Ligamentum Flavum Hypertrophy: Thickening, Causes & Care Options
Ligamentum flavum hypertrophy on an MRI report usually raises two questions: does it explain the back or leg symptoms, and does it mean surgery? A thickened ligamentum flavum takes up room at the back of the spinal canal. The nerves then have less space, most of all during long periods of standing or when leaning back. The scan shows the narrowing, and the examination shows how much it affects the nerves.
Symptoms tend to build with standing or walking: aching, heaviness, numbness or tiredness in the legs that eases with sitting or bending forward. Most of the causes are mechanical: stress on the spine over the years, past injuries, posture and daily habits. A disc that loses height also lets the ligament buckle inward. Age is one factor among several.
Care starts with an examination that compares the scan with how the back moves and how far the person can walk. Gentle, non-rotatory methods come first, and surgery is the last option. Care is kept within what you can comfortably tolerate. Further down, this guide explains the causes, report terms such as "mild" and "bilateral", facet arthropathy, the care plan and when surgery is considered.
For more information about ligamentum flavum hypertrophy, contact the Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000
Ligamentum Flavum Hypertrophy: Key Takeaways
| Point | What to know |
|---|---|
| On the MRI report | Ligamentum flavum hypertrophy means the elastic ligament along the back wall of the spinal canal has thickened. Reports usually list it beside a disc bulge and facet arthropathy at the same level. |
| Is it serious? | It is serious when the narrowing affects the nerves. "Mild" describes how the scan looks, not how much it matters: numbness, weakness or trouble walking can appear before much pain. |
| Can it be reversed? | No medication, injection or method of care is shown to reverse the scar-like thickening. Care aims at the room the nerves have during daily life. |
| Does it mean surgery? | Not on its own. Surgery is considered when nerve problems keep progressing or function is badly limited, and focused conservative care, given properly, has not worked. |
| What the tissue shows | In surgical samples, thicker ligaments held more scar tissue and fewer elastic fibers, and MRI showed the ligament thicker than the tissue actually removed. |
| Normal thickness | No single figure separates a normal ligament from a thick one. A lower back CT study concluded that 4 mm should not be the dividing line. In the neck, a cut-off of 1.71 mm separated narrowed canals from normal ones most accurately. |
| Care at CSC | Flexion-distraction, spinal decompression, chiropractic manipulation that is non-rotatory using the Activator instrument, and soft-tissue work, combined with physiotherapy. Pelvic floor (Kegel) exercises start at once; other exercise waits until the body is ready, and deadlifts and free weights are avoided. |
Ligamentum Flavum Hypertrophy: Page Guide & Key Sections
- Ligamentum Flavum Hypertrophy Symptoms: What People Notice
- Arranging an Assessment for Ligamentum Flavum Thickening in KL
- What Causes Ligamentum Flavum Hypertrophy?
- Where the Ligamentum Flavum Sits and What It Does
- What Counts as Normal Ligamentum Flavum Thickness
- How Posture and Load Change the Room for the Nerves
- Facet Arthropathy & Ligamentum Flavum Thickening Together
- Ligamentum Flavum Buckling or True Thickening?
- What “Indenting the Thecal Sac” and “Mild Hypertrophy” Mean
- Ligamentum Flavum Hypertrophy Treatment Starts With Mechanics
- When Surgery Is Considered for a Thick Ligament
- Ligamentum Flavum Hypertrophy, Disc Changes & Nerve Effects: Video Talk
- Related Educational Pages
- Frequently Asked Questions on Ligamentum Flavum Hypertrophy
- How to Read This Ligamentum Flavum Guide
- References and Evidence Context
Ligamentum Flavum Hypertrophy Symptoms: What People Notice
Ligamentum flavum hypertrophy causes symptoms only when the space it takes away starts to press on the nerves. So the same finding can be silent in one person and limiting in another. In the lower back, the usual signs are:
- Aching, heaviness or tiredness in the buttocks, thighs or calves that builds with standing or walking
- Numbness or tingling in one or both legs, sometimes with weakness
- Symptoms that settle after sitting down or bending forward, and an easier walk when leaning on a shopping cart
- Back stiffness on rising from a chair that eases after a few steps
- A walking distance that shrinks over months
In my video Poor Posture Damages Your Spine, I explain that when nerves are pinched, pain increases, weakness sets in and long walks become hard. When the thickening sits in the neck, symptoms can travel down an arm instead.
In the neck, a thick ligamentum flavum can press on the spinal cord itself, which in my view makes the neck the more serious site. Pressure higher up the cord affects more of the body below it, a point from my Back Pain to Leg Pain talk. Signs include clumsy hands, an unsteady or shuffling walk, weak arms or legs, and pins and needles in the legs or feet. These need a prompt medical assessment.
In the mid-back, a thick ligament can press on the cord as well, but it leaves the shoulders, arms and hands alone. Its effects run from the mid-back down to the toes, and they need the same prompt medical assessment.
Arranging an Assessment for Ligamentum Flavum Thickening in KL
Leg symptoms from a thickened ligamentum flavum can overlap with those from a disc, a facet joint, the hip or the circulation. So the first visit compares them. It checks walking tolerance and what eases it, posture, lumbar and hip movement, leg strength, reflexes and feeling. Any MRI or X-ray is reviewed against those findings before care options are discussed. Either Kuala Lumpur center can arrange it:
- Bukit Damansara (KL, main center): Call +603 2093 1000 or WhatsApp +60 17 269 1873 to see the Bukit Damansara / KL center.
- Bandar Sri Damansara (KL): Call +603 6262 5777 or WhatsApp +60 12 455 6939 to see the Bandar Sri Damansara center.
Directions and opening hours for both centers are on CSC Locations in Kuala Lumpur.
What Causes Ligamentum Flavum Hypertrophy?
In ligamentum flavum hypertrophy, most of the thickening is scar-like tissue. A study measured 308 ligaments on MRI and examined 20 removed at surgery. Thicker ligaments held more scar tissue and fewer elastic fibers, most of all along their back surface. A computer model showed the highest stress there, and the authors concluded that the scarring comes from mechanical stress that builds up over the years.
The disc in front comes first: as I see it, lower back wear starts there, and the facet joints and their capsule follow its state. I describe the chain in my Back Pain to Leg Pain talk. A narrowed disc puts stress on the facet joints and lets the ligamentum flavum buckle into the canal. As I say there, "You have to pay attention to the mechanics, because if you don't understand the mechanics, you'll not know what to do for it."
In my view, the wear behind these changes comes mostly from daily mechanics: poor posture, long hours of sitting, bending and twisting, and free-weight lifting. Past injuries, lifestyle and genetics play a part as well. Age is a factor, but not the only one, and I have seen healthy discs in people in their 80s.
In my experience, an old compression fracture can lead to the same changes. At its level, the ligamentum flavum can thicken and buckle, beside facet hypertrophy and a degenerated disc. Care then addresses those changes and their symptoms, not the fracture itself. An acute fracture is outside my care: I encourage a visit to a spine surgeon, who may guide surgical or non-surgical care.
Where the Ligamentum Flavum Sits and What It Does
The ligamentum flavum joins the bony arch of one vertebra to the next, along the back wall of the spinal canal. It lies right behind the spinal cord and nerve roots, deep inside the canal, so it cannot be seen or felt from outside the body. Only a scan can show how thick it is.
Flavum is Latin for yellow, the color its elastin gives it, so it is also called the yellow ligament. Elastin is the protein that lets a tissue stretch and spring back. A healthy ligamentum flavum is mostly elastin: it lengthens as you bend forward and recoils as you straighten, which keeps it from folding into the canal. Once it has thickened and lost that elasticity, it folds in more easily.
In my view, the disc, the two facet joints and this ligament work as one unit at each level, so a change in one soon shows in the others. That is why a single millimeter figure on a report rarely explains the symptoms by itself.
What Counts as Normal Ligamentum Flavum Thickness
Thickness is not the same at every level of the spine, and there is no single agreed figure that separates a normal ligament from a thickened one.
In the lower back, 4 mm has often been used as the dividing line. A CT study compared 65 people with lumbar spinal stenosis and 150 people without its symptoms. It found the ligament thicker at L3-L4 and L4-L5 in the stenosis group, and thicker on the right side than the left. Its authors concluded that the borderline between a normal and an abnormal ligament should not be set at 4 mm.
In the neck, an MRI study measured the ligament at the C6-C7 level. It averaged about 1.4 mm in 87 people without canal narrowing and about 2.1 mm in 88 people with central narrowing. A cut-off of 1.71 mm separated the two groups most accurately.
These figures describe groups of people, not fixed rules. Actual values vary by person, age, exact level and measuring method, so a measurement on a report is read together with the examination. A plain X-ray cannot measure this ligament: in my words from Is Chiropractic Safe? 13 Questions Answered, an X-ray "only sees bones." The studies above measured it on CT and MRI.
How Posture and Load Change the Room for the Nerves
The ligamentum flavum is not rigid. Bending forward stretches it out of the canal, while leaning back or standing for long periods lets it fold inward. A thick, stiff ligament folds in further, so the canal can be tighter when you are on your feet than a lying-down MRI suggests. That posture-dependent narrowing is sometimes called dynamic stenosis, and it is one reason symptoms change with posture and walking.
Pressure inside the canal also rises for a moment when you cough, sneeze or strain, as blood fills the epidural veins around the spinal canal. With a thick ligament, there is less spare room when that happens.
A Clinical Pattern That Often Points to Ligament Involvement
One pattern raises the possibility of a significant thickening: stiffness or difficulty getting up from a chair after sitting a while, which eases after a few steps. In my experience, this pattern is common in people with a thickened ligamentum flavum. A likely reason is that moving shifts posture and load enough to give the nerves a little more room. The pattern is not diagnostic on its own, and it is weighed with the examination and the scan.
Facet Arthropathy & Ligamentum Flavum Thickening Together
Facet arthropathy means the facet joints, the paired joints behind each disc, have worn and enlarged. The ligamentum flavum lies right beside them, so a report often lists both with a disc bulge, as in the drawing above. A typical line reads "diffuse disc bulge with ligamentum flavum hypertrophy and facet arthropathy". Diffuse means the bulge spreads around a wide part of the disc's edge.
Each one takes a little room from the canal or from the openings where the nerves leave the spine. Together they can narrow the space more than any one of them alone. That is why the report's summary line, such as "moderate canal stenosis", matters more than any single finding.
The ligamentum flavum and the facet joints are physically joined. The ligament's outer part runs into the capsule around each facet joint and forms its front wall. I compare the ligament to a guardrail in my Back Pain to Leg Pain talk: it stops the joints jamming as you bend and straighten.
To judge whether a thick ligament affects the nerves, I check two things first: the spinal canal and any thickening of the facet joint's capsule. In my experience, a thick ligament often comes with facet hypertrophy, and it can worsen and buckle into the canal.
I call the changes that develop alongside a thick ligament co-conditions. A mild disc bulge on its own seldom narrows the canal. Once disc damage reaches the moderate stages, the ligament and the facet joints are often involved too.
With an extruded disc, I find the ligament thickened to a mild or moderate degree in nearly every case. A forward slip of one vertebra on the next, called spondylolisthesis, often brings a thick ligament and enlarged facet joints with it. Each one is weighed alongside the ligament when care is planned. In my experience, a damaged disc with these co-conditions is more likely to cause nerve problems that limit daily life.
Related reading: the guides to slipped disc and disc changes and to facet joint hypertrophy.
Ligamentum Flavum Buckling or True Thickening?
On an MRI report, a thick ligamentum flavum can mean two different things. The ligament may have truly grown thicker, with scar-like tissue building up over time. Or it may have folded inward, or buckled, as the disc in front of it wears and the space behind it shortens.
Think of a rubber band between two fingers. Move the fingers closer, and the band sags and bunches up without growing any bigger.
A 2024 study compared the ligament’s thickness on MRI with the real thickness of tissue removed during surgery in 70 people with spinal stenosis. The MRI made the ligament look thicker than it really was. Buckling added to that look, and buckled ligaments had less true thickening but more worn discs.
This matters because buckling depends partly on posture and on how worn the disc is. Leaning back and long periods of standing tend to fold the ligament inward, while bending forward stretches it out. That is why many people with this finding feel better sitting or leaning on a shopping cart. It is also why care at CSC leans on flexion-based methods and spinal decompression, with other exercise added once the body is ready.
What “Indenting the Thecal Sac” and “Mild Hypertrophy” Mean
Reports often pair a thick ligament with words like “mild,” “indenting the thecal sac” or “narrowing the canal.” The thecal sac is the fluid-filled tube around the nerve roots. “Indenting” means the ligament touches the back of that tube and pushes its outline in a little.
“Mild” refers to how the scan looks, not to how much the finding matters. In my experience, narrowing can affect the nerves, with leg numbness, weakness or trouble standing and walking, before much pain appears. What counts is the total space left in the canal. That depends on the ligament, the disc in front and the facet joints at the side, all together. Even so, a thicker ligament does not automatically bring pain, numbness or weakness: some people with clear thickening have few symptoms, while others with modest figures are badly limited. Shape and side matter as much as thickness, and so does the room left when you stand and walk, which a lying-down scan may not capture. Nerves also differ in how sensitive they are, and in how much daily activity asks of them. Studies that measure the canal most often describe central stenosis as a front-to-back width under 10 millimeters or an area under 70 square millimeters.
The pattern of symptoms matters as much as the numbers. When the examination and the scan agree, care focuses first on positions that open the canal. Movement and strength work follow once the body is ready, and walking distance is checked regularly to track progress.
Ligamentum Flavum Hypertrophy Treatment Starts With Mechanics
Ligamentum flavum hypertrophy is primarily a mechanical issue. The thickened tissue physically occupies space inside the spinal canal or the neural foramina.
Oral medication and epidural steroid injections are aimed at pain and inflammation around the nerves, not at the thickened tissue itself. They may ease symptoms for a period of time, but they do not remove the tissue that narrows the canal. Injections also carry risks of their own, which the doctor offering them can explain. Steroid injections and surgery are not what I recommend first, a view I give in Sciatica vs Slipped Disc: Video Explanation.
The thickening is linked to mechanical stress on the segment. So care is aimed at the mechanics: how load is shared across the segment, how it moves and the condition of the soft tissues around it.
Why Gentle, Non-Rotatory Methods Suit a Thickened Ligament
I never use sudden, forceful twisting of the spine (high-velocity rotatory manipulation) where the ligament is thickened or the canal is clearly narrowed. In my view, the disc in front of the ligament wore first, and I do not twist or crack a spine whose disc is damaged. The scarring in a thick ligament is also traced to mechanical stress over the years, so care that adds stress to the segment works against it. Gentle, non-rotatory methods are used instead.
Non-Surgical Methods That Focus on Load, Movement and Soft Tissue
After the examination, the care plan at CSC combines gentle methods such as:
- Flexion-distraction, a gentle method that flexes the lower back, the position that gives the nerves more room
- Controlled, non-rotatory spinal decompression when suitable, with lighter and shorter sessions for older patients
- Chiropractic manipulation that is non-rotatory using the Activator instrument, so the spine is never twisted
- Gentle soft-tissue work, such as trigger point and myofascial therapy, with stretching delayed until the body is ready
- Physical methods such as therapeutic ultrasound, high-intensity laser therapy, electrotherapy and shockwave therapy
- Cold therapy on the QMD cryothermal device; its heat setting is kept off the spine whenever a disc or facet joint is involved
- Balance and stability work on wobble and rocker boards and a gym ball, once the body is ready
- Pelvic floor (Kegel) exercises, which start right away rather than once the body is ready; tightening and relaxing the buttocks, and side-lying leg raises, can also come early
Care is kept within what you can comfortably tolerate. Discomfort during care means it is being done too aggressively, so tell the clinician at once. Progress is checked by repeating the first visit's tests. Without improvement by the fifth session, the plan is reviewed, and with still none by the tenth session, the next step is discussed together.
At Chiropractic Specialty Center, chiropractors and physiotherapists plan this care together after the examination. Their plan follows NSD Therapy®, the method of spine care I first created in 2006. Under it, the ligament, facet joints, disc and muscles at each level are treated as one unit, not one at a time. The main center's page is Chiropractor in Kuala Lumpur with Physiotherapy.
When nerve problems are absent or mild, activity changes, posture and, once the body is ready, carefully chosen exercise and rehabilitation come first. In my view, nothing here should be a standard procedure: each plan is shaped case by case, around the co-conditions at that level. I ask patients to keep a record of how long they can walk, and as they improve, more strenuous activity is added.
Daily Habits for a Narrowed Spinal Canal
I give the same daily advice for any damaged lower back, and it matters even more when the canal is narrowed:
- Sitting: with back pain, leave the chair every 15 to 20 minutes, standing, walking or moving about for 30 seconds to a minute. Without back pain, get up and walk around at least every 30 to 40 minutes.
- Sleep: seven to eight unbroken hours where possible, and no less than six. Side sleepers need a pillow height that keeps the spine level and a bolster between the knees; back sleepers move it under the knees.
- Lifting: best left out; where it cannot be, the load stays under 2 kg.
- Gym: discouraged at first; once stable, no deadlifts, free weights or leg presses.
- Ice: wrap the pack in cloth and set a timer for 10 to 15 minutes. Do this two or three times a day, with a gap of two hours or more, and keep hot packs off the spine.
- Stretching: no general stretching or side bending at first. As my Back Pain to Leg Pain talk shows, a sideways lean compresses the joints on that side and pinches any bulge there.
When Surgery Is Considered for a Thick Ligament
When nerve problems keep progressing or function is badly limited, and focused conservative care, given properly, has not worked, medical specialists may discuss image-guided procedures or surgical decompression. Surgery has its place, but for disc problems I say in Sciatica vs Slipped Disc: Video Explanation that it "should be the last option. Exhaust conservative route."
Focused care is what I mean by conservative care: care planned from what the scan and the examination show. It is aimed at the causes they document, takes in the whole segment and does no harm. Routine treatment is not the same, and many forms of it are useless.
In my view, decompression surgery for a narrowed canal is done for the ligament more than the bone. The surgeon removes part or all of the lamina, the bony arch at the back of the canal, and the thickened ligamentum flavum with it. The guide Spine Surgery Risks & Non-Invasive Alternatives describes these operations and their risks.
Leg weakness that keeps getting worse should not be ignored. It calls for a careful assessment by a competent provider, and conservative care can continue only while the weakness itself is improving.
When a thickened ligamentum flavum narrows the spinal canal, report any change in your symptoms. If you have back or leg pain and develop new or worsening numbness around your genitals, between your genitals and anus, or around your anus, get urgent medical attention: a thorough assessment at a hospital emergency department straight away, within hours. New difficulty passing urine, or any loss of bladder or bowel control, needs the same urgent assessment. These symptoms have several possible causes. Some may call for an invasive procedure, but assessment does not automatically mean surgery is needed.
Ligamentum Flavum Hypertrophy, Disc Changes & Nerve Effects: Video Talk
My Back Pain to Leg Pain talk, given before a live audience, lasts 1 hour 47 minutes. It follows a disc from its structure to the stages of damage, shows how a worn disc, a buckled ligament and stressed facet joints crowd the nerves, and explains why symptoms can travel into an arm or a leg. Posture, sitting and sleep are covered too, and two chapters deal with the ligamentum flavum directly.
The page Back Pain to Leg Pain Video: Disc or Sciatica? lists every chapter of this talk.
Chapters on the Ligamentum Flavum
- 51:05 Sleep Position, Disc Height and L4-L5: As a disc loses height, the nerve openings narrow, more load falls on the facet joints, and the ligamentum flavum may buckle inward. I explain that L4-L5 is where most forward bending happens.
- 57:13 Deadlifts, the Ligamentum Flavum and MRI: I advise against deadlifts and explain how a thickened or buckled ligamentum flavum narrows the room for the nerves. As I put it there, "Pain is not a yardstick. Pain is a symptom."
The chiropractic price in Kuala Lumpur and physiotherapy fees in Kuala Lumpur pages list each fee, item by item. The fee for a plan is explained and agreed before care begins.
Frequently Asked Questions on Ligamentum Flavum Hypertrophy
What does ligamentum flavum hypertrophy mean on my MRI report?
It means the radiologist saw thickening of the ligamentum flavum, the elastic ligament that lines the back wall of the spinal canal between the vertebrae. A thicker ligament leaves less room for the nerves, and reports usually describe it beside disc bulges and facet arthropathy at the same level. The finding on its own does not show how much it affects the nerves. So it is read together with the symptoms, the examination and the canal size at that level.
Is ligamentum flavum thickening serious?
It is serious when it narrows the canal enough to affect the nerves. The symptoms and the examination decide that, not the word on the report. Signs that it matters include a walking distance that keeps shrinking and numbness or weakness in a leg. With thickening in the neck, numbness or weakness can appear in an arm instead. Pressure on the spinal cord there, with clumsy hands or an unsteady walk, calls for a medical assessment without delay.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
What does bilateral ligamentum flavum hypertrophy mean?
Bilateral means both sides. The ligamentum flavum has a left and a right half at each level, and the report is saying both halves are thickened. A CT study of the lower back found the ligament thicker on the right side than the left on average. When both halves are thick, the canal can narrow from both sides at the back, and the report may also mention canal stenosis.
Why does ligamentum flavum hypertrophy show up so often at L4-L5?
In a study of 308 ligaments measured on MRI, the ligament thickened more over the years at L4-L5 and L3-L4 than at the other levels studied. Its computer model showed the highest stress on the ligament's back layer at L4-L5, about five times that on the front layer in forward bending. I make a related point in my Back Pain to Leg Pain talk: most forward bending happens at L4-L5. That, in my view, is why disc problems turn up most often there and at L5-S1.
Thickening of the ligament itself, though, is less common at L5-S1 in my experience. In the neck, I see it most from C4-C5 to C6-C7, often beside a disc bulge or spondylosis at the same levels.
Can ligamentum flavum hypertrophy be reversed?
No medication, injection or method of care is shown to reverse the scar-like part of the thickening. Part of what an MRI shows can be buckling, the ligament folding inward, which changes with posture. Leaning back folds it in, and bending forward stretches it out. Care therefore aims at the room the nerves have during daily life, through posture, movement, the disc in front and the muscles around the spine. Progress is judged by repeating the examination's tests, such as walking distance, rather than by the millimeter figure on the report.
Can collagen or other supplements undo ligamentum flavum hypertrophy?
In my view, no supplement on its own can undo a thickened ligamentum flavum. Collagen should do no harm, but a medical doctor should approve any supplement before you start it. Where a doctor prescribes one, I see it as an addition to focused care, not a replacement for it. That care works on posture, movement and the disc in front of the ligament.
Which exercises suit ligamentum flavum hypertrophy?
With ligamentum flavum hypertrophy, I start exercise only once the body is ready, usually from about the fifth to seventh session. Kegel exercises for the pelvic floor do not wait for that point, because every lower back problem calls for them. In my Neck and Back Self-Help Tips video, I ask patients to start them right away.
Next come wall-assisted squats and core canister breathing, then strength work for the glutes, hamstrings, calves and thighs as severity allows. For older patients with a narrowed canal, I add more balance and stability work and hold stretching back.
Deadlifts, free weights, leg presses and hard hamstring stretches are avoided. Yoga must be avoided with a narrowed canal or a damaged disc. Its backbends fold the ligament further into the canal, and its twists strain the disc. For the same reason, I leave out McKenzie press-ups and other exercises that arch the lower back.
Does ligamentum flavum hypertrophy cause sciatica?
Ligamentum flavum hypertrophy can add to sciatica by narrowing the space for the nerve roots, often together with a disc bulge and facet changes. In Sciatica vs Slipped Disc: Video Explanation, I describe sciatica as a symptom rather than a diagnosis. In every case I have seen, a damaged disc is involved to some degree. So the examination looks at the disc and the ligament together. Leg pain that builds with walking and eases with sitting points to a narrowed canal.
What should I do next?
Bring the full MRI report and the images to a registered practitioner who can examine you and compare the findings with your symptoms. Note how far you can walk before your legs tire and what eases it, such as sitting or leaning forward. That pattern and the examination guide the plan more than the millimeter figure does. Keep a short weekly record of the walking distance, so changes are easy to see.
How to Read This Ligamentum Flavum Guide
Views given in the first person are mine. When one draws on a video or talk of mine, its title appears beside it. The studies are summarized in the evidence table below, each under its first author and year. They describe groups of people, not one person's spine. This guide explains ligamentum flavum hypertrophy in general; it cannot read your scan, and only an examination that compares your MRI with your symptoms can judge your own.
References and Evidence Context
| What the published evidence shows | Source |
|---|---|
| Thickening of the ligamentum flavum is part of what narrows the lumbar canal in spinal stenosis. In this study it came mainly from scar-like tissue. The authors traced it to mechanical stress building up over the years, most of all along the ligament's back surface and at L4-L5. | Sairyo et al., Spine, 2005 |
| Some of the thickening seen on MRI comes from the ligament buckling inward, which went with more worn discs, not only from true tissue growth. MRI showed the ligament thicker than the tissue removed at surgery. | Yabe et al., Spine, 2024 |
| In the lower back, the ligament was thicker at L3-L4 and L4-L5 in people with stenosis, and thicker on the right side. The authors concluded that 4 mm should not be used as the dividing line between a normal and an abnormal ligament. | Abbas et al., Spine, 2010 |
| In the neck, the ligament at C6-C7 averaged about 1.4 mm in people without canal narrowing and about 2.1 mm in people with central narrowing. A cut-off of 1.71 mm separated the two groups most accurately. | Jeong et al., Medicine, 2021 |
| The measures most often used for central lumbar stenosis are a front-to-back canal diameter under 10 mm and a cross-sectional area under 70 square millimeters. | Steurer et al., BMC Musculoskelet Disord, 2011 |
| A review of seven sets of guidance found that up to two-thirds of the listed warning signs of cauda equina syndrome describe a late stage that often cannot be reversed. It recommended referral at the early stage. | Todd, Br J Neurosurg, 2017 |
1. Sairyo K, Biyani A, Goel V, et al. Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine (Phila Pa 1976). 2005;30(23):2649-2656.
2. Yabe Y, Ishikawa K, Kurosawa D, Murakami E, Aizawa T. Buckling of the Ligamentum Flavum in Patients with Lumbar Spinal Canal Stenosis. Spine (Phila Pa 1976). 2024;49(17):E284-E290.
3. Abbas J, Hamoud K, Masharawi YM, et al. Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine (Phila Pa 1976). 2010;35(12):1225-1230.
4. Jeong HW, Yi J, Lee S, et al. Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis. Medicine (Baltimore). 2021;100(34):e27084.
5. Steurer J, Roner S, Gnannt R, Hodler J; LumbSten Research Collaboration. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord. 2011;12:175.
6. Todd NV. Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage. Br J Neurosurg. 2017;31(3):336-339.
These references describe ligamentum flavum thickening, spinal stenosis and cauda equina syndrome in general. None of them evaluates care at Chiropractic Specialty Center.
The Author of Ligamentum Flavum Hypertrophy: MRI, Symptoms & Treatment
Ligamentum Flavum Hypertrophy: MRI, Symptoms & Treatment was written by Yama Zafer, D.C., who has 30+ years in chiropractic and physiotherapy and founded Chiropractic Specialty Center in Kuala Lumpur in 2006.
Last Updated: Ligamentum Flavum Hypertrophy: Thickening, Causes & Care Options
Ligamentum Flavum Hypertrophy: Thickening, Causes & Care Options was last reviewed and updated on October 16, 2026.
Dear Dr. Yama,
I have severe spine fracture at T11-12, DDD, spinal stenosis, osteoporosis and spondylolisthesis. My XR lumbar 6+ views with bending showed instability at L4-5 and L5-S1. Multilevel disc space tearing and listhesis. Degenerative changes of fact complexes. L4-5 is the worst with 6mm of anterolisthesis in flexion, 3-4 mm in extension. Retrolisthesis at L2-3, L3-4 is stable in flexion and extension.
My MRI without contrast showed L4-5 severe spinal stenosis with 70% canal narrowing, cysts in the spine, and moderate stenosis at L3-4 and L4-5, mild to moderate stenosis persists at L5-S1. Multilevel mild neural foraminal stenosis; with trace retrolisthesis of L3-L4. Grade I anterolisthesis of L4-L5, and L5-S1.
L3-L4 mild disc bulge. Mild spine stenosis. Mild bil. foraminal stenosis.
L4-L5 Grade I anterolisthesis. Disc bulge with superimposed post central disc protrusion. Advanced facet arthropathy. Severe spinal stenosis. Mild bil. foraminal stenosis.
L5-S1 Grade I anterolisthesis. Diffuse disc bulge. Advanced facet arthropathy.
Based on above information, can I stretch my piriformis muscle? What's your advice for me, please? Thank you for your time and comments!!
Please do not stretch the piriformis on your own for now. With slipping at L4-L5 and L5-S1 that moves 6 mm when you bend, a stretch that pulls on the hip and pelvis can move those segments further. In my view, sciatica-type pain is a nerve issue, not a muscle issue, and your MRI shows severe narrowing at L4-L5 that can press on the nerves to the buttock and leg.
The osteoporosis and the T11-T12 fracture come first in any plan. Your doctor should manage the bone health, and any spinal care must be gentle and non-rotatory: no cracking, twisting or forceful pressure on the spine. Stretching waits until an examination shows your body is ready, and even then it stays gentle, never aggressive.
With instability, cysts and 70 percent narrowing at L4-L5, ask a spine surgeon what is causing your symptoms and what each option would do. Surgery has its place, and severity can change the usual order in which it comes last. Avoid bending, twisting and lifting, and when sitting, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
D10 D11 ligament flavor Mota ho gaya hai isko kaise theek Karen aur kitna time lagta hai theek nahin hai physiotherapy se theek ho jaega ya operation karna padega
The thickened ligament at D10-D11 does not thin again with physiotherapy, medication or any other treatment, so there is no time frame for reversing it. What care aims at is the room the spinal cord and nerves have during daily life, and that is what physiotherapy and gentle chiropractic care work on, when the examination shows they are suitable.
At D10-D11 the canal holds the spinal cord, so the first question is whether the cord is pressed. Weakness or stiffness in the legs, unsteady walking, numbness spreading up from the legs to the trunk, or a change in bladder or bowel control are signs of cord pressure, and they call for a neurosurgeon's assessment with your MRI. In that case an operation may be needed, because severity changes the usual order of care. If none of these are present, focused conservative care can be tried first; surgery should be the last option, after that care has been given properly and has not worked.
Whatever the plan, the spine must not be cracked or twisted, heavy lifting and bending are avoided, and care is kept within what you can comfortably tolerate. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Sir
I am 36 and i am suffering
-Ligamentum Falvum hypertropy at lumbar
-central disc protrusion at L4-L5 with narrow of 4.2 mm
-mild at l3-l4 with narrowing of 9.4mm…
pls recommend me the best solution to go for as doctors recommended Surgery. I am avoiding surgery is it possible ??
Second is it chance that latter i have to prepare for l3-L4
Also give ur views on vertiflex procedure of surrgery
, I am from Agra ,India
Whether surgery can be avoided depends on how your nerves are doing, not on the millimeter figure alone. If strength, feeling, walking distance and bladder and bowel control stay stable, focused conservative care can be tried; in my view, surgery should be the last option, once that care, properly given, has not worked. If they get worse, surgery moves up.
L3-L4 at 9.4 mm is mild today. Whether it narrows further depends partly on daily mechanics: long sitting, bending, twisting and heavy lifting load the discs and the ligament, so the habits that protect L4-L5 protect L3-L4 as well.
About the procedure you mention: it places a spacer between the bony processes at the back of the spine to keep the segment from bending backward. It is an implant procedure, and whether it suits a 4.2 mm canal with a central disc protrusion is a question for your spine surgeon, together with what it is expected to improve and what happens if it does not.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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
No, there are no centers in Texas or New Mexico. All of our centers are in Malaysia, and we cannot vouch for individual practitioners there, so here is what to look for instead.
Look for a registered practitioner whose first visit is an examination, not a treatment: how your spine moves, how far you can walk, and the strength, reflexes and feeling in your legs, compared with your MRI. For a thickened ligament and disc changes, the methods should be gentle and without twisting or cracking, such as flexion-distraction and low-force adjustments, combined with physiotherapy, and care should stay within what you can comfortably tolerate.
Ask how progress will be measured. A good plan repeats the first visit's tests, reviews the approach if there is no improvement by the fifth session, and discusses the next step together if there is still none by the tenth. Exercise should start only when your body is ready, apart from Kegel exercises for the pelvic floor, which start at once, and yoga should be avoided with a damaged disc. Surgery has its place, but it should be the last option, once focused conservative care, properly given, has not worked.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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.
Hello Zafer!
Thank you for this in-depth explanation. I’m a 39 year pharmacist, mother of 1, weight 165 lb, 5’7” that has dealt this chronic lower back pain for about 5 years. I have tried physical therapy and chiropractic therapy separately without success.
I recently pulled my lower back in November of this year while transferring a load of about 20 pounds which caused severe pain that radiated down my right buttock. MRI revealed several disc bulges at L3 to L5, disc dessication from L1 to L5, bilateral facet and ligamentum hypertrophy, mild neural foraminal stenosis, and compression of L5 nerve root.
I live in the United States and currently searching for an integrated care like you recommended above. My physiatrist recommended McKenzie exercise which is a bad idea and physical Therapy.
What would you recommend in terms of daily exercises or lifestyle changes (e.g sleeping on my back or side/belly, nutrition and supplements , walking/running, elliptical/stair climbers). Also, my job requires standing 90% of the time.
I’m also considering having another baby. Would this worsen my condition?
Thank you
Chiropractic and physiotherapy tried separately may be one reason care did not hold: I recommend both combined in one plan. With the L5 root pressed after a lifting injury, that plan starts with an examination of the L5 root, the strength of the ankle and big toe and the feeling on the top of the foot, compared with the MRI.
Desiccation from L1 to L5 at 39 is not simply age. In my experience, genetics, daily living, past injury and posture all bring it on far earlier than most people expect, so daily habits matter. Sleep at least six hours, seven to eight unbroken where possible, on your side, with a pillow keeping the spine straight and a bolster between the knees, or on your back with a bolster under the knees, never on your stomach. At work, stand tall with equal weight on both feet and knees unlocked, and change position often. Lifting stays light, and running and stair climbers wait until the examination shows your body is ready.
Kegel exercises can start at once; other exercise starts with gentle steps such as core canister breathing and wall-assisted squats, never deadlifts or yoga. No supplement repairs a disc. Pregnancy adds load to the lower back, so plan it with your doctor and keep care going alongside.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
with MRI I have an hypertrophy of ligament flawvn at D5 D6 D8 D9 with legs impotence and pain. Is it a spinal stenosis
Yes. A thickened ligamentum flavum that narrows the canal is a form of spinal stenosis. At D5-D6 and D8-D9, in the mid-back, the canal holds the spinal cord itself, so narrowing there can press on the cord, and weakness and pain in the legs fit that.
This needs a prompt assessment by a neurosurgeon or spine surgeon with your MRI, including whether the report mentions any change inside the cord. Leg strength, reflexes, feeling and walking are checked, and the result decides the order of care: with cord pressure and leg weakness, a surgical opinion comes first, because severity can change the usual rule that surgery is the last option. Until then, the spine must not be cracked, twisted or pulled, and heavy lifting is avoided.
Weakness that keeps getting worse should not be ignored, and it calls for a careful assessment by a competent provider without delay. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Hi Dr Yama
Iam in Brisbane Australia,
I have same diagnosis Ligamentum Flavum
after traying osteo, physio, acupuncture, no good
Iam reluctantly booked for surgery in 10 days to remove thickened ligament
have you got clinic in Australia as I would do anything to avoid surgery
I have sent your clinic email but no response
mile
We have no clinic in Australia; all of our centers are in Malaysia. We are sorry your email was not answered.
With surgery ten days away, the most useful step is to be clear with your surgeon about why it is planned. Ask what your examination shows, especially leg strength, reflexes, feeling and walking distance, and how the MRI compares with an earlier one. If your nerves are getting worse, surgery has its place and timing matters. If they are stable and the main problem is pain, you can ask whether a further trial of gentle, focused conservative care is reasonable first; in my view, surgery should be the last option for disc and canal problems.
Conservative care for a thickened ligament does not shrink the ligament itself; it works on the room the nerves have during daily life. In my approach that means flexion-based methods, such as flexion-distraction and gentle spinal decompression, non-rotatory manipulation with the Activator instrument, physiotherapy and daily habits: with back pain, a break every 15 to 20 minutes, walking or moving for 30 seconds to a minute; at least six hours of sleep, seven to eight unbroken where possible, on your side or back; and no lifting or twisting. Whatever you decide, decide it with your surgeon rather than by cancelling at the last minute.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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.
A numb foot with tingling is a nerve sign, so the examination should find which nerve root it follows. The L5 root supplies the top of the foot and the big toe, and the S1 root the sole and the outer edge. The L5 root passes the left lateral recess at L4-L5, where your report shows the bulge and the narrowing.
Which foot is numb matters: the report describes narrowing on the left, so numbness in the left foot fits it better than the right. The strength of the ankle and toes, the ankle reflex and the feeling in the foot are compared with the MRI, and if they do not match, the levels above and below are looked at again. In my experience, a mild finding on a scan can still affect a nerve before much pain appears.
Care for a disc problem like this is gentle, without twisting or cracking the spine, kept within what you can comfortably tolerate, with flexion-distraction and gentle decompression where suitable, and exercise added only when your body is ready, apart from Kegel exercises for the pelvic floor, which start at once. While the back hurts, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute, and avoid bending, twisting and lifting.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Hi! I just had an MRI that says my Flavun thingy is thickened. Where is your nearest Center in southwest USA? Oh plz help! Thanks
Cathy T
There are no centers in the United States. All of our centers are in Malaysia.
The finding itself is easier to understand than the report makes it sound. The ligamentum flavum is an elastic ligament along the back wall of the spinal canal, and a thickened one takes up some of the room the nerves use. Whether it matters depends on whether it presses on them, and that is decided by your symptoms and an examination, not by the wording of the report. In my view, the thickening comes mostly from mechanical stress over the years, from posture, sitting, bending, twisting and heavy lifting, with a narrowed disc adding to it; age is a factor, but not the only one.
Signs to watch are legs that ache, tire or go numb with standing or walking and ease with sitting, a walking distance that shrinks, or weakness. If any of these appear, see a spine specialist with your MRI. Care, when it is needed, should be gentle, without twisting the spine, and within what you can comfortably tolerate.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Respected sir, is collagen intake harmful to patients with ligamentum flavum hypertrophy? And if so, which supplements should we take in ligamentum flavum hypertrophy?
There is no evidence that eating collagen thickens the ligamentum flavum. Collagen taken by mouth is broken down in digestion like any other protein, and the scar-like tissue in a thickened ligament is traced to mechanical stress that builds up over the years, most of all along its back surface, not to diet.
No supplement has been shown to thin the ligament either, so the effort is better spent on the mechanics: posture when sitting and standing; with back pain, a break every 15 to 20 minutes, walking or moving for 30 seconds to a minute; at least six hours of sleep, seven to eight unbroken where possible, on your side or back; no deadlifts, free weights or yoga; and no lifting in poor postures. If you take supplements for other reasons, check them with your doctor, especially alongside other medicines.
Care for the narrowing itself starts with an examination and an MRI review, then gentle methods without twisting, kept within what you can comfortably tolerate, with exercise added once the body is ready and Kegel exercises for the pelvic floor started at once. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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
Ankle pain on both sides that builds after 10 to 15 minutes of standing or walking can come from a narrowed lumbar canal, but it is not the usual pattern, which is heaviness or aching in the buttocks, thighs or calves. So the examination should test both: the strength, reflexes and feeling of the L4, L5 and S1 roots in each leg, and the ankles and feet themselves, with the circulation of the legs checked as well, since standing and walking also bring on vascular and joint pain.
Epidural injections are aimed at pain and inflammation around the nerves, not at the disc, the facet joints or the thickened ligament that narrow the canal, so two without benefit neither confirm nor rule out the canal as the source. If it is the source, care would lean on flexion-based methods, such as flexion-distraction and gentle spinal decompression, with non-rotatory manipulation and physiotherapy, kept within what you can comfortably tolerate and checked against the first visit's tests.
Note what eases the ankles: if sitting or bending forward eases them, the canal is more likely; if simply standing still eases them, other causes come first. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Sir
I am 36 and i am auffering from central disc protrusion along with ligamentum falvum hypertrophy which creating canal narrowing to 4.2 mm at L4-L5 and mild atl3-l4 with narrowing of 9.4mm… pls recommend me the best solution to go for as doctors recommend Surgery , I am from Agra … pls also suggest exercise nd precautions
A canal of 4.2 mm at L4-L5 is severe narrowing, much tighter than the 9.4 mm at L3-L4. At 36 it is worth asking your surgeon whether your canal was narrow to begin with, because that changes how much room the disc and the ligament can take before the nerves are pressed.
No treatment is the best for everyone; the choice depends on what the examination finds. If your leg strength, reflexes, feeling and bladder and bowel control are normal and stable, a fair trial of gentle, focused conservative care is reasonable, and in my view surgery should be the last option. If any of them is getting worse, the order changes and the surgical opinion comes first.
Precautions while you decide: avoid bending, twisting and lifting, and keep any load under 2 kg; no deadlifts, free weights, leg presses or yoga; while the back hurts, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute; and sleep at least six hours, seven to eight unbroken where possible, on your side with a bolster between the knees. Exercise starts only when your body is ready, under supervision, with gentle steps such as wall-assisted squats and core canister breathing; Kegel exercises for the pelvic floor can start at once.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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
We do not know a practitioner in Tallahassee to refer to, and all of our centers are in Malaysia, but good care has the same shape anywhere.
With a thickened ligament and disc changes at L3-L4 and L4-L5, I start with an examination and an MRI review, then use gentle methods without twisting: flexion-distraction, spinal decompression where suitable, non-rotatory chiropractic manipulation with the Activator instrument, and physiotherapy. Exercise is core to recovery, but only when the body is ready, usually from about the fifth to seventh session, and it starts gently, with wall-assisted squats and core canister breathing. Kegel exercises for the pelvic floor need no wait and can start at once. Exercises that bend the lower back backward again and again can fold the thickened ligament further into the canal, so ask how any program suits her narrowed canal before she starts it.
I do not recommend steroid injections or surgery as a first choice; surgery has its place, but it should be the last option, once focused conservative care, properly given, has not worked. Daily habits matter as much: a break every 15 to 20 minutes while her back hurts, walking or moving for 30 seconds to a minute; at least six hours of sleep, seven to eight unbroken where possible, on her side or back; and no lifting, deadlifts or yoga.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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
New pins and needles in the legs, a hand and a band across the trunk, with cord compression at C3-C4 and myelomalacia on the MRI, mean the spinal cord itself is affected. That needs a neurosurgeon's assessment promptly, not a wait to see how it goes. Myelomalacia means the cord tissue has been harmed by the pressure, and no treatment repairs it; the aim is to stop further harm.
For disc and ligament problems, surgery should be the last option, after focused conservative care has been given properly and has not worked, but cord compression with new symptoms is a situation where severity changes the order of care. Ask the surgeon what the latest MRI shows compared with the earlier one, and what each option is expected to do. While the cord is pressed, the neck must not be cracked, twisted or pulled, and any other care should wait for the surgeon's advice.
Chest pain needs a medical check straight away, and blood pressure readings of 170 to 190 need your doctor's review, because both can have causes outside the spine.
New clumsiness of the hands, unsteady walking, or any change in bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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.
No, it is not too late to look for the cause. Twenty years of pain with medication alone usually means the source has not been fully assessed, and an examination can still find out which structures are involved and what loads them during the day.
In my view, there is no such thing as normal back pain: pain is a symptom, and ignoring it lets a problem progress. A first visit should check how you move, stand and walk and the strength, reflexes and feeling in your legs, and compare those findings with an MRI where a disc problem is suspected. Care for a long-standing problem is gentle, without twisting the spine, kept within what you can comfortably tolerate, and builds strength only when your body is ready, though Kegel exercises for the pelvic floor can begin at once. Progress is checked against the first visit's tests, and without improvement by the fifth session the plan is reviewed.
The habits of the other 22 hours of the day matter as much as any session: posture when sitting and standing; with back pain, a break every 15 to 20 minutes, walking or moving for 30 seconds to a minute; at least six hours of sleep, seven to eight unbroken where possible, on your side or back; and no lifting in poor postures. All of our centers are in Malaysia, so look for care near you that works this way.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
I had fusion surgery seven years ago for c4c5, and now I have ligament flavum thickening on c5c6 . Can you help me?
A fusion stops movement at C4-C5, so the levels next to it, C5-C6 among them, take more of the neck's bending and turning. That extra load over the years is a common reason for changes such as a thickened ligamentum flavum to appear at the level below a fusion.
What matters first is whether the thickening presses on the spinal cord. Clumsy hands, dropping things, unsteady walking, symptoms in both arms or in the legs, or a change in bladder control call for a prompt review by your spine surgeon with a current MRI. With a fusion above and a possible cord narrowing, the neck must not be cracked, twisted or pulled.
If the cord is clear and the symptoms are neck pain, or pain down one arm, gentle care is reasonable: non-rotatory methods such as the Activator instrument, gentle soft-tissue work and physiotherapy, kept within what you can comfortably tolerate. Daily habits protect the level below the fusion: screens at eye level, the phone held up rather than the head bent down, a break every 15 to 20 minutes while the neck hurts, walking or moving for 30 seconds to a minute, and a pillow that keeps the neck level with the spine. Surgery has its place, but it should be the last option, after focused conservative care has been given properly and has not worked.
I’m 77. I have all of the above. Do you have any office near the Lancaster, Pennsylvania, Downingtown, Pennsylvania, Reading Pennsylvania areas
No, there are no offices in Pennsylvania. All of our centers are in Malaysia.
At 77, care for a narrowed canal is gentler, and I adapt it in several ways: more change to daily habits, stretching delayed, more balance and stability work, and lighter, shorter spinal decompression sessions where decompression is used. Methods are non-rotatory, so the spine is never twisted, and care is kept within what you can comfortably tolerate.
Position helps with this finding. Leaning slightly forward opens the canal, which is why walking with a shopping cart or a wheeled walker is often easier than walking unaided, and short rests before the legs tire help you keep walking. Balance matters as much as the pain at your age: loose rugs, cords and poor lighting at home are worth fixing, and any medicine that causes drowsiness is worth reviewing with your doctor.
Age alone does not decide whether surgery is right; your general health and how much your walking is limited do. Surgery has its place, but it should be the last option, once focused conservative care, properly given, has not worked.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Do you have any centers in India where we can go for treatment?
No, there are no centers in India. All of our centers are in Malaysia.
Good care for a spinal problem has the same shape wherever it is given. The first visit is an examination, not a treatment: when the symptoms began, what changes them, how the spine moves, and, where pain travels into a leg or arm, the strength, reflexes and feeling of that limb. When a disc problem is suspected, an MRI confirms it rather than guessing a final diagnosis.
The plan should use gentle methods without twisting or cracking for a damaged disc, keep care within what you can comfortably tolerate, and add exercise only when your body is ready; for a lower back problem, Kegel exercises for the pelvic floor can start at once. Progress is checked by repeating the first visit's tests: without improvement by the fifth session the plan is reviewed, and if there is still none by the tenth, the next step is discussed together. Be careful with large prepaid courses before an examination has been done.
Daily habits matter as much as the sessions: with back pain, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute; sleep at least six hours, seven to eight unbroken where possible; and avoid bending, twisting and lifting. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
I am also having the same back problem with pain shooting down my buttocks and legs. What can be done? Please advice.
Pain that shoots into the buttocks and down the legs usually comes from nerves pressed in the lower back. I describe sciatica as a symptom rather than a diagnosis, and in my experience a damaged disc is involved to some degree in every case, often together with a thickened ligament or enlarged facet joints, as on this page.
The first step is an examination: how far down each leg the pain reaches, whether it builds with walking and eases with sitting, and the strength, reflexes and feeling in both legs. An MRI is used when a disc problem is suspected. With pain in both legs, the canal itself may be narrowed, so both sides are checked.
Until then, avoid bending, twisting, lifting and any exercise that brings on pain. While the back hurts, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute. Sleep at least six hours, seven to eight unbroken where possible, on your side with a bolster between the knees, or on your back with a bolster under the knees. Care for a disc problem is gentle, without twisting and within what you can comfortably tolerate, with exercise added when your body is ready; Kegel exercises for the pelvic floor can start at once.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Sir, do you have any branches in India?
No, there are no branches in India. All of our centers are in Malaysia.
A good step where you are is to collect your MRI as images, not only the typed report, and to ask that four things are stated: the canal size in millimeters at the narrowest level, which structures narrow it (the disc, the ligamentum flavum, the facet joints or a mix of them), whether a nerve root or the spinal cord is pressed, and whether the cord shows any change inside it. Those answers shape the plan more than the choice of clinic.
When you choose care, look for an examination before any treatment, gentle methods without twisting or cracking for a damaged disc, care kept within what you can comfortably tolerate, and progress checked against the first visit's tests. If there is no improvement by the fifth session, the plan should be reviewed. Surgery has its place, but for disc problems it should be the last option, after focused conservative care, given properly, has not worked.
New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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?
In the neck, a thickened ligamentum flavum takes room from the canal that holds the spinal cord, so the first step is to find out whether the cord is affected. The signs are not neck pain. They are clumsy hands, dropping things, trouble with buttons or handwriting, unsteady walking, symptoms in both arms or in the legs, and any change in bladder control. If any of these are present, see a neurosurgeon with a current MRI before any treatment, and the neck must not be cracked, twisted or pulled.
If none are present and the pain stays in the neck, or travels down one arm, gentle care is reasonable. For damaged discs at C3-C4 and C4-C5, I use care without twisting the spine, such as chiropractic manipulation that is non-rotatory with the Activator instrument, together with physiotherapy and gentle soft-tissue work. Care is kept within what you can comfortably tolerate, and progress is checked against the first visit's tests: without improvement by the fifth session, the plan is reviewed.
Looking up for long periods narrows the canal further, so screens belong at eye level and overhead work is limited. No treatment shrinks the thickened ligament itself, so the aim is the room the nerves and the cord have during daily life. Surgery has its place, but it should be the last option, after focused conservative care has been given properly and has not worked.
Adding the daily side, since that is where most of the 24 hours are spent.
Sleep at least six hours, and seven to eight unbroken hours where possible, on your side or back, with a pillow that keeps the neck level with the rest of the spine. There is no perfect pillow: a rolled towel under the neck, or a pillow with a thin and a thick side, can work. Do not sleep on your stomach, which holds the neck turned for hours.
At a desk, raise the screen so your eyes are slightly below its top edge, hold the phone up rather than bending the head down, and, while the neck hurts, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute. Avoid long periods of looking up, and do not let anyone crack, twist or yank your neck.
Exercise for the neck and shoulder blades starts only when your body is ready, as your clinician advises. Before your next visit, note how long you can sit at a screen before the pain builds and how far it travels into the arm, so progress can be measured.
If your hands become clumsy, your walking unsteady or your bladder control changes, stop treatment and see a neurosurgeon promptly.
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
No, we have no center in California. All of our centers are in Malaysia.
With findings at several levels, the examination decides which ones explain your symptoms. Tingling in the toes on both sides, weakness and right buttock pain point to more than one nerve root, so the strength, reflexes and feeling of each root are compared with the MRI level by level. Your report also names epidural lipomatosis, extra fat around the nerve sac. It has been linked with long courses of steroid medication and with body weight, so it is worth raising with your physician.
For a canal narrowed by the ligament, the facet joints and the disc together, care at our centers leans on flexion-based methods, such as flexion-distraction and gentle spinal decompression, and on non-rotatory chiropractic manipulation with the Activator instrument. The spine is never twisted, and care is kept within what the patient can comfortably tolerate. Surgery has its place, but it is the last option, once focused conservative care, given properly, has not worked.
Weakness that keeps getting worse should not be ignored. It calls for a careful assessment by a competent provider, and conservative care can continue only while the weakness itself is improving. The occasional bowel urgency you mention should be reported to your physician. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
Hello. I have multiple degenerative disc diseases and ligamentum flavum hypertrophy. Do you have any offices in the Tampa Bay, Florida area?
No, there are no offices in Florida. All of our centers are in Malaysia.
With degenerative disc disease and a thickened ligamentum flavum together, the canal can narrow from the front and the back at once. I explain it this way: a disc that loses height puts more load on the facet joints and lets the ligament buckle into the canal. So whoever you see locally should begin with an examination that compares the MRI with how you walk, stand and move, and with the strength, reflexes and feeling in your legs.
In that care, look for gentle, non-rotatory methods for a damaged disc, with no cracking or twisting of the spine, care kept within what you can comfortably tolerate, and progress checked against the first visit's tests, with the plan reviewed if there is no improvement by the fifth session. Exercise should start only when your body is ready, apart from Kegel exercises for the pelvic floor, which can start at once, and yoga must be avoided with damaged discs. Surgery has its place, but for disc problems it should be the last option, when focused conservative care, properly given, has not worked.
Daily habits matter as much as any treatment: with back pain, stand up every 15 to 20 minutes and walk or move for 30 seconds to a minute; sleep at least six hours, seven to eight unbroken where possible, on your side with a bolster between the knees; and avoid lifting. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.
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
Loss of movement in both legs with a thickened ligament at D10-D11 means the spinal cord has been pressed at that level for a long time. That needs care from a neurosurgeon and a rehabilitation specialist, and the spine must not be cracked, twisted or pulled.
The most urgent point in your message is the weakness in your right hand. The D10-D11 level supplies the trunk and the legs, not the arms, so hand weakness and shoulder pain point to the neck. Ask for an MRI of the neck as well as the mid-back, and a neurosurgical assessment, because your arms are what you rely on now, and pressure in the neck should be looked for before more strength is lost.
A rehabilitation specialist can also help with what matters every day in a wheelchair: skin care to prevent pressure sores, bladder and bowel care, keeping the joints of the legs from stiffening, a seating check, and protecting the shoulders, which carry much more load when you push and transfer. Your left shoulder pain may come from that extra load.
Weakness that keeps getting worse should not be ignored, and it calls for a careful assessment by a competent provider without delay. New numbness around the genitals or anus, new difficulty passing urine, or loss of bladder or bowel control needs urgent medical attention at a hospital emergency department straight away, within hours.