¿Qué es el síndrome iliolumbar o dolor difuso en el deportista?

Hace unos meses, después de leer un excelente artículo, entendí mucho mejor algunos de los dolores lumbopelvicos que a menudo acuden a mi consulta. La publicación habla del rol del ligamento iliolumbar (LIL) en el dolor sacroilíaco y muestra el Sd Iliolumbar como una de sus principales causas.

El Sd Iliolumbar fue descrito por Hirschberg, en el año 1979, en la publicación “Iliolumbar syndrome as common cause of low back pain: diagnosis and prognosis”. Arch Phys Med Rehabil 1979: 60: 415-419.

En este artículo se explica el LIL como la causa primaria de muchos casos de dolor lumbar crónico con las siguientes características:

  1. Dolor espontáneo en el aspecto posterior de la cresta ilíaca.
  2. Dolor unilateral y localizado.
  3. Incrementa con una inclinación contralateral.
  4. No hay déficit neurológicos asociados

Estoy convencido que después de leer esto se te vendrán a la mente todos los pacientes que tratas habitualmente.

El ligamento iliolumbar es el componente más débil del llamado Triángulo Multífido (Ilíaco articulado con sacro, sacro articulado con L5 y L5 al ilíaco a través del LIL). Su función es dar estabilidad a la charnela lumbosacra. Tiene una gran posibilidad de lesión debido a la disposición de sus inserciones (gran estrés mecánico). Es el inhibidor primario del exceso de nutación sacra y el más débil de los tres ligamentos participantes (sacrociáticos, sacrotuberosos e iliolumbares).


Lee también:


El síndrome Iliolumbar, también conocido como síndrome de dolor de cresta ilíaca, implica una inflamación o desgarro del ligamento iliolumbar. Este ligamento se extiende desde la columna vertebral hasta la cresta ilíaca, que es la parte posterior de la pelvis. Puede conducir a dolor referido en la ingle, la pelvis, la cadera, la espalda e incluso las áreas testicular, vaginal y rectal.

La lesión del ligamento iliolumbar se produce a través de repetidas flexiones y torsiones. Los más propensos son aquellos que practican golf o voleibol. También aquellos que hayan sufrido accidentes vehiculares.

¿Cuáles son los síntomas del síndrome iliolumbar?

Los síntomas del síndrome iliolumbar incluyen ataques recurrentes de dolor lumbar agudo en el área denominada “Triángulo Multifidus”. Esto afecta directamente a los músculos erectores de la columna, la fascia lumbar, el cuadrado lumbar y los ligamentos iliolumbares.

Algunas personas se quejan de dolor sólo después de estar sentados o de pies por largo tiempo o al levantarse de la cama en la mañana. También se puede experimentar dolor en la zona de la cadera o de la ingle. El área involucrada puede ser muy sensible.

¿Cuál es el mejor tratamiento para este síndrome ?

Dado que el síndrome iliolumbar suele implicar dolor en la parte baja de la espalda, la cadera y / o la ingle o el área pélvica, el dolor suele ser reconocido como tensión muscular y se suele tratar con hielo y descanso.

Sin embargo, no es suficiente para mejorar la sintomatología de la persona. Si se realiza una buena evaluación podemos arrancar con varias hipótesis y de esta manera planificar el tratamiento fisioterapéutico ideal. Podríamos usar técnicas manuales específicas, no solo trabajamos con agentes físicos y AINES (antiinflamatorios no esteroideos)

Otra práctica habitual de la medicina moderna es el uso de esteroides (cortisona o derivados) y medicamentos antiinflamatorios. Pero, a largo plazo, estos tratamientos hacen más daño que bien. Aunque se ha demostrado que las inyecciones de cortisona y los fármacos antiinflamatorios producen beneficios a corto plazo para el dolor, ambos resultan en una pérdida, a largo plazo, de la función y más dolor crónico al inhibir realmente el proceso de curación de los tejidos blandos y acelerar la degeneración del cartílago.

Además, el uso de estos fármacos puede producir otras fuentes de dolor crónico, alergias y síndrome de intestino permeable.

Y finalmente, cuando todo lo demás falla, los pacientes que experimentan dolor crónico suelen ser referidos a un cirujano.

No descubriré nada nuevo, pero sí comparto que la biomecánica de la zona sacroilíaca es una de las más complejas de comprender, que es mucha y muy variada la clínica de esta zona y que su tratamiento conlleva dificultad. No obstante, la comprensión de los mecanismos que llevan al LIL a “chillar de dolor” me ha ayudado a enfocar mejor el abordaje de la terapia manual  en los pacientes que sufren este tipo de dolores. 

Un buen tratamiento fisioterapéutico manual puede salvarte de una intervención quirúrgica.

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