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| Parivrtta Baddha Parsvakonasana which can stretch related TL fascia muscles (Ref: https://doctorlib.info/anatomy/yoga-anatomy/7.htm) |
Thoracolumbar fascia (TLF) is a strong aponeurosis of a large, roughly diamond - shaped area of connective tissue constituted by the thoracic and lumbar parts of the deep fascia enclosing the intrinsic back muscles. Moreover, the superficial part separates the paraspinal muscles from the muscles of the posterior abdominal wall and serves as an attachment site for various muscles of the back.
Many muscles connected to TLF include multifidus, erector spinae, latissimus dorsi, transverse abdominis, gluteus maximus, biceps femoris of hamstring, and trapezius that can be related with shoulder problems and lower back problems.
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| TL fascia and connected muscles (Ref: https://www.greatbigcanvas.com/) |
Some studies stated TLF release was effective in reducing shoulder pain. The results of this study can be applied in clinical practice for TLF release performed to reduce shoulder pain. According to some studies addressed TLF release can help to improve low back pain as well. The TLF release technique was recommended in the terms of manual fascia release and foam rolling.
In my opinion, the manual fascia release must be run by practitioners that cannot do home base exercise. Foam rolling and stretching has the potential to do the self TLF release that I would like to present in this article.
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| Manual TL fascia release (Ref: https://www.researchgate.net/publication/ 282410517_The_clinical_efficacy_of_thoracolumbar_fascia_release_for_shoulder_pain) |
Conclusion of thoracolumbar fascia release (Please stop and see physiotherapist in case of strong worse pain, radiation of numbness or pain to leg, dizziness. Moreover, patients with disc herniation must consult physiotherapist before start this instruction.)
Exercise #1: Foam rolling: roll around pelvic bone including sacrum and iliac crest, and lumbar area.
Exercise #2: Tennis ball massage: roll around pelvic bone including sacrum and iliac crest, and lumbar area.
Exercise #3: Multifidus and Erector spinae stretch: bend torso to opposite side of target muscle.
Exercise #4: Latissimus dorsi stretch: do this exercise on the floor for more stability.
Exercise #5: Gluteus maximus stretch: move the knee to opposite shoulder.
Exercise #6: Hamstring stretch: keep knee and lower back straight.
Exercise #7: Trapezius stretch: this is modified stretching pose that need bend over with following of bend head forward. Patients with disc herniation or dizziness problems must do it carefully and consult physiotherapist before start stretching.
Exercise #8: Torso rotation stretch: move both knee to opposite target muscle. During stretching need keep both knees together with keep ribs and thoracic spine on the floor.
Additionally, to improve TLF imbalance and pain does not need only stretching but also strengthening all muscles which attach to TLF.
Anatomically, TLF covers lower thoracic spine, lumbar spine, and sacrum level. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed "the lateral raphe".
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| The lateral raphe (LIFT) (Ref: Schuenke MD, et al. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. J Anat. 2012 Dec;221(6):568-76.) |
This complex structure becomes especially notable at the caudal end of the lumbar spine where multiple layers of aponeurotic tissue unite and blend to form a thickened brace between the two posterior superior iliac spines (PSIS) and extending caudalward to reach the ischial tuberosities. Various myofascial structures with differing elastic moduli contribute to the formation of this thoracolumbar composite (TLC).
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| Dimples are the surface anatomy landmark of posterior superior iliac spine (Ref: https://www.stalbanstherapyclinic.co.uk/sacroiliac-joint-pain) |
Numerous descriptions of this structure have presented either a two-layered model or a three-layered model. Both models will be summarized, and a consensus approach will be attempted to present a summary diagram illustrating the two- vs. three-layered model of the TLF.
The two-layered model presents a posterior layer that attaches to the tips of the spinous processes of the lumbar vertebrae as well as the supraspinous ligament, and wraps around the paraspinal muscles reaching a raphe on their lateral border. The posterior layer is typically described as being composed of two sheets, a deep lamina that invests the paraspinal muscles and a superficial lamina that joins the deep lamina in the lower lumbar region. In the cervical region, the deep lamina of the posterior layer continues to cover the paraspinal muscles (all the muscles innervated by the posterior primary ramus) including the splenius capitis, as it blends with surrounding cervical fascias; eventually this paraspinal fascial sheath fuses to the cranial base.
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| The two - layered model of TL fascia (Ref: https://www.physio-pedia.com/Thoracolumbar_Fascia) |
The three-layered model has strong similarities with the previously described model containing two layers. It is the most commonly used model in most research studies that is the reason why I wrote in the QL stretching article previously. The posterior layer consists of two laminae: superficial (the aponeurosis of the Latissimus Dorsi); and deep lamina. In between these laminae above the L4 level, the aponeurosis of the Serratus Posterior Inferior is present. The Middle Layer of TLF is the fascial band that passes between the paraspinal muscles and the QL. The anterior layer is defined as passing anterior to the QL and ending by turning posterior to pass between the QL and the psoas. The anterior layer has been described as being an extension of the transversalis fascia. As previously stated, typically authors using the two-layered model refer to the fascia anterior to the QL simply as transversalis fascia and exclude it from the model.
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| The three - layered model of TL fascia (Ref: https://ittcs.wordpress.com/tag/thoracolumbar-fascia/) |
The TLF envelops the back muscles from the sacral region, through the thoracic region, and is composed of anterior (ALF), middle (MLF), and posterior (PLF) layers. Of these, the PLF consists of superficial and deep laminae. The superficial lamina of the PLF is continuous with the latissimus dorsi (LD), and partially continuous with the gluteus maximus, external abdominal oblique (EO) and trapezius and contribution from the serratus posterior inferior (SPI). The deep lamina of the PLF has contributions from the SPI, lumbosacral attachments to interspinous ligaments, the long dorsal sacroiliac ligament, and the iliac crest and cranial attachments extending into the cervical paraspinal region. Along the lateral border of the PRS, a complex interaction occurs between the attachments of the abdominal muscles. The blending of the aponeurotic sheaths of the transversus abdominis (TA) and internal oblique (IO) muscles along with the lateral margin of the TLF gives rise to a ridged-union of dense connective tissue. This area of fascial fusion exists just lateral to the paraspinal muscles through much of the lumbar region, and was coined the lateral raphe (LR). The LR extends from the iliac crest caudally to the 12th rib cranially. Thus, the raphe is formed at the location where abdominal myofascial structures join the fascial structures surrounding the paraspinal muscles. Since Bogduk and MacIntosh’s original use of the phrase ‘lateral raphe’, several articles.
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| TL fascia layer and muscles (Ref: https://id.pinterest.com/pin/703898616752662141/) |
TLF plays a multi role including enveloping posterior and lateral torso muscles, stability of spine and posture, movement of limbs and spine, transmission force between upper and lower limbs.
The lumbosacral spine plays a central role in sustaining the postural stability of the body; however, the lumbar spine alone is not capable of sustaining the normal loads that it carries daily. To stabilize the lumbar vertebrae on the sacral base requires the assistance of a complex myofascial and aponeurotic girdle surrounding the torso. On the posterior body wall, the central point of this girdling structure is the thoracolumbar fascia (TLF), a blending of aponeurotic and fascial planes that forms the retinaculum around the paraspinal muscles of the lower back and sacral region
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| Stabilizer function of TL fascia (Ref: https://www.researchgate.net/publication/ 51654116_Reduced_thoracolumbar_fascia_shear_strain_in_human_chronic_low_back_pain/ download) |
Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine.
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| Ref: https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7580.2012.01511.x |
There is bilateral force transmission from gluteus maximus to the latissimus dorsi and lower trapezius muscles. These muscles are connected by the fascial network of the back. The gluteus maximus and latissimus dorsi share the origin from the aponeurotic posterior layer of the thoracolumbar fascia (PTLF). In conditions like idiopathic back pain, radiating pain, etc., instead of focusing on single structures like a muscle or a fascia, more holistic approaches seem appropriate. In pathological conditions, the connection through PTLF may contribute to altered biomechanics of the back of the trunk.
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| Force transmission tarjectory to opposite side obliquely (Ref: https://openhealthclinic.com/) |
The principle to stretch this muscle is the same as the others: stretch to the point where “tightness with pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5 reputations following demonstrated VIDEO.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512280/
https://kmbase.medric.or.kr/Fulltext/10120/2015-4-1/55-59.pdf
https://www.mskscienceandpractice.com/article/S1356-689X(16)30756-1/pdf
https://www.kenhub.com/en/library/anatomy/thoracolumbar-fascia
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