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3 Transverse processes Psoas major Vertebrae Transverse abdominis Exterior obliques Interior obliques Latissimus dorsi Quadratus lumborum 114 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 4 Working with the Lumbars The Thoracolumbar Fascia By Til Luchau To be human is to have back pain. As one of the most common physical disorders—affecting about 90 percent of Americans at some point in their lives— back pain is also the leading cause of disability worldwide. 1 Numerous theories regarding the primary cause of low-back pain have circulated over the years, including referred sacroiliac joint pain and nerve inflammation (early 1900s); "muscular rheumatism" (fibromyalgia) and psychological issues like "hysteria" (1920s–1930s); quadratus lumborum (QL) spasm (up until the 1950s); disc issues (1930s–1980s); transversus abdominis strength (1990s); multifidus size (2000s); and "core stability" (in the last decade). 2 While many of these theories are important in understanding back pain, up to 85 percent of cases still have no known cause. 3 Researchers have recently identified that the thoracolumbar fascia (TLF) may also contribute to low-back pain. THE THORACOLUMBAR FASCIA'S ROLE IN LOW-BACK PAIN The TLF, or lumbodorsal fascia, covers and separates many of the muscle groupings that lie posterior to the spine. It is usually depicted as a diamond-shaped structure over the lower back, connecting the gluteal fascia to the latissimus dorsi (Image 1). However, from other angles it becomes clear that this structure is much more complex. Multiple layers wrap three- technique MYOFASCIAL TECHNIQUES 1 Images 1, 2, and 3: The thoracolumbar fascia (TLF). A tough, fibrous, and multilayered confluence of fascia connecting each lower limb to the opposite-side upper limb, it is highly innervated and plays a role in many cases of back pain. The TLF wraps and connects many of the structures involved in low-back pain: the interior and exterior obliques of the abdomen, latissimus dorsi, transverse abdominis, quadratus lumborum, erector spinae and multifidi, and attaches to the psoas major fascia, as well as the spinous and transverse processes of the vertebrae. Image 1 courtesy Robert Schleip, ©fascialnet.com. Image 2 courtesy Primal Pictures. Image 3 based on de Rosa and Porterfield, courtesy Advanced-Trainings.com. 2 Erector spinae Spinous processes