Massage & Bodywork

November | December 2014

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106 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4 Working with the Lumbars, Part 2 The Iliolumbar Ligament and the 12th Rib By Til Luchau Deeper isn't necessarily better. But with skill and sensitivity, working deeper can sometimes help in ways that nothing else can. In our last column ("Working With the Lumbars: The Thoracolumbar Fascia," Massage & Bodywork, September/October 2014, page 114), we discussed how strain and microtearing in the sensitive thoracolumbar fascia (TLF) has recently been implicated in many kinds of previously unexplained back pain. 1 Some of the richly innervated TLF's layers are just below the skin; in our Advanced Myofascial Techniques seminars, we often encourage participants to work with less pressure, and at more superficial layers than many are accustomed to. The powerful results they get with back pain come as a revelation to both practitioners and their clients. However, the TLF has very deep layers, and it makes sense to also include these in our work with back pain. In addition to greater sensitivity and skill, deeper work also requires greater tissue preparation and client rapport. The Iliac Crest and Thoracolumbar Fascia Techniques described in the last column are ideal preparation for the deeper, more specific techniques I'll discuss this time. Use them, or any other approach that helps differentiate tissue layers, relax resting tone, and accustom your client to your touch before attempting the deeper techniques described here. technique MYOFASCIAL TECHNIQUES THE THORACOLUMBAR FASCIA As a refresher, the TLF envelops many of the muscular structures of the low back, including the erector spinae and quadratus lumborum (Images 1 and 4). It also serves as the tissue bridge that connects the abdominal muscles (transversus abdominis, etc.) to the spine. Its central position in the body means the TLF connects each arm to its opposite side leg, giving the TLF a crucial force transmission role in contralateral activities such as walking, running, reaching, and throwing. Working with the TLF is most clearly indicated when clients complain of low- or mid-back stiffness or pain. Back pain has been correlated both to TLF thickness and to lack of sliding between its many layers, and hands-on myofascial work has been shown to improve both of these parameters. 2,3 Deeper TLF work is also useful when the motion of diaphragmatic breathing is posteriorly limited, or when arm/ leg cross-patterns (such as a tennis serve, using elliptical trainers, running, or walking) elicit back pain or strain. And, because the TLF links upper and lower body as well as left and right, it is indirectly implicated in many other complaints, among them hip or sacroiliac pain, hamstring pain, abdominal wall issues (such as pain or restriction after cesarean section, hernia repair, etc.), and more. ILIOLUMBAR LIGAMENT TECHNIQUE Back pain linked to the iliolumbar ligaments (ILLs) will often be felt by the client as a deep, dull, generalized ache, or sometimes as a deep, sharp, sudden pain with spinal sidebending, rotation, or flexion. ILL pain can also refer to the hips, groin, rectum, or genitals. 4 1 The thoracolumbar fascia or TLF (green) is a source of many kinds of low-back pain. The iliolumbar ligament (purple) is a thickening in this fascia's lower end, where it spans between the lower lumbars and the iliac crest. Image courtesy Primal Pictures.

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