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Thoracolumbar Fascia

 
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Thoracolumbar Fascia - July 8, 2004 12:41:00 AM   
coloradojulie

 

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In the last post, most recently closed, Diane brought up a great connection between the lats and their relationship to other muscles in the trunk.

Clinically, we are finding more and more that the lats and the thoraco lumbar fascia are closely connected with postural faults and shoulder instability/impingement patterns. Ranging from forward shoulder posture, increased kyphosis, forward head posture and increased lumbar lordosis, with cascading consequences.

Wondering if anyone else has comments on this functional connection.

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Re: Thoracolumbar Fascia - July 8, 2004 8:01:00 AM   
Sebastian Asselbergs

 

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coloradojulie, I would take that connection even a bit further to the opposite gluteus, hamstrings and peroneals complex. Andry Vleeming et al have done some very interesting studies on the continuum connection from shoulder to opposite ankle through the fascial planes of the thoraco-lumbar and sacral areas. There are folks who have deep lumbar lordosis with shoulder complaints - you can see their mid and low back straining to more extension when trying to fully flex/elevate the shoulder. I have no doubt that these structures can be involved in distorting the subtle and complex motion patterns of the shoulder girdle - a symphony of motion becomes a cacaphony of irritation. However, I have been moving less and less to "stretching" tight muscles and more and more to "playing" on balls and mats with hands on varying parts for feedback/facilitation - very fuzzy, I know, but this playing seems to help people develop much more awareness of their body and its motions of different parts, then having them "do their daily routine of streches". Besides, I believe (no references come to mind right now) that most "tight muscles" are not frozen muscles, but need different input from propriocepsis and CNS.
NEway, that's my 5 cents.

Sebastian

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Re: Thoracolumbar Fascia - July 8, 2004 10:10:00 AM   
Diane

 

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I've heard about those Vleeming studies Sebastian, but haven't read them yet, about the crossover of the lats at L4; rather than attaching to L4, the lats send a slip right over which embeds on the opposite side sacrum. It was Servaas Mes who mentioned this...

Meanwhile, thoraco lumbar fascia..very complex structure with lots of layers. Of interest I think is its connection to the lateral arcurate ligaments of diaphragm. If the TL fascia is tightened down by any of its other attachments, the diaphragm could be restricted at its posterior borber. I'll post some notes I took from Gray's 38th on it, with a couple comments mixed in, in square brackets:

(I've been taking a look lately at the different embryonic derivations of back musculature, sorting out epaxial (deep, innervated by dorsal rami) hypaxial (lats, derived from limb structures) and branchiomeric (traps, derived from head/branchial arch structures)

Thoracolumbar (lumbar) Fascia:(p 809, p 816
- It is a passive but important transverse divider in the back [effectively separating the deep musculature (epaxial) from the superficial (hypaxial)]
- [covers the deep muscles of the back and trunk, contains them, gives them greater strength, something to push away in hydraulic fashion perhaps.]
- [provides slidey surface over which the overlying traps and lats may glide (see above)]
- [connects to the lateral arcurate ligament (p 816) which provides partial anchorage for the lumbar portion of the diaphragm. (Thus is the diaphragm connected to the thoracolumbar fascia, and therefore theorectically, indirectly stimulable by any voluntarily contractile muscle outside the cage that inserts into or can otherwise pull upon the TL fascia.)]
- exists as three lamina with varying attachments/anchorages to skeleton
- converges laterally to provide anchorage for TrA
- provides anchorage for some of the longissimus thoracis fibers
Attachments: Above: passes anterior to serratus posterior superior, is continuous with the superficial lamina of the deep cervical fascia on the back of the neck.
Thoracic region: provides a thin fibrous covering for the extensor muscles of the vertebral column and separates them from the muscles connecting the vertebral column to the upper extremity.
Medially: attaches to the spines of the T vertebrae
Laterally: attaches to the angles of the ribs
Lumbar region: exists in three layers or laminae;
1. Posterior layer: attaches to the spines of the lumbar and sacral vertebrae and to the supraspinous ligaments.
2. Middle layer: attaches to tips of transverse processes of lumbar vertebrae and the intertransverse ligaments, below to the illiac crest, above to the lower border of the 12th rib and the lumbocostal ligament.
3. Anterior layer: covers QL;
medially: attaches to the anterior surfaces of the TPs of the L vertebrae behind the lateral part of the psoases major,
below: attaches to the iliolumbar ligaments and adjoining parts of the iliac crest,
above: forms lateral arcurate ligament (p 816)

- its posterior and middle layers unite at the lateral margin of erector spinae, and at the lateral border of QL they are joined by the anterior layer to form the aponeurotic origin of transversus abdominis.

[Gray?s neglects to mention innervation of this or any other fascia. It simply seems to be not their habit to bother with this idea. For years it was thought that fascial innervation didn?t exist. Lately there have been studies to show that fascia is extensively innervated, by free nerve ending that are primarily ( probably exclusively) sensory.]

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Re: Thoracolumbar Fascia - July 8, 2004 11:46:00 AM   
PTupdate.com


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Julie,

I have used lat strengthening exercises for years for my low back pain patients...ever since I saw that picture of "fascia man", and saw that so much soft tissue attached right at the SI/PSIS region...similar to the rays coming out of the old Japanese rising sun flag.

And just as Sebastian suggests, focusing on the glutes and hamstrings is just as important. Interestingly enough, I also use lat exercises as a method of reciprocol inhibition for the cervical patients!

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

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www.PTupdate.com

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Re: Thoracolumbar Fascia - July 19, 2004 5:02:00 PM   
JayKnows

 

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Hey there just found this forum, and this thoraco l. fascia discussion. Was interested to see that fascia was described as inert. Although i dont have the papers with me, i think it was Yahia who found smooth muscle in fascia, which has quite lovely implications when u think about its key areas (i.e areas of intelligence, like t.l fas, and indeed the ankle). The reason i like t.l fascia is its rubber pull on the lumbar facets via the t.a fascial link.

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Re: Thoracolumbar Fascia - July 19, 2004 8:55:00 PM   
Synergy

 

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Duff,

Could you explain a little more in detail how you use lat exercises as a method of recip. inhib. for the c-spine patients. Thanks in advance!

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Chris Adams, PT, MPT

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Re: Thoracolumbar Fascia - July 19, 2004 11:05:00 PM   
PTupdate.com


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Chris,

I use the lat pulls, behind neck style, for persons with higher upper trap tone, either from joint/disc pathology, or just stress/tension/postural issues. The use of the scapular adductors and down-rotators seems to "shut off" the elevators and upward rotators....just feel a persons upper traps when performing the exercise...relaxed. Plus, the working of the interscapular musculature during the exercise facilitates some postural improvement.

Duff

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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com

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Re: Thoracolumbar Fascia - July 19, 2004 11:15:00 PM   
Synergy

 

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Duff,

Thanks for the quick reply and for the useful information. I'll make sure that I employ those in the near future. I do have all of my cervical patients performing scapular adduction as well as anterior stretching of the pec minor and any other culprit of negative posture. Thanks Duff!

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Chris Adams, PT, MPT

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