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

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