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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 115 the mechanical and proprioceptive control of walking, running, throwing, and all contralateral motions. As a whole-body connector it can be significantly involved in low-back pain and midback pain, recurring tightness in the thoracic spine or low back, spinal stiffness and restricted rotation/ flexion, inhibited contralateral arm/ leg motion, and limited rib or back motion in diaphragmatic breathing. It is also implicated in many other conditions, including hip or sacroiliac pain, plantar fasciitis, and suboccipital headaches, given its indirect fascial connections to these regions. 6 ILIAC CREST TECHNIQUE The TLF's layers insert on the thin, bony ridges of the iliac crest, forming the bony attachments of the transverse abdominis, obliques, and iliocostalis— the largest and most lateral of the spinal erectors. Since we are preparing for low-back work, we'll emphasize the superior aspect of these bony ridges where these low-back structures attach. Using a soft fist, feel for the ridge of the iliac crest. Slightly wrap around the crest's ridge with the furrow between two of your knuckles (Images 4 and 5). On many clients with long- term low-back pain, you'll find thick, dense fascial buildup here. Starting at the lateral-most part of the hip crest, sink in slowly, feeling for tissue softening in response. By waiting for this, we are evoking a reduction in the resting tone of the fascia's associated dimensionally around the structures of the low back (Images 2 and 3), extending from the base of the neck (where it is contiguous with the deep cervical fascia) to the sacrum and iliac crests of the pelvis. Its layers adhere to the processes of the lumbar vertebrae and spinal ligaments (along the midline of the back), and to the ribs (laterally). The TLF wraps and connects several of the structures thought to be responsible for low-back pain, such as the multifidi, QL, spinal erectors, and spinal ligaments, and it connects other muscles such as the diaphragm, obliques, and transverse abdominis. The increasing awareness of fascia's role in sensation and pain perception (see "Understanding Fascial Change: Continuity, Plasticity, and Sensitivity" in Massage & Bodywork, May/June 2014, page 114) has led to research showing there are numerous free nerve endings and mechanoreceptors in the back's TLF and that it is physically different in those with low-back pain. One study showed that the TLF was significantly thicker in those with low-back pain than in those without. 4 Less gliding has also been observed between the deeper layers of the TLF in people with low-back pain, suggesting that our goals of achieving fascial elasticity and layer differentiation could explain why manual therapy has helped relieve chronic back pain. 5 Because the sensitive TLF diagonally joins each leg to its opposite-side arm, it is important in muscles via a Golgi tendon organ reflex. 7 This allows our work to have a much greater effect, and it helps prepare for more direct work with the lumbar sections of the TLF. Once the tissue softens slightly in response to your static pressure, glide medially along the crest to move to a new area. Wait here for tissue softening, which will allow you to glide to the next area. As you glide along the crest, you'll encounter the more muscular attachments of the QL and iliocostalis. Slow down. Take a more superficial layer. Continue this process of waiting for a response in each place until you've reached the posterior superior iliac spine. Repeat at a slightly deeper level, or perform the next technique. THORACOLUMBAR FASCIA TECHNIQUE The TLF is composed of dense, fibrous connective tissue layers, separated by thin layers of loose connective tissue that allow the dense layers to glide against one another during trunk motion. Less gliding between the layers has been correlated with low-back pain. We'll address each layer of the TLF in turn, restoring differentiation and elasticity. Superficial and Posterior Layers There are several outer layers in the low back, which include the posterior layer of the TLF. This layer covers the erector/multifidi group and gives rise Images 4 and 5: In the Iliac Crest Technique, gently use the knuckles of a soft fist to work the attachments of the TLF and other structures along the entire length of the crests. Glide slowly to prepare the outer layers; use static pressure on deeper layers. Images courtesy Advanced-Trainings.com. 4 5