less elastic over time, influencing flexibility and movement
- Movement patterns and daily habits: The way the body moves during routine activities can influence how ligaments respond over time
Ligament changes are often seen together with disc changes and facet joint changes. When these occur together, they may influence how the spine moves and how space is maintained around nearby nerves.
Spinal Decompression and Advanced Care Solutions
CSC follows structured spinal decompression protocols designed to improve spinal alignment and function. Our approach integrates:
- Chiropractic and Physiotherapy Techniques
- Customized Movement Plans
- Spinal Decompression Methods
By incorporating these strategies, CSC aims to enhance spinal mobility and overall well-being.
How Daily Activities and Repetitive Strain May Influence Ligament Changes
Ligamentum flavum thickening is often influenced by how the spine is used over time. Repetitive loading, posture habits, and movement patterns can gradually affect how discs, joints, and ligaments respond.
In some individuals, these changes may be linked to:
- Repeated loading of the spine: Activities that involve frequent bending, lifting, or spinal compression may influence how stress is distributed across spinal structures
- Periods of prolonged sitting after activity: Sitting for extended periods, especially after physical exertion, may increase stiffness when standing or walking
- Posture-related strain: Slouched or sustained positions can alter how load is shared between discs, joints, and ligaments
- Recurring spinal discomfort over time: Episodes of neck or lower back issues that come and go may reflect ongoing changes within spinal structures
Over time, these patterns may contribute to changes in disc height, joint loading, and ligament behavior. Because these structures are interconnected, repeated stress in one area may influence others at the same spinal level.
Early Evaluation and Non-Invasive Solutions
Seeking an early evaluation for spinal changes may help address concerns before they progress. Chiropractic care and physiotherapy provide non-invasive strategies to support mobility, alignment, and spinal flexibility.
At Chiropractic Specialty Center® (CSC), our collaborative approach combines advanced spinal care methods to promote long-term spinal health. Our structured programs focus on safe, effective techniques that support movement, posture, and spinal alignment.
Why Ligament Thickness Measurements Can Vary
Ligamentum flavum thickness is often assessed using imaging, with general reference values used to guide interpretation. For example, measurements in the lower back are commonly considered increased when they exceed typical ranges reported in clinical literature .
However, these values are not absolute and may vary between individuals.
Several factors can influence how ligament thickness should be interpreted:
- Body size and build: Individuals with larger frames may naturally have thicker supporting structures, while smaller individuals may have thinner ligaments
- Ethnic and population differences: Reference values are often based on specific populations and may not fully reflect variation across different groups
- Segment-to-segment comparison: Comparing one spinal level to adjacent levels may provide additional context when assessing whether a ligament is relatively thickened
Because of these variations, a measurement that falls within a “normal” range may still be significant depending on the individual and how other spinal structures are functioning.
Why Symptoms May Not Always Match Imaging Findings
Ligamentum flavum changes seen on imaging do not always reflect how the spine behaves during daily activity. Most imaging is performed while lying down, which may not fully show how structures respond under load.
In standing or walking positions, changes within the spine may become more pronounced. When disc height reduces, the space between spinal segments may decrease further during movement. This can allow the ligament to fold or “buckle” inward.
This effect may:
- reduce space within the spinal canal
- increase pressure on nearby nerves
- become more noticeable during standing or walking
Because of this, individuals with moderate imaging findings may experience symptoms similar to those with more advanced structural changes.
Understanding how the spine responds under different conditions helps explain why symptoms and imaging findings do not always match.
Common Spinal Segments Affected by Ligamentum Flavum Thickening
Changes in the ligamentum flavum are most frequently observed in regions that experience greater weight-bearing responsibilities and movement demands.
In the Lumbar Spine, the Most Affected Segments Include:
In the Cervical Spine, the Most Affected Segments Include:
Among these, C5-C6 is highly mobile and often associated with additional structural changes, such as variations in spinal disc composition or joint movement patterns. Interestingly, the upper neck (Occiput-Atlas, C1-C2 and the C2-C3) or the C3-C4 0r the middle neck is not as often impacted segment.
Considering Non-Surgical Care for Chronic Spinal Concerns
For individuals with ongoing spinal challenges, non-invasive methods may provide a sustainable alternative to more aggressive interventions.
Points to Consider Regarding Certain Procedures:
- Some approaches may increase scar tissue formation in spinal structures.
- Targeted interventions that support spinal alignment may provide a more structured recovery approach.
- Long-term spinal stability benefits from a focus on movement, posture, and flexibility.
At Chiropractic Specialty Center®, we emphasize a patient-centered approach to spinal care, integrating chiropractic methods, physiotherapy strategies, and movement-based solutions. Contact us today to explore non-invasive methods designed to support spinal function and mobility.
How Non-Invasive Care Is Structured for Ligament Changes
A structured plan may include:
- Gentle spinal joint mobilization or adjustment: Focused, non-rotatory methods (Activator) are used to improve segmental movement and reduce stress on joints without forceful twisting
- Hands-on physiotherapy: Targeted soft tissue methods are applied carefully to address muscle and fascia changes, while avoiding aggressive stretching when disc or joint involvement is present
- Condition-specific rehabilitation exercises: Movements are tailored based on the individual’s spinal condition, level of symptoms, and overall function, especially when space around nerves is reduced
- Therapeutic modalities: Options such as shockwave, ultrasound, or high-intensity laser may be used to reach deeper tissues. Positioning techniques, including side-lying with slight spinal flexion, may be applied to improve access to targeted areas
- Spinal decompression and flexion-distraction methods: Gentle decompression approaches may be considered to reduce loading across spinal segments and support movement
- Postural and movement guidance: Daily habits are adjusted to improve how the spine handles load during sitting, standing, and activity
Care is typically adjusted over time based on how the spine responds to movement and daily demands.
When Non-Surgical and Procedural Options Are Considered
Ligamentum flavum changes are often part of a broader spinal pattern that may include disc changes, joint enlargement, or reduced space around nerves. Because of this, different approaches may be discussed depending on how symptoms present and progress.
Non-invasive approaches are commonly considered first, especially when symptoms are influenced by posture, movement, or how the spine handles load during daily activity.
Procedural options may be discussed in certain situations, particularly when:
- symptoms persist or progress over time
- nerve-related changes affect movement or function
- imaging shows multiple structures contributing to reduced space
- daily activities become increasingly limited
Decisions are typically based on how the spine functions as a whole rather than focusing on a single structure alone.
Lifestyle Tips for Spinal and Ligament Health
Maintaining spinal health requires a combination of healthy movement habits and postural awareness. Implementing the following strategies can help support long-term spinal flexibility and function:
- Maintain Proper Posture: Sitting and standing with a neutral spine reduces strain on ligaments.
- Incorporate Gentle Movement: Engaging in low-impact activities such as walking or swimming promotes flexibility.
- Practice Safe Lifting Techniques: Lifting with the legs rather than the back minimizes spinal stress.
- Support Spinal Alignment During Sleep: Using a supportive mattress and proper pillow positioning helps maintain spinal balance.
- Hydration and Nutrition: Staying hydrated and consuming nutrient-rich foods supports tissue health and flexibility.
- Manage Daily Activities Mindfully: Avoid prolonged sitting or repetitive movements that may contribute to structural stress.
Chiropractors and physiotherapists can provide additional guidance on movement patterns and postural improvements. By making conscious lifestyle adjustments, individuals can support spinal ligament health and overall mobility.
Ligamentum Flavum Hypertrophy: What to Understand
Ligamentum flavum hypertrophy involves thickening of a key spinal ligament that may reduce space within the spinal canal and influence how nearby nerves respond. These changes rarely occur alone and are commonly seen together with disc changes and facet joint enlargement at the same spinal level.
Because multiple structures are involved, symptoms can vary and may change with posture, movement, or daily activity. Imaging findings may not always reflect how the spine behaves under load, which helps explain why symptom severity can differ between individuals.
A structured, non-invasive approach that considers discs, joints, ligaments, and movement patterns together is often used to guide care decisions and support spinal function.
Author: Yama Zafer, D.C. – Ligamentum Flavum Hypertrophy: Non-Invasive KL Care
Yama Zafer, D.C., with an educational background in physiotherapy and chiropractic, graduated from Cleveland Chiropractic University in Kansas City and has spent nearly three decades in physiotherapy and chiropractic—read more about Y. Zafer on his official bio page.
Peer-Reviewed Medical Citations for Ligamentum Flavum
- Kalichman L, et al. “Ligamentum flavum hypertrophy in lumbar spinal stenosis.” Spine J. 2009;9(4):326–331.
- Park JB, et al. “Histologic changes of ligamentum flavum in degenerative lumbar stenosis.” Spine. 2005;30(1):68–73.
- Sairyo K, et al. “Pathomechanism of ligamentum flavum hypertrophy: role of inflammation.” Spine. 2005;30(23):2689–2694.
- Ahn SS, et al. “Comparison of surgical and non-surgical care for lumbar spinal stenosis.” J Bone Joint Surg Am. 2013;95(3):195–204.
- Genevay S, Atlas SJ. “Lumbar spinal stenosis.” BMJ. 2010;343:d6436.
- Chou R, et al. “Diagnosis and care of low back pain.” Ann Intern Med. 2007;147(7):478–491.
- Issack PS, et al. “Degenerative lumbar spinal stenosis: a review.” HSS J. 2012;8(2):103–112.
Ligamentum Flavor Post Was Lat Updated on April 19, 2026
Page last updated on Thursday, April 19,, 2026, with the H1 title: “Ligamentum Flavum Hypertrophy: Safe Care Options.”
Ligamentum Flavum Hypertrophy: Common Questions Answered
The questions below address common concerns about ligamentum flavum hypertrophy, including how it develops, how it relates to disc and joint changes, and what to consider when exploring non-invasive care options.
What is ligamentum flavum hypertrophy in simple terms?
It refers to thickening of a spinal ligament that helps guide movement. When it thickens, it may reduce space around nerves.
Is ligamentum flavum hypertrophy the same as spinal stenosis?
Not exactly. It is one of the contributors to spinal canal narrowing, which is known as spinal stenosis.
Does ligamentum flavum thickening always cause symptoms?
No. Some individuals may have structural changes without noticeable symptoms.
Can ligamentum flavum hypertrophy occur without disc problems?
It is often seen together with disc changes such as disc bulges, herniations, or reduced disc height.
Why do symptoms improve when bending forward or sitting?
Certain positions may temporarily increase space within the spinal canal, reducing pressure on nerves.
Can MRI miss ligamentum flavum problems?
MRI is helpful, but it is done lying down. It may not fully reflect how the spine behaves during standing or movement.
What is ligamentum flavum “buckling”?
It refers to the folding of the ligament inward when disc height reduces or spinal segments shift under load.
Why do symptoms feel worse after sitting for long periods?
Prolonged sitting can change how load is distributed in the spine, leading to stiffness when standing.
Which part of the spine is most affected?
The lower back (lumbar spine) is most commonly affected due to higher load and movement demands.
How is ligamentum flavum hypertrophy assessed?
Assessment includes history, physical examination, and imaging such as MRI or CT when needed.
What structures are usually involved together?
Ligaments, discs, and facet joints often change together at the same spinal level.
When should someone consider getting it checked?
If stiffness, reduced movement, or nerve-related symptoms persist or change over time.
Ligamentum Flavum Hypertrophy, Disc Changes & Nerve Effects Explained (2-Hour Guide Video)
In this in-depth session, Yama Zafer explains how spinal disc changes, ligamentum flavum thickening, and joint stress can influence nerve function. The video breaks down how these structures work together, why symptoms may travel into the arms or legs, and how posture, sitting, and movement patterns affect the spine over time.
This discussion is especially useful for understanding how ligamentum flavum hypertrophy may develop alongside disc bulges, herniations, and facet joint changes.
Video’s Key Moments:
- 1:33:12 Non-Invasive vs Procedural Considerations
- 00:00 Understanding Back & Nerve-Related Symptoms
- 04:06 Key Functions of the Spine & Load Handling
- 06:22 Spinal Disc Structure & Support System
- 18:30 Disc Changes & Degeneration Explained
- 28:49 Stages of Disc Bulge, Protrusion & Herniation
- 38:00 Sitting & Spinal Pressure Effects
- 45:12 Load Changes: Sitting vs Standing vs Leaning
- 51:05 Sleep & Spinal Positioning
- 57:13 Movements to Be Careful With in Disc Conditions
- 1:12:46 Nerve Involvement & Sciatic Patterns
- 1:21:40 Movement & Muscle Balance Around the Spine
- 1:33:12 Non-Invasive vs Procedural Considerations
Do you have NSD Therapy clinics in the East San Francisco Bay Area in California> I require my multi-level moderate to severe mid-Lumbar (worst at L3-4, based on MRI). Also, I have foraminal stenosis due mostly to Ligamentum Flavum, epidural lipomatous. MRI also showed facet hypertrophy and disc bulging. Symptoms include moderate achy/diffuse LBP, mild to moderate right shooting pain in the buttocks. Also suffer from leg pain, weakness, numbness, and tingling coming from L2-L3, L4-5 & L5-S1. Tinginglin is the greatest in toes (both sides). No pain with Valsalva, no claudication symptoms, no acute progressive weakness or bowel & bladder issues or incontinence, but occasional bowel urgency. Thank you1 com
Dear Dr. Marciano,
Thanks for posting on our blog. I will respond to your question through email shortly.
Hello. I have multiple degenerative disc diseases and ligamentum flavum hypertrophy. Do you have any offices in the Tampa Bay, Florida area?
Dear Margaret,
Please accept my apologies for not replying sooner. Unfortunately, at present, we are only located in Malaysia. We do not have any centers in the United States.
I am suffring from lingament flames d10 d11 on 20 years I am 56 year old present I am on wheel chair legs pain no movement. stesses right hand weakness left shoulder pain
Dear Bp Sing,
Thanks for posting a question. Hypertrophy of ligamentum flavum is a leading cause of spinal canal stenosis (shrinkage of the spinal canal). I suspect that you have a moderate to severe case of spinal canal stenosis resulting from a ligamentum flavum thickening. However, canal stenosis or ligamentum flavum hypertrophy at the D10-D11 will not cause issues in the shoulders, arms, or hands. Canal stenosis resulting from hypertrophy of Ligamentum flavum at D10-D11 can cause problems from mid-back down to your toes.
In your specific case, I suspect the issue to be related to an injury. Therefore, I encourage you to call our Bukit Damansara center at 03 2093 1000 to set up a consultation. You will need to bring all diagnostic imaging (MRI, CT & X-rays). Let us assess you and review your imaging to see if our methods of spine care can get you feeling better.
Your shoulder and arm symptoms are possibly due to a neck and upper back problem. We can assess that as well.
Hope this helped
Sir, I am suffering from degenerated disc disease involving c3-4,c4-5. I also have ligamentum flavum hypertrophy at c4-c5. What is the solution, sir, as I am in pain daily?
Thank you for posting your question. We can certainly help! Our neck and back pain treatments are through the combined efforts of our chiropractors and physiotherapists. In your case, we will also use advanced therapy devices to fix and repair as much of the damage as possible. The care we will provide can eliminate your neck pain and any pain that runs into the upper back, shoulders, or arms.
Thickening of ligamentum flavum and degenerative disc disease are two conditions that co-occur in the neck or back. They arise from repeated injuries to the spine. Surgeons recommend surgery, but they can be addressed through non-surgical methods. Our center offers the best non-surgical treatment for degenerative disc disease, slipped discs, spondylosis, neck pain, and back pain. Also, we provide advanced methods of treating hypertrophy of ligamentum flavum. I would encourage you to visit our center. Please call us on 03 2093 1000 to schedule an appointment. Please bring all your X-rays and MRIs. Let me and my team assess you.
Dear Anjanireddy,
Please forgive us for replying late. Spinal disc degenerations in the neck combined with hypertrophy of ligament flavum lead to compression of the spinal cord and nerves. These can become quite serious, as they are progressive in nature. Spinal disc disease and thickening of ligamentum flavum are difficult conditions to treat. As such, you will need focused treatments that are specialized through therapy devices, chiropractic, physiotherapy, and targeted rehabilitation. We have treated thousands of patients with similar conditions successfully. Please contact our center at 03 2093 1000 to learn about our services. We will be glad to answer your questions when you call. Also, our team members can help schedule a one-on-one consultation with one of our clinical team members.
Sir, do you have any branches in India?
Dear Chandra,
I am sorry, but as of now, we only have centers in Malaysia. Hopefully, one day we will expand to India and the Indian subcontinent.
I’m 77. I have all of the above. Do you have any office near the Lancaster, Pennsylvania, Downingtown, Pennsylvania, Reading Pennsylvania areas
Dear Ann,
Thanks for posting, but unfortunately, we do not have any offices in your area. And we wouldn’t know who to refer you to in Pennsylvania.
Do you have any centers in India where we can go for treatment?
Dear Mr. Jaykaran Singh,
Unfortunately, we don’t have any centers in India. The nearest one to you is in Kuala Lumpur, Malaysia.
I am also having the same back problem with pain shooting down my buttocks and legs. What can be done? Please advice.
Dear Mr. Ramu,
Back pain due to nerve impingement and impairments arising from a slipped disc, facet, and ligamentum flavum hypertrophy is treatable without surgery or injections. However, there aren’t many centers with adequate technology or skill sets to provide the needed conservative treatments.
In short, patients with multi-faceted issues (problems arising from two or more events in parallel) need personalized treatment plans focusing on root causes. In your instance, you will need highly specialized treatment through manual and therapy devices specialized for full recovery, and we can help. Our center is the leading non0-surgical clinic for the spine and joints; we have helped thousands recover. Give us a call today and schedule a consultation with one of our non-surgical spine specialists.
I hope this helps, do contact us on 03 2093 1000 or Whatsapp us at +(60)17 269 1873 for more information.
I had fusion surgery seven years ago for c4c5, and now I have ligament flavum thickening on c5c6 . Can you help me?
Dear America,
Patients with cervical fusions can be treated for pain and stiffness, which are common after surgery. We will not be able to provide you with the same level of care as we would for persons without fusions. Spinal fusions limit our ability to provide comprehensive care. However, we can provide treatments to help with the pain and stiffness you might be experiencing. I hope this helped.
I read your website about spine issues related to ligamentum flavum hypertrophy.
I am 31 years old; I had an accident and injured my neck (the soft tissue of my neck ). I started to have symptoms about three mounts ago. Now years after the trauma is causing severe chronic neck due to degenerative changes, including damage to my ligament flavum (hypertrophy and buckling of ligamentum flavum).
My ligamentum flavum hypertrophy involves the C3-C4 segments of my neck, causing compression of my spinal cord and nerves from the center to the left.
MY symptoms include neck pain, pins & needles, and tingling in the legs and hand. The pins & needles started last week. I am also experiencing pins & needles in my trunk, along with pain in the chest.
Moreover, my blood pressure increased with the systolic pressure ranging between 170 and 190m, but it is lower now, fluctuating between 110 and 130.
I like to find out if my condition is treatable without surgery, as I am not looking forward to neck surgery. Also, is there a way to help repair my Myelomalacia without getting surgery?
thanks
Dear Meni,
Thanks for posting your question about our neck pain treatment for soft tissue damage to spinal discs, spinal cord, and spinal soft tissues (muscles & ligaments).
Ligamentum flavum, also known as the yellow ligament, is a highly specialized soft tissue that functions as a ligament with a contractile ability like a muscle. Its’ ligament function is to connect spinal segments, while the muscular or contractile capabilities of the ligamentum flavum help assist with the extension of the spine (neck or back) when returning to an upright position from a bent or flexed posture or position.
Damage or hypertrophy of ligamentum flavum is typically seen among active gym-goers (deadlifts, free weight workouts, and intense leg press exercises), whiplash injuries as seen in sports injuries or car accidents.
Gym workout involving free weights or heavy lifting, especially with poor mechanics, is the leading cause of ligament flavum hypertrophy in the lower back. Hypertrophy of ligamentum flavum in the neck is almost always associated with a whiplash-like injury.
Whiplash is an acceleration-deceleration injury caused by hyperflexion and hyperextension of the neck. Acceleration-deceleration injury of the neck results from a forceful and sudden snapping movement of the head and neck—such injury damage the neck’s soft tissues, including the ligamentum flavum.
Thank you for submitting a link to your MRI video with your posted comment. Although our technical web team has removed the YouTube link you provided, I can assure you that I studied them carefully. Here are my findings based on the limited views I had of your cervical MRI video:
• Moderate to severe thickening of ligamentum flavum that compresses the spinal cord posteriorly on the left.
• Spinal cord compression dorsally on the left (back of the spinal cord on the left side) with signs of Myelomalacia (softening of the spinal cord).
• Retrolisthesis of C3 on C4 may have resulted from injuries to anterior and posterior spinal ligaments.
• Mild to moderate disc bulge at C3-C4
• Degenerative disc disease at multiple segments
Myelomalacia is a condition that softens and damages the spinal cord due to injury, hemorrhagic infarcts, or cervical myelopathy. In your comment, you mentioned a traumatic event that I suspect resulted from a whiplash-like injury. In such an instance, the head and neck forcefully extend and flex forward and backward, damaging the ligaments (including the spinal discs & ligamentum flavum), muscles, and spinal cord.
Discussion on your specific conditions:
The severity of damage and thickening in your ligamentum flavum on the left side of C3 and C4 leads me to believe that you suffered from a whiplash-like injury. Sudden and forceful injuries of the neck that damage the ligamentum flavum will certainly injure the spinal cord, spinal discs, spinal joints, and the remaining ligaments and muscles of the neck. Based on what I can see, there are signs of damage to all structures, most notable in the spinal cord, ligamentum flavum, and supportive soft tissues at C3-C4 spinal segments.
In addition to ligamentum flavum hypertrophy and cord softening, you have slipped vertebrae (retrolisthesis of C3-C4). Your third cervical segment (C3) appears to have slipped backward on your fourth cervical segment (C4). The backward slippage of a vertebra known as a retrolisthesis or spondylolisthesis results when the connecting ligaments are weakened due to degenerative condition or torn following an injury. The degenerative causes of retrolisthesis (spondylolisthesis) are typically seen in the elderly and, as such, may not apply to you.
X-rays of the cervical spine combined with your MRI are critical for accurately evaluating the injuries you sustained. Therefore, one of the first things you will need to do is get a comprehensive assessment of your neck’s stability with x-rays. I encourage you to get a complete cervical spine series (Davis series) to assess your cervical stability before proceeding with any form of treatment.
The Davis series consists of 7 views:
1). AP open mouth
2). AP lower cervical
3). Left oblique cervical
4). Right oblique cervical
5). Neutral lateral view of the cervical spine
6). Flexion lateral view of the cervical spine
7). Extension lateral view of the cervical spine
However, if you are not able to do a Davis series or if you are worried about the radiation exposure, I would recommend the minimum four views below:
1). AP cervical
2). Neutral lateral view of the cervical spine
3). Flexion lateral view of the cervical spine
4). Extension lateral view of the cervical spine
The most critical view needed for you are the side-views of your neck:
* Neutral lateral view of the cervical spine
* Flexion lateral view of the cervical spine
* Extension lateral view of the cervical spine
These three side-view x-rays or lateral x-rays are needed to assess the stability of your neck. More importantly, they are essential in planning your treatment.
Is it possible to get you better without neck surgery?
Yes, it is possible to get you better without surgery. However, the non-surgical treatment will need focused holistic therapies and consistency. Holistic means comprehensive; in other words, every aspect of your conditions must be identified and treated for you to get better. If you live in Malaysia, please contact our center on 03 2093 1000 to schedule an appointment with us. We will need to assess you in person thoroughly. During your consultation, we will discuss the possibility of getting your neck treated without surgery.
I hope this helped.
I learned a lot from reading your website. Thank you for the information. I receive no treatment, just drugs from Drs, and I’ve been in pain for 20 years. Is it too late for me? Thanks, Martha from California.
Dear Martha,
Thanks for posting your question and praising our published content on our blog and website pages. Hypertrophy of ligamentum flavum is a relatively common finding in patients with chronic neck and back issues. It often results from excessive loading, improper bending, injuries, or poor posture.
Unfortunately, most doctors do little for patients with thickening ligamentum flavum. Like you, many take medication to help with daily symptoms. Specialized & advanced methods of chiropractic treatment combined with physical therapy can help. The good news is that it is never too late to get the joints, ligaments, and spinal discs of the spine treated, including the ligamentum flavum. The aim of focused therapy is two folds:
1- To repair the damaged tissues as much as possible non-surgically
2- To prevent progression as thickening of ligamentum flavum is a progressive condition and a leading cause of spinal canal stenosis, foraminal stenosis, and disability in the longterm
I advise you to find a non-surgical center that offers chiropractic combined with physical therapy service (physiotherapy). The best therapeutic modalities that help include EWST Shockwave therapy, high-intensity laser therapy (HILT), and focused spinal decompression. Spinal decompression therapy should not be confused with DTS decompression as it is mainly a traction device. A better spinal decompression therapy device is the RxDecom® or comparable units. To dos & don’ts of ligamentum flavum include:
• Avoid bending and twisting activities, stretches, or therapy methods
• Avoid physiotherapy, physical therapy, and chiropractic treatments or therapy processes that incorporate twisting of the spine
• Do take breaks from sitting every 30 minutes and avoid sitting with a forward-leaning posture
• Start strengthening pelvic floor muscles with Kegel exercises, squats, and planks if your condition is stable
I hope this helped, and should you have any additional concerns or wish for more information, please WhatsApp our main center in Bukit Damansara (Kuala Lumpur, Malaysia).
Howdy, My wife has this condition primarily L3-L4 and L4-L5 and additional mild issues L1 through L-3. The orthopedic doctor prescribed McKenzie exercises, pain meds, and, if necessary, an injection and down the road surgery. I think it’s a bad idea! Proper exercise is the best approach. Is there anyone you know of in Tallahassee, Florida, she could go to?
Thanks,
Her Husband
Dear Mr. Lanier,
You are correct; surgery and injections are not the way forward. The best means of treating your wife is through focused therapies that target the L3-L4 and L4-L5 spinal discs. Also, McKenzie exercises may not be suitable as it causes the discs and ligamentum flavum to buckle more, causing more issues later. I am not aware of any clinic in Florida that can offer the same treatments that we do. But, I am confident that the great Sunshine State has many clinics that provide therapies similar to what we provide. You should start calling around integrative centers that combine chiropractic and physical therapy.
In the meantime, it would be good to have her ice her lower back for 15-minutes every two to three hours to decrease inflammation. She will also need to avoid the following:
1). No bending or twisting at the waist
2). Avoid any exercises that put her spine in a rotated position
3). Avoid sitting for longer than 45 minutes
4). Avoid sitting with a forward-leaning posture
I hope this helps.
Hi Doctor Yama,
My daughter is a chiropractic doctor in Indianapolis, Indiana, in the US. She has suggested that I contact you. I have had pain in both ankles for eight weeks. The pain worsens after walks or if I stand for 10-15 minutes.
I am a retired pain management physician. I have had Epidural steroid injections twice, but it has not helped. X-rays and MRIs have been taken. The MRI shows canal stenosis, disc bulge, facet hypertrophy, and ligamental hypertrophy. What is your advice for me?
Vinu Patel MD
Dear Dr. Patel,
Spinal disc bulges in the presence of facet and Ligamentum Flavum hypertrophy are leading causes of foraminal and central canal stenosis. The pain you are experiencing is possibly the result of compressed exiting and traversing nerves. Steroid injections may not be the best option. Therefore, you should look for integrative centers offering physical therapy with chiropractic. However, they should avoid stretching hamstrings, bending, twisting, or McKenzie exercises. I would encourage a course of non-rotatory chiropractic and physical therapy combined.
I have emailed you the therapies and treatments you need. I hope it helps
Respected sir, is collagen intake harmful to patients with ligamentum flavum hypertrophy? And if so, which supplements should we take in ligamentum flavum hypertrophy?
Dear Jai,
Collagen should not harm you, but you should get with your medical providers before you start taking any supplements. However, supplements alone are not sufficient to undo the effects of ligamentum flavum hypertrophy. To recover from aches and pains caused by ligamentum flavum hypertrophy, you will need a clinical team that targets and addresses the root causes of a thickened ligamentum flavum. A suitable treatment for patients with ligamentum flavum disorder is NSD Therapy®. NSD Therapy® service is a combination of chiropractic, physiotherapy, and rehabilitation that targets problematic segments in the spine. And in such an instance, you can start with supplements prescribed by your medical provider as an adjunct to focused treatments.
I am 38years old and have back pain with tingling and numb foot. I recently had an MRI of the Lumbar spine; below is my report; kindly assist.
The highlights of my MRI findings are as follows:
Multilevel ligamentum flavum hypertrophy and facet arthropathy. At L4-L5 level, mild central bulge causing minimal thecal sac indentation and minimal left lateral recess stenosis.
Dear Basit,
Thanks for posting a question. I suspect you have had back problems for some time, even if you had no symptoms. Back pain resulting from spinal disc bulges and herniations is treatable without surgery, even if it presents with hypertrophy of ligamentum flavum and facets (facet arthropathy).
Spinal joint arthritis (facet arthropathy) and thickening of ligamentum flavum (hypertrophy of ligamentum flavum) is all too familiar in patients with chronic back problems. When facet arthropathy, ligamentum flavum issues, and slipped discs (bulges and herniation) present together, they will cause some degree of the canal and foraminal stenosis (shrinkage in the size of the spinal canal and the openings between vertebra (lateral recesses).
Your surgeon may recommend surgery, but you should start with an effective conservative treatment program. Surgery should be considered only if conservative measures fail. Given your current situation, you require price treatments for your joints, spinal discs, and their associated soft tissue. In other words, you need therapy from centers and clinics with experience. Chiropractic Specialty Center® is one of the best places for patients similar to you, as we have the skillsets, therapy techniques, and integrative solutions, with a success rate of over 95%.
To recover, you should get treated through the combined efforts of chiropractors and physiotherapists. The best non-surgical treatment for you is the NSD Therapy® methods, an integrative back pain treatment in KL through therapy devices combined with personalized care through physiotherapy and chiropractic. If you live in Malaysia, you can WhatsApp us to book a consultation.
thank you for your attention and comment .
I can share with you my symptoms for at least 15 mounts .
problem with long walking (pain in legs after and weakness in 2 legs.
I have neck pain but in the last year it was less chronic neck pain (but before i have the problem with lower extremity i have a chronic neck pain for 6 years .
I was have a trauma to the neck , but this was crash head in the backstroke swimming (to the wall of the pool ) in 2010.
what do you think (my ossification or hypertrophy LF in my case ]
it is caused by trauma (I was accident in a swimming pool hit my head on a wall when I 20 (it is happened because the coach teach me technic swimming backstroke (don’t warning me their is no FLAG to see when the end of the pool end (for swimmer of back stroke )
of course after trauma life with degeneration increase stress on the facet joint (causes facet arthritis)
I m very be a ware from 2016 to my problem with the disc in the neck (after first MR ) .
so i use a good ergonomic lifestyle,low impact exercise, and chin tuck (but I m not accepted to get chiro manipulation because i think this will be dangerous (but get some exercise like chin tuck, and also some stretches, prevention .
but all of this not prevent from i get the LF buckling in c3-4 .
I share with you the link for 1 minute https://youtu.be/GwNqMEClqKk
(what is situation now 22 to 23 and u can also see image from 2016 .
MY MJOA score it is 16 points .
thanks
I live in the El Paso Tx or Las Cruces New Mexico area and am trying to find the specialist as noted in your articles. Can you find or recommend any centers in these areas? Thank you
Dear Patricia,
Thank you for reaching out for assistance in finding a specialist in the El Paso, TX, or Las Cruces, NM, areas. While we do not have direct affiliations with specific centers in those regions, I recommend contacting local hospitals, chiropractic clinics, or physical therapy centers or searching online for healthcare providers specializing in the treatment you require. Websites like Healthgrades or local hospital sites can provide detailed profiles and reviews of specialists in your area.
Additionally, your primary care physician can be a valuable resource for referrals to trusted specialists nearby. If you need further assistance or have other health-related questions, please don’t hesitate to contact us on our WhatsApp line at +6016-269-1870. We’re here to help!
Thank you for considering our recommendations, and we wish you the best in finding the right specialist for your needs.
Kind regards,