Thoracolumbar Fascia: An Unsuspected, Overlooked Cause of Low Back Pain

Low back pain: this enigmatic, draining problem effects more than 600 million people worldwide, and is the number 1 cause of disability in the world according to The World Health Organization. Draining because addressing it can quickly eat your finances, comfort, health, and joy. Enigmatic because low back pain is often determined idiopathic - medical speak for, "We've got no clue why this is happening." Toot causes may be found in any one of the four bodies (energetic, emotional, mental or physical).

Structurally, the usual suspects are herniated discs, nerve damage, physical trauma, or weak intervertebral muscles. This article focuses on an unusual suspect and a potential cause of idiopathic low back pain: the thoracolumbar fascia.

Though massage therapists 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 exploring this topic was written in 2012 by Willard et al. I’ll be referencing this paper throughout the rest of my post. The below image of the thoracolumbar fascia and musculature was sourced 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, 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 connected to and supported by this structure. It is formed by two to three layers depending on the anatomical model used. The TLF's jobs include stabilizing the lumbar spine and pelvis during movement, distributing load force and tension during activity, and possibly contributing to back extension. Previously it was thought that nerves only passed through fascia to innervate muscles, skin, and organs. Now we recognize that fascia itself is innervated with mechanoreceptors, proprioceptors, and/or nociceptors meaning that deformations, restrictions, and injuries to the fascia can illicit instability and pain. 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 in the 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)

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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