Tuesday, January 8, 2013

Thoracolumbar Fascia: The Forgotten Culprit of Low Back Pain

Each week I am inundated with people that complain about low back pain.Although I don't necessarily discount the severity of low back pain, I do find that most complainers exhibit the same factors that are typical for low-grade lower back discomfort:

Characteristic #1: Sit for long periods
Characteristic #2: Overweight by 20 pounds
Characteristic #3: Poor posture
Characteristic #4: Overly tight hamstrings

Most of the clients I attract are members of the general population that don't dedicate much time to activity--let alone flexibility training or myofasical therapy. My first recommendation is always massage therapy. I have worked with a handful of massage therapists over the last 6 years, and I am astonished at the incredible results one can receive after a session of tissue manipulation. Like trainers, not all massage therapists are great at their craft. Some have become stagnant in their service and sessions are redundant. Others really demonstrate a passion for what they do and really put some "muscle" into it.

As with most trainers dealing with clients that suffer from low back pain,  they will usually recommend stretching and tend to focus on a muscular tandem of short and tight tissue. It is my opinion, with most clients from the general population, low back pain is not necessarily a muscular issue. It is a fascia one. Let me explain the role of fascia throughout the body.

Fascia is a highly adaptable tissue. Due to its elastic properties, superficial fascia can stretch to accommodate the addition of adipose tissue that accompanies weight gain. The superficial fascia can also slowly revert back to its original level of tension after weight loss. Deep fascia can contract. What happens during the fight-or-flight response is an example of rapid fascial contraction. In response to a real or imagined threat to the organism, the body responds with a temporary increase in the stiffness of the fascia. Bolstered with tension, people are able to perform extraordinary feats of strength and speed under emergency conditions.

Deep fascia also has the ability to relax. However, some tension is needed in order to maintain proper function of structures—much like ligaments around a joint. One of the largest areas of fascia is located at the trunk. The thoracolumbar fascia and the rectus sheath provide strong fascial support between the bottom of the ribcage and the top of the pelvis. This area forms your “corset.  The thoracolumbar fascia (lumbodorsal fascia) is a deep investing membrane that covers the deep muscles of the back of the trunk. Two main muscle groups lie within the layers of the fascia. The quadratus lumborum muscle lies between the anterior and middle layer, and the erector spinae muscle is enclosed between the middle and posterior layers. These two muscle groups are responsible for lateral, flexion, and extension of the vertebral column and should be strong specifically for vertically loaded lifts like squats, push presses, and deadlifts. They are also located at an important junction of the fascia.

As with any region of fascia, repetitive stress (static or active) can damage the tissue leaving trigger points, adhesions and ultimately, scar tissue. For the general population that sits all day and uses poor mechanics when using their bodies to lift, squat, or move,  this region becomes a troublesome spot for low back pain and discomfort. Most people with low back pain that is predominately muscular are typically laborers that use their bodies to lift loads that are moderately heavy (electrical workers, construction workers, farmers, etc). Your typical weight-trainer that uses poor technique falls into this category. 

Back to the general population...Massage therapy is what I strongly recommend to alleviate the discomfort in the thoracolumbar region.  With regular tissue manipulation by the hands of a qualified professional and the tolerance for high levels of pain--massage should do the trick in increasing mobility, blood flow, and decrease tension in this area. If regular massage is not something that can be afforded regularly (once per month is my suggestion), my next recommendation is self-myofasical release with a foam roller or other self-massage tool like a Rumble Roller, Massage Stick or Thera-Cane.

Using the massage stick on the thoracolumbar region
These massage techniques are great when performed as regular as getting up to use the bathroom. In the past, I have had clients keep a massage stick in their office and perform this drill inside the office or cubicle. You would be surprised, but after the strange looks from co-workers,  the next emotion is curiosity and a desire to own a massage stick too.

Foam rolling this area can be tough for people that don't have alot of muscle in this region. Usually lifters with developed erectors and back muscles can tolerate the pressure of rolling on the thoracolumbar region, but I don't suggest it with the general population.

Once massage and self-massage have helped increase blood flow and improve mobility in the lower back region, I like to introduce a side lying trunk rotation stretch. This stretch can be difficult for some--especially getting on the floor without exacerbating any discomfort in other areas. But I like it combined with localized massage and recommend it after targeting the area with the Massage Stick, TheraCane or Rumble Roller.

This stretch does not limit to just the fascia, it's also a great stretch for the trunk musculature including the obliques, erectors, and abdominals. With a population that sits stagnant and statically for hours on end,  this rotational stretch is great for increasing mobility upwards the torso. I like this drill performed directly after self-massage with a hold of 20-30 seconds. And with all stretches, I like a few more degrees of movement performed as the area becomes less stiff.

So before you look at muscle stiffness and weakness in your clients with low back pain, don't neglect to examine the thoracolumbar region. Although this area is usually palpated by massage therapists, we, as trainers, cannot do much in way of hands-on work--but we can recommend drills that the client can self-perform.


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