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Nerdy Info about Low Back Pain and FASCIA

***Go to the bottom of the page for cliff notes

The following info is borrowed from the text "Fascia: The Tensile Network of the Human Body" within chapter 5.8: Potential Sources of Low Back Pain.

Studies show that 85% of low back pain cases show no specific cause...this is called non-specific low back pain (LBP).

Clinicians say causes of LBP could be attributed to psychological factors (stress, depression and anxiety) or intervertebral discs, facet joints, SI joints, ligaments, fascia, muscles and nerve root dura as tissue for transmitting pain in lumbar region.

Acute LBP is the leading cause of chronic LBP in most cases.

There are three possible causes of acute LBP that should be considered:

  • intrinsic spine: compressions fractures from trauma, herniated disc, lumbar strains, spinal stenosis, spondylolisthesis, spondylolyis

  • systemic: connective tissue disease, inflammatory spondyloarthropathy, malignancy, vertebral diskitis/osteomyelitis

  • referred: abdominal aortic, aneurysm, gastrointestinal conditions, herpes zoster, pelvic conditions, retroperitoneal conditions

Pain is the result of nociceptors (pain receptors) transmitting signals to the central nervous system as a result of stimuli. Chronic LBP occurs when these stimuli persist, resulting in central and peripheral sensitization...shifting acute LBP to chronic.

The most common causes of LBP are usually from muscular tension or spasm.

It is thought that pain could be coming from ligament or capsular tension, extraneous compression or shear forces, hyper-mobility, altered joint mechanics...

In addition to muscles, ligaments and tendons function to load bear & fascial tissues act as elastic springs with load bearing functions during oscillatory movements...& are densely innervated by myelinated nerve endings. Micro-tearing and inflammation of fascia could be a direct source of musculoskeletal pain causing low back pain.

Thoracolumbar Fascia (TLF)

The efficiency of human movement is the combination of harmonized active and passive systems around the foundational support of the thoracolumbar spine.

This stability is complemented by the thoracolumbar fascia: a structure that exhibits spring-like behavior of fascial substance engulfing the torso and penetrating through the different muscular layers assisting with load transfer.

Characteristics of the thoracolumbar fascia (TLF):

  • splits the para-spinal muscles from the transversus abdominis, internal oblique, & external oblique

  • spans the entire thoracic vertebrae around the extensor muscles to attach to the ribs

  • connects to the lumbar vertebrae but envelops within the surrounding paraspinal layers to connect with the abdominal wall muscles through the common tendon of the transverse abdominis

  • attaches to the capsule of facet joints and supraspinous and interspinous ligaments

  • the paraspinal muscles are embedded within the TLF

  • an encapsulation of various paraspinal muscle compartments engulfing the torso and connecting to the abdomen...this unique anatomy raises questions of its involvement in LBP

TFL has been linked to LBP, especially the tensioning of the anterior fibers of glute medius muscle and TFL in patients with CLBP...strengthening and relaxing these sets tended to relieve pain.

The synergy between the TFL, paraspinal pressure, intra-abdominal pressures and muscle activation is offset, then one's aspiration towards regular spinal mechanics may be difficult.

In the addition to on-off presence or activation, the actual mechanical properties of tissues such as the TFL can have important implications to how loads are distributed or handles within our bodies.

***OK I know this is really dense, nerdy material. But it's pretty darn fascinating. All in all these are the simplified take-aways.

  1. Most chronic low back pain has no specific cause.

  2. Acute low back pain is the most common cause of chronic low back don't ignore the pain or put a bandaid on the body when your body is signaling information like pain to you.

  3. Dysfunction in the TFL muscles is directly related to thoracolumbar fascia dysfunction, which is a potential cause of low back pain.

  4. The most common cases of LBP are from muscular tension or spasm. Ligaments, tendons and other connective tissue around muscles help with movement, are densely innervated and highly sensitive. Micro-tearing and inflammation of this tissue could be a direct source of the muscular tension/spasm.

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