The Thoracolumbar Fascia and Back Pain
Once regarded mere “packing material”, fascia has emerged from anatomical obscurity to being the subject of diligent research, gaining prominence as we strive to understand human movement, pain, and dysfunction. The implication of its role in proprioception, nociception, the immune response, inflammation, lymphatic efficacy, thermoregulation, force transmission and elastic recoil validates this more exhaustive scrutiny. Fascia is ubiquitous throughout the body, forming an “endless web” profoundly and inextricably affiliated with muscle, as well as encompassing a variety of structural components from thick aponeuroses to tendon, to ligament, and to the loose and compliant tissue immediately beneath the skin. Derived from the mesodermal layer during embryologic development, fascial form follows function as it adapts structurally and morphologically to the load demands in any given somatic locale, in health and disease.
The thoracolumbar fascia and its connection to multiple muscle components in the trunk has been the focus of considerable attention elevating our speculative appreciation of spinal pain and pathology. Consideration of its anatomical associations, thickness, and its capacity to glide relative to adjacent tissue and bone are hallmarks in the determination of its viability and functionality. Previous studies in the observed differences between healthy versus chronic low back pain patient cohorts has served to inform clinical practice. The potential impact on bony spinal components, discs and associated neural tissue secondary to chronic dyskinesis, adaptive postures, fear avoidance behaviours, compensatory movement patterns, scar tissue and fascia’s response to resultant relative inactivity cannot be overlooked. This will provide the basis of my studies going forward, as I strive to pursue a PhD with fascia as my focus.