The thoracolumbar fascia (TLF) is the connective tissue that spans the thoracic and lumbar areas of the deep fascia. The TLF is a potential pain-causing area of the back, and as a result, thoracolumbar fascia strengthening exercises and stretches have become more popular.
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Thoracolumbar Fascia and Back Pain
The fascia is a connective tissue that is very thin and encases and holds in all of your organs, blood vessels, nerve fibers, bones and muscles. Your fascia is quite sensitive, as sensitive as your skin since it contains nerves.
When the fascia is under stress, it becomes tight. Since your fascia is supposed to stretch freely as you move, when it becomes thickened and sticky, dried up and tight around your muscles, it can result in limited mobility and painful knots, according to Johns Hopkins Medicine.
The diamond-shaped thoracolumbar fascia encases the intrinsic back muscles and has become a focus of researchers as a central player in low back pain. Due to this emerging research, lumbar fascia exercises have come to the forefront in the fight against a high prevalence of low back pain.
The World Health Organization (WHO) estimates that low back pain occurs in 60 to 70 percent of all people in industrialized countries. Although the age for the most complaints of low back pain peaks between the ages of 35 and 55, an aging population will lead to a higher incidence as intervertebral discs deteriorate in older people.
The WHO explains that the implications of such a high rate of low back pain are the leading cause of people's inability to be active and increase work absence rates. This high incidence of low back pain create financial hardships that could otherwise be avoided.
It is estimated that 149 million workdays are lost every year in the United States due to low back pain, which in turn cost between 100 billion and 200 billion dollars a year. Two-thirds of this is considered to be due to lost wages and reduced productivity.
According to John Hopkins Medicine, the fascia has been ignored until recently, although it contributes majorly to human movement. Your fascia can become stiff with adhesions as a result of factors such as a lack of activity, overworking singular parts of your body in repetitive motions, or due to trauma and injury. This stiffness can result in muscle pain.
It might be hard to tell whether or not your lower back pain is due to problems with your fascia or whether your muscles or joints are to blame. Typically if your muscles and joints are injured, then the more you move, the more it hurts. When the problem arises from fascial adhesions, movement usually improves the condition. Pain due to fascia stiffness also commonly responds well to heat, which returns elasticity to the tissues.
If fascial adhesions are left untreated, they can get worse and cause compression and contortion of your muscles. You may end up feeling sore knotted areas in your muscles, which are called trigger points. This pain will be felt during physical activity, if you press on them, and can arise in parts of your body that seem unrelated to the origin of your pain — something called referred pain.
Treating Thoracolumbar Fascia Pain
The main treatments prescribed for low back pain are analgesics which only address the symptoms and not the root cause of the pain. Physical therapy rehabilitation and spinal manipulation are effective treatment options that are used less often.
You can improve your thoracolumbar fascia muscle pain by strengthening the muscles of your core, practicing good posture, maintaining a healthy weight, being sure to adequately warm up before exercising or lifting heavy objects, getting massage therapy when you feel stiff and taking breaks from sitting. If low back pain is your problem, yoga therapy or other lumbar fascia exercises could help, says John Hopkins Medicine.
If you believe that your low back pain is a result of myofascial pain syndrome, a technique called myofascial release could help when combined with core stabilization exercise. An October 2019 article published in Clinical Interventions in Aging shows myofascial release techniques with a foam roller massager combined with core stabilization exercises are an excellent choice for the treatment of lower back pain in the elderly.
A December 2012 meta-analysis published in PLOS One says that core stability exercise is more effective than general exercise in reducing pain and increasing back-specific functional status in patients with lower back pain. Core stability exercises help to improve deep muscle strength in the trunk and reduce levels of disability due to low back pain in older adults.
Moreover, myofascial release techniques can result in significant improvement for pain and disability. Combining these techniques was shown to be an excellent treatment option for those with lower back pain due to fascial adhesions.
In this study, core stabilization exercises were used three days per week for six weeks for a total of 18 sessions. Each session lasted for 60 minutes and began with 10 minutes of warming up and ended with five minutes of cooling down. It is important to note that proper abdominal activation was taught to the study participants, focusing on abdominal bracing to activate the transverse abdominis and internal oblique muscles.
Here's how to properly brace your abdominals, according to Dr. Stuart McGill, professor emeritus of spine biomechanics at the University of Waterloo and the foremost expert on lower back pain, in an article published by the American Council on Exercise:
- Fully relax your abdominals and push your fingers into your oblique muscles, which are on the side of your abdomen, about 2 to 5 inches laterally from your navel.
- Begin to stiffen your abdominals gently while feeling your fingers pushing out from this resistance.
- Maintain this stiffness throughout all thoracolumbar fascia strengthening exercises or stretches.
Thoracolumbar Fascia Strengthening Exercises
The exercises in the Clinical Interventions in Aging article are similar to Dr. Stuart McGill's "Big 3" lower back exercises, as explained by the American Council on Exercise, including a side-lying plank, a curl-up and a quadruped bird dog exercise.
Perform eight reps, four on each side for your first set. Then perform more sets while decreasing the number of repetitions by two each time with your last set consisting of four reps, two on each side (eight, six, four).
Move 1: The McGill Curl-Up
- While lying on your back, extend one of your legs and bend the knee of the other leg.
- Keep a natural arch in your back, placing your hands under your lower back to facilitate this.
- Lift your chest while pulling your shoulders and head off the floor as a unit. Your back should stay in a neutral position without touching your chin or tilting your head backward.
- Perform this hold for 10 seconds before lowering yourself back down in a slow and controlled manner.
Move 2: Side Bridge
- Lying on your side with your forearm on the floor, elbow stacked under your shoulder, place the hand of your other arm on the opposite shoulder for stabilization. Your feet should be pulled back and knees bent at 90 degrees with your knees resting on the floor.
- While maintaining a straight line from your head to your knees, lift your hips off the floor and hold for 10 seconds.
- Repeat on the opposite side.
- To advance this movement, straighten your legs and rest on the sides of your feet instead of your knees.
Move 3: Bird Dog
- Get on the floor on your hands and knees with your knees stacked under your hips and hands stacked under your shoulders.
- Extend your left arm forward and extend your right leg backward at the same time until both are parallel to the floor. Your hips should be in line with your torso and not dipping to one side or the other.
- Hold this position for 10 seconds before repeating on the other side.
- Johns Hopkins Medicine: "Muscle Pain: It May Actually Be Your Fascia"
- World Health Organization: "Low Back Pain"
- Clinical Interventions in Aging: "The Effects of Myofascial Release Technique Combined With Core Stabilization Exercise In Elderly With Non-Specific Low Back Pain: A Randomized Controlled, Single-Blind Study"
- PLOS One: "A Meta-Analysis of Core Stability Exercise Versus General Exercise for Chronic Low Back Pain"
- American Council on Exercise: "Low Back Exercises: Stuart McGill’s Big Three"