Low back pain. The World Health Organization estimates that as many as 70% of adults in industrialized countries will present with this enigmatic, draining problem. Draining because it can quickly eat your finances, comfort, health, and joy as you work to resolve it. Enigmatic because often low back pain is determined idiopathic, or of an unknown cause. When a cause is suggested, it can range from psychological to structural.
Structurally, the usual suspects are herniated discs, nerve damage, physical trauma, or weak intervertebral muscles. This article will focus on an unusual suspect and a potential cause of idiopathic low back pain: the thoracolumbar fascia.
Though massage therapist have subjectively improved low back pain working the thoracolumbar fascia (TLF), the research decoding why clients might be having these experiences is slim. One article that explores this topic was written in 2012 by Willard et al. I’ll be referencing this paper throughout the rest of my post; the anatomic picture is borrowed from there as well.
The TLF resides in the low back, stretching from the iliac crests (top of the hips) and over the sacrum
up to just underneath the 12th ribs and extending up to the base of the skull. It is a huge. In fact, it took Willar et al. nearly half of their 30 page paper on the TLF to describe all of the bones, ligaments, aponeuroses (essentially broad, flat ligaments), and muscles it attaches to and surrounds. It consists of two to three layers depending on the anatomical model used. The TLF stabilizes the lumbar spine and pelvis during movement, distributes load force and tension during activity, and possibly contributes to back extension. Fascia in general is now recognized as innervated with mechanoreceptors, proprioceptors, and even nociceptors meaning that deformations, restrictions, and injuries to the fascia can illicit pain. Previously it was thought that nerves only passed through fascia to innervate muscles, skin, and organs. Looking at the TLF specifically, all three of the aforementioned nerve types have been identified in several studies. It is possible that inhibited mechanoreception (our ability to sense movement) due to tight or inflamed thoracolumbar tissue can trigger enhanced nociception (our ability to process noxious stimuli) in the body’s attempt to guard against further injury therefore causing pain. Also worth noting is that pinching or otherwise deforming the TLF (as shown in a study performed on cats) can also induce spasm in the glutes and hamstrings as well as in the back. Considering this connection, it is reasonable to suggest that lumbar fascia dysfunction could also cause hip pain, leg pain, and possibly even sciatic-like symptoms depending upon what other muscles get involved to create a compensation pattern.
Restrictions of this fascia can occur in multiple ways:
Overuse
Improper body mechanics
Stress
Injury through impact, tear, or puncture
Tension in attaching muscles (trap, rhomboid, lat, glute max, bicep femoris, transverse abs, internal obliques, and external obliques to a small degree)
Interestingly, most of the nerve endings in the TLF are located in the superior portion of the posterior layer of this intricate complex. In other words, they sit in a relatively thin section closest to the skin. Working the facial layer to enhance nerve function and reduce inflammation then requires a much softer touch than what most people might believe. So when looking for massage and bodywork to address your low back pain, therapists who practice modalities such as Bowenwork, Spontaneous Muscle Release Technique, and Myofascial Stretching and Unwinding will be of most benefit to you.
To read in depth about the thoracolumbar fascia, read Willard et al.’s full article:
Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of Anatomy, 221(6), 507–536. http://doi.org/10.1111/j.1469-7580.2012.01511.x
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