Thoracolumbar Fascia: Difference between revisions

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== Description  ==
== Description  ==
[[File:PP Thoracolumbar Fascia.png|thumb|The thoracolumbar fascia is the gray area at bottom center.]]
The thoracolumbar [[fascia]] (TLF) is a girdling structure consisting of several [[Aponeurosis|aponeurotic]] and fascial layers that separate the [[Paraspinal Muscles|paraspinal muscles]] from the muscles of the posterior [[Abdominal Muscles|abdominal wall]]. 


The thoracolumbar fascia [TLF] is a large area of connective tissue - roughly diamond-shaped -&nbsp;which comprises the thoracic and lumbar parts of the deep fascia enclosing the intrinsic back muscles.  
Most developed in the [[lumbar]] region, it consists of multiple layers of crosshatched [[collagen]] fibres that cover the [[Back Muscles|back muscles]] in the lower [[Thoracic Anatomy|thoracic]] and lumbar area before passing through these muscles to attach to the [[sacrum]]. Above, it is continuous with a similar investing layer on the back of the [[Cervical Anatomy|neck]]—the nuchal fascia. <ref name=":0">Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512278/ The thoracolumbar fascia: anatomy, function and clinical considerations]. Journal of anatomy. 2012 Dec;221(6):507-36.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512278/ (accessed 14.2.2022)</ref><ref name=":3">Askinglot What is thoracolumbar fascia?Available: https://askinglot.com/what-is-thoracolumbar-fascia<nowiki/>(accessed 14.2.2022)</ref>


Most developed in the lumbar region, it consists of multiple layers of crosshatched collagen fibres that cover the back muscles in the lower thoracic and lumbar area before passing through these muscles to attach to the sacrum.  
The TLF is a critical part of a myofascial girdle that surrounds the lower portion of the torso, playing an important role in [[posture]], load transfer and [[Muscles of Respiration|respiration]]. <ref name=":0" /> The fascial system is  a "fibrous collagenous tissue which is part of a body-wide tensional force transmission system".<ref>George T, De Jesus O. [https://www.ncbi.nlm.nih.gov/books/NBK568725/ Physiology, Fascia].2021 Available: https://www.ncbi.nlm.nih.gov/books/NBK568725/<nowiki/>(accessed 14.2.2022)</ref>


== Anatomy&nbsp; [[Image:PP Thoracolumbar Fascia.png|right|200px]]  ==
The TLF contains [[Nociception|nociceptive]] free [[Neurone|nerve]] endings and has been proposed to represent a possible source of idiopathic [[Low Back Pain|low back pain]]. In addition, chemical stimulation of the TLF nociceptors has been shown to elicit severe and particularly long-lasting [[Peripheral Sensitisation|sensitization]] processes. <ref name=":2">Wilke J, Schleip R, Klingler W, Stecco C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444000/ The lumbodorsal fascia as a potential source of low back pain: a narrative review.] BioMed research international. 2017 May 11;2017.</ref>


The TLF is a complex of several layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall,[[Quadratus Lumborum|quadratus lumborum (QL) and ]][[Psoas Major|psoas major]]<ref name="Willard et al">The thoracolumbar fascia: anatomy, function and clinical considerations. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R.J Anat. 2012 Dec;221(6):507-36</ref>.
Injury to the thoracolumbar fascia usually manifests as tightness, [[spasticity]] and increased tone in the lower thoracic spine and lumbar spine / paraspinal regions causing severe [[Pain Behaviours|pain]]<nowiki/>s. <ref>Kenhub Thoracolumbar fascia Available:https://www.kenhub.com/en/library/anatomy/thoracolumbar-fascia (accessed 14.2.2022)</ref>


Numerous descriptions of this structure have presented either a two-layered model or a three-layered model.  
== Anatomy ==
The TLF ( or lumbodorsal fascia) is a deep investing membrane that covers the deep muscles of the back of the trunk.


In the thoracic region, it forms a thin covering for the extensor muscles of the vertebral column. Medially, it is attached to the spines of the thoracic vertebrae, and laterally it is attached to the ribs, near their angles. In the lumbar region, it is also attached to the vertebral spines, but in addition it forms a strong aponeurosis that is connected laterally to the flat muscles of the abdominal wall. Medially, it splits into anterior, middle and posterior layers. The first two layers surround quadratus lumborum and the last two form a sheath for the [[Erector spinae|erector spinae and ]][[Lumbar multifidus|multifidus]] muscles. Below, it is attached to the [[Iliolumbar ligament|iliolumbar ligament]], the iliac crest and the sacroiliac joint. Via its extensive attachment to vertebral spines, the thoracolumbar fascia is attached to the supraspinous and interspinous ligaments and to the capsule of the facet joints.&nbsp;
In the thoracic region, the TLF forms a thin covering for the extensor muscles of the vertebral column. Medially, it is attached to the spines of the thoracic vertebrae, and laterally it is attached to the [[ribs]], near their angles<ref name=":1" />.
[[File:Thoracolumbar fascia greys.png|thumb|485x485px|Transverse section: posterior abdominal wall - the disposition of the TLF fascia.|alt=]]
In the lumbar region the TLF is divided into three layers (previously described as two layers, anterior and posterior):


The three-layered model<ref>Barker PJ, Briggs CA, Bogeski G. Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments. Spine. 2004;29:129–138.</ref> differs from the model containing two layers as follows:&nbsp;
# The posterior layer: is attached to the spinous processes of the lumbar and sacral vertebrae and the supraspinal ligament;
# The middle layer (previously anterior layer): attached, medially, to the tips of the transverse processes lumbar vertebrae and the intertransverse ligaments; below, to the [[iliolumbar ligament]]; above, to the lumbocostal ligament.
# The anterior layer (fascia Covering the [[Quadratus Lumborum]]) is a thin layer: attached, medially, to the bases of the transverse processes lumbar vertebrae; below, to the iliolumbar ligament; above, to the apex and lower border of the last rib. Laterally, it blends with the lumbodorsal fascia, the anterior layer of which intervenes between the Quadratus lumborum and the erector spinae muscles.


#the Posterior Layer consists of two laminae: superficial (the aponeurosis of the LD); and deep lamina. In between these laminae above the L4 level, the aponeurosis of the SPI is present.
The three layers unite at the lateral margin of the paraspinal muscles, to form the tendon of origin of the Transversus abdominis. The aponeurosis of origin of the Serratus posterior inferior and the Latissimus dorsi are intimately blended with the TLF.<ref>IMAIOS TLF Available: https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Thoracolumbar-fascia (accessed 14.2.2022)</ref>
#the MLF is the fascial band that passes between the paraspinal muscles and the Quadratus Lumborum (QL). The anterior layer is defined as passing anterior to the QL and ending by turning posterior to pass between the QL and the psoas.
#the Anterior Layer has been described as being an extension of the transversalis fascia.
 
Authors using the two-layered model refer to the fascia anterior to the QL simply as transversalis fascia and exclude it from the model.
 
The illustration&nbsp;above shows the superficial muscles of the back. The thoracolumbar fascia is the gray area at bottom centre.
 
The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles.  
 
The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxialmusculature.<br>  


The nuchal fascia (fascia covering the [[Splenius Capitis|splenius]] and [[Semispinalis Capitis|semispinalis capitis]] muscles of the neck as a part of the cervical fascia) is a continuation of the posterior layer of the TLF.<ref>IMAIOS Nuchal fascia Available:https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Nuchal-fascia (accessed 14.2.2022)</ref><br> The video below gives a good functional view of the TLF{{#ev:youtube|https://www.youtube.com/watch?v=TS2lT_gFlus|width}}<ref name=":1">Education Institute Throacaolumbar fascia Available from: https://www.youtube.com/watch?v=TS2lT_gFlus (last accessed 25.5.2019)</ref>
== Function  ==
== Function  ==
[[File:Thoracolumbar fascia.jpeg|thumb|alt=|Thoracolumbar fascia]]


The unyielding character of the deep fascia enables it to serve as a means of containing and separating groups of muscles into relatively well-defined spaces called ‘compartments’. The deep fascia integrates these compartments and transmits load between them.  
The unyielding character of the deep fascia enables it to serve as a means of containing and separating groups of muscles into relatively well-defined spaces called ‘compartments’. The deep fascia integrates these compartments and transmits load between them.  


The TLF is a critical part of a myofascial girdle that surrounds the lower portion of the torso, playing an important role in the following functions<ref name="Willard et al" />:
Numerous trunk and extremity muscles with a wide range of thicknesses and geometries insert into the connective tissue planes of the TLF and can play a role in modulating the tension and stiffness of this structure 


*stabilisation  
The TLF, being important in the myofascial girdle that surrounds the lower portion of the torso, plays an important role in stabilisation and load transfer <ref name="Willard et al">The thoracolumbar fascia: anatomy, function and clinical considerations. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R.J Anat. 2012 Dec;221(6):507-36</ref>.
*load transfer


==== Stabilisation  ====
* The connection that the thoracolumbar fascia has with the posterior ligaments of the lumbar spine allows it to assist in supporting the vertebral column when it is flexed by developing fascial tension that helps control the abdominal wall<ref name="Gracovetsky">Determination of safe load. Gracovetsky S Br J Ind Med. 1986 Feb; 43(2): 120–133</ref>.
* When the spine is placed in full flexion, the TLF increases in length from the neutral position by about 30%<ref>Gracovetsky S, Farfan H F, Lamy C. The mechanism of the lumbar spine. Spine 1981; 6: 249-62.</ref>. The expansion in length of this tissue is accomplished by a tightening in width. This deformation places ‘strain-energy’ into the tissue, which should be recoverable in the form of reduced muscle work when the spine moves back in extension


The connection that the thoracolumbar fascia has with the posterior ligaments of the lumbar spine allows it to assist in supporting the vertebral column when it is flexed by developing fascial tension that helps control the abdominal wall<ref name="Gracovetsky">Determination of safe load. Gracovetsky S Br J Ind Med. 1986 Feb; 43(2): 120–133</ref>.  
=== Load Transfer Role Limbs ===
[[File:Muscles back drawing.jpeg|thumb|280x280px|Fascia: long downplayed as an insignificant protective layer on muscles and organs.|alt=]]
Vleeming et al<ref name="Vleeming et al">The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. LRSpine (Phila Pa 1976). 1995 Apr 1; 20(7):753-8.</ref> have highlighted the importance of the TLF in integrating the activity of muscles (traditionally regarded as belonging to the lower limb, upper limb, spine or pelvis and whose action is thus often considered in that territory alone).  


When the spine is placed in full flexion, the TLF increases in length from the neutral position by about 30%<ref>Gracovetsky S, Farfan H F, Lamy C. The mechanism of the lumbar spine. Spine 1981; 6: 249-62.</ref>. The expansion in length of this tissue is accomplished by a tightening in width. This deformation places ‘strain-energy’ into the tissue, which should be recoverable in the form of reduced muscle work when the spine moves back in extension
They argue that a common attachment to the TLF means that the latter has an important role in integrating load transfer between different regions.  


==== Load Transfer between upper and lower limbs<br> ====
In particular, they propose that the [[Gluteus Maximus|gluteus maximus]] and [[Latissimus Dorsi Muscle|latissimus dorsi]] (two of the largest muscles of the body) contribute to co-ordinating the contralateral pendulum-like motions of the upper and lower limbs that characterise eg [[Running Biomechanics|running]] or [[Swimming: Freestyle|swimming]]<ref name="Vleeming et al" />.


Vleeming et al<ref name="Vleeming et al">The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. LRSpine (Phila Pa 1976). 1995 Apr 1; 20(7):753-8.</ref> have highlighted the importance of the thoracolumbar fascia in integrating the activity of muscles traditionally regarded as belonging to the lower limb, upper limb, spine or pelvis and whose action is thus often considered in that territory alone. They have argued that a common attachment to the thoracolumbar fascia means that the latter has an important role in integrating load transfer between different regions. In particular,&nbsp;these authors&nbsp;have proposed that [[Gluteus Maximus|gluteus maximus]] and latissimus dorsi (two of the largest muscles of the body) contribute to co-ordinating the contralateral pendulum like motions of the upper and lower limbs that characterize running or swimming<ref name="Vleeming et al" />. They suggest that the muscles do so because of a shared attachment to the posterior layer of the thoracolumbar fascia.&nbsp;  
They suggest doing this via their shared attachment to the posterior layer of the TLF.&nbsp;


== Pathology/Injury&nbsp; ==
== Clinical Significance ==
[[File:Mr-lee-f4RBYsY2hxA-unsplash.jpeg|thumb|420x420px|Stretching the TLF]]The existing research suggests that the lumbodorsal fascia may play a role in causing  [[Mechanical low back pain|low back pain]] (LBP) through nociceptive mechanisms. <ref name=":2" />


People are starting to investigate the TLF&nbsp;as a potential pain-generating structure in the back<ref name="U/s evidence TLF" />], its role in[[Mechanical low back pain|low back pain ]](LBP) pathophysiology is poorly understood. In a study using ultrasound, patients with chronic LBP of more than 12 months duration&nbsp;were found to have&nbsp;increased thickness and echogenicity&nbsp;(thought to be a result of the presence of fat)&nbsp;of the the thoracolumbar fascia in the low back <ref name="U/s evidence TLF">Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH:  Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. In Fascia research ii. Edited by Huijing PA, Hollander AP, Findley T, Schleip R. Elsevier, Munich; 2009</ref>]. Abnormal connective tissue structure may be a predisposing factor for LBP, or a consequence of injury and/or changes in movement patterns occurring as a result of chronic pain. A potentially important consequence of injury may be fibrosis and adhesions, causing loss of independent motion of adjacent connective tissue layers which could further restrict body movements.  
The first quantitative study on abnormal connective tissue structure in the lumbar region in people with chronic LBP of more than 12 months duration<ref name="U/s evidence TLF">Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH:  Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. In Fascia research ii. Edited by Huijing PA, Hollander AP, Findley T, Schleip R. Elsevier, Munich; 2009</ref>,  using [[Ultrasound Scans|ultrasound]], found increased thickness and echogenicity (thought to be a result of the presence of fat) of the perimuscular connective tissue structure in the lumbar region in the LBP group compared to the No-LBP group. Abnormal connective tissue structure may be a predisposing factor for LBP, or a consequence of injury and/or changes in movement patterns occurring as a result of chronic pain. A potentially important consequence of injury may be fibrosis and adhesions, causing loss of independent motion of adjacent connective tissue layers which could further restrict body movements. <ref name="U/s evidence TLF" />


== Resources  ==
The below video shows an injury to TLF on MRI and US images ...excuse the push for plasma-guided injections at the end.
{{#ev:youtube|https://www.youtube.com/watch?v=AqMQrXttxVE|width}}<ref>Chris Centeno TLF injury causing back pain Available from: https://www.youtube.com/watch?v=AqMQrXttxVE (last accessed 25.5.2019)</ref>


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed)]  ==
== Treatment ==
<div class="researchbox">
For people with [[Chronic Low Back Pain|chronic low back pain]], [[Myofascial Release|myofascial release]] of the lumbar region has a higher and moderate level of evidence of pain improvement compared to other osteopathy techniques. <ref>Dal Farra F, Risio RG, Vismara L, Bergna A. [https://www.sciencedirect.com/science/article/pii/S0965229920318835 Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis.] Complementary Therapies in Medicine. 2021 Jan 1;56:102616.</ref>
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1z_pxc-9fhPQGP1Z0xX_DYsZlUGa_rZV4LP2TQQ3L_ayPSrEDw|charset=UTF-8|short|max=10</rss>  
</div>
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial.]]  
A study suggests that [[Myofascial Release|myofascial release]] and [[Instrument Assisted Soft Tissue Mobilization|Graston]] techniques can be applied to TLF as they showed similar results such as increased lumbar range of motion and proprioception in the acute period of young adults. <ref>GÜNEŞ, Musa; YANA, Metehan. Acute effects of thoracolumbar fascia release techniques on range of motion, proprioception, and muscular endurance in healthy young adults. ''Journal of Bodywork and Movement Therapies'', 2023, 35: 145-150.</ref>


== References  ==
<references /> &nbsp;  
<references /> &nbsp;  


[[Category:Low_Back_Pain]] [[Category:Lumbar_Anatomy]]
[[Category:Lumbar Spine]]  
[[Category:Lumbar Spine - Anatomy]]
[[Category:Lumbar Spine - Muscles]]
[[Category:Thoracic Spine]]
[[Category:Thoracic Spine - Anatomy]]
[[Category:Thoracic Spine - Muscles]]

Latest revision as of 14:33, 1 September 2023

Original Editor - Wendy Walker

Lead Editors - Wendy Walker, Lucinda hampton, Kim Jackson, Sehriban Ozmen, WikiSysop, Naomi O'Reilly and Bruno Serra

Description[edit | edit source]

The thoracolumbar fascia is the gray area at bottom center.

The thoracolumbar fascia (TLF) is a girdling structure consisting of several aponeurotic and fascial layers that separate the paraspinal muscles from the muscles of the posterior abdominal wall.

Most developed in the lumbar region, it consists of multiple layers of crosshatched collagen fibres that cover the back muscles in the lower thoracic and lumbar area before passing through these muscles to attach to the sacrum. Above, it is continuous with a similar investing layer on the back of the neck—the nuchal fascia. [1][2]

The TLF is a critical part of a myofascial girdle that surrounds the lower portion of the torso, playing an important role in posture, load transfer and respiration. [1] The fascial system is a "fibrous collagenous tissue which is part of a body-wide tensional force transmission system".[3]

The TLF contains nociceptive free nerve endings and has been proposed to represent a possible source of idiopathic low back pain. In addition, chemical stimulation of the TLF nociceptors has been shown to elicit severe and particularly long-lasting sensitization processes. [4]

Injury to the thoracolumbar fascia usually manifests as tightness, spasticity and increased tone in the lower thoracic spine and lumbar spine / paraspinal regions causing severe pains. [5]

Anatomy[edit | edit source]

The TLF ( or lumbodorsal fascia) is a deep investing membrane that covers the deep muscles of the back of the trunk.

In the thoracic region, the TLF forms a thin covering for the extensor muscles of the vertebral column. Medially, it is attached to the spines of the thoracic vertebrae, and laterally it is attached to the ribs, near their angles[6].

Transverse section: posterior abdominal wall - the disposition of the TLF fascia.

In the lumbar region the TLF is divided into three layers (previously described as two layers, anterior and posterior):

  1. The posterior layer: is attached to the spinous processes of the lumbar and sacral vertebrae and the supraspinal ligament;
  2. The middle layer (previously anterior layer): attached, medially, to the tips of the transverse processes lumbar vertebrae and the intertransverse ligaments; below, to the iliolumbar ligament; above, to the lumbocostal ligament.
  3. The anterior layer (fascia Covering the Quadratus Lumborum) is a thin layer: attached, medially, to the bases of the transverse processes lumbar vertebrae; below, to the iliolumbar ligament; above, to the apex and lower border of the last rib. Laterally, it blends with the lumbodorsal fascia, the anterior layer of which intervenes between the Quadratus lumborum and the erector spinae muscles.

The three layers unite at the lateral margin of the paraspinal muscles, to form the tendon of origin of the Transversus abdominis. The aponeurosis of origin of the Serratus posterior inferior and the Latissimus dorsi are intimately blended with the TLF.[7]

The nuchal fascia (fascia covering the splenius and semispinalis capitis muscles of the neck as a part of the cervical fascia) is a continuation of the posterior layer of the TLF.[8]
The video below gives a good functional view of the TLF

[6]

Function[edit | edit source]

Thoracolumbar fascia

The unyielding character of the deep fascia enables it to serve as a means of containing and separating groups of muscles into relatively well-defined spaces called ‘compartments’. The deep fascia integrates these compartments and transmits load between them.

Numerous trunk and extremity muscles with a wide range of thicknesses and geometries insert into the connective tissue planes of the TLF and can play a role in modulating the tension and stiffness of this structure

The TLF, being important in the myofascial girdle that surrounds the lower portion of the torso, plays an important role in stabilisation and load transfer [9].

  • The connection that the thoracolumbar fascia has with the posterior ligaments of the lumbar spine allows it to assist in supporting the vertebral column when it is flexed by developing fascial tension that helps control the abdominal wall[10].
  • When the spine is placed in full flexion, the TLF increases in length from the neutral position by about 30%[11]. The expansion in length of this tissue is accomplished by a tightening in width. This deformation places ‘strain-energy’ into the tissue, which should be recoverable in the form of reduced muscle work when the spine moves back in extension

Load Transfer Role Limbs[edit | edit source]

Fascia: long downplayed as an insignificant protective layer on muscles and organs.

Vleeming et al[12] have highlighted the importance of the TLF in integrating the activity of muscles (traditionally regarded as belonging to the lower limb, upper limb, spine or pelvis and whose action is thus often considered in that territory alone).

They argue that a common attachment to the TLF means that the latter has an important role in integrating load transfer between different regions.

In particular, they propose that the gluteus maximus and latissimus dorsi (two of the largest muscles of the body) contribute to co-ordinating the contralateral pendulum-like motions of the upper and lower limbs that characterise eg running or swimming[12].

They suggest doing this via their shared attachment to the posterior layer of the TLF. 

Clinical Significance[edit | edit source]

Stretching the TLF

The existing research suggests that the lumbodorsal fascia may play a role in causing low back pain (LBP) through nociceptive mechanisms. [4]

The first quantitative study on abnormal connective tissue structure in the lumbar region in people with chronic LBP of more than 12 months duration[13], using ultrasound, found increased thickness and echogenicity (thought to be a result of the presence of fat) of the perimuscular connective tissue structure in the lumbar region in the LBP group compared to the No-LBP group. Abnormal connective tissue structure may be a predisposing factor for LBP, or a consequence of injury and/or changes in movement patterns occurring as a result of chronic pain. A potentially important consequence of injury may be fibrosis and adhesions, causing loss of independent motion of adjacent connective tissue layers which could further restrict body movements. [13]

The below video shows an injury to TLF on MRI and US images ...excuse the push for plasma-guided injections at the end.

[14]

Treatment[edit | edit source]

For people with chronic low back pain, myofascial release of the lumbar region has a higher and moderate level of evidence of pain improvement compared to other osteopathy techniques. [15]

A study suggests that myofascial release and Graston techniques can be applied to TLF as they showed similar results such as increased lumbar range of motion and proprioception in the acute period of young adults. [16]

References[edit | edit source]

  1. ↑ 1.0 1.1 Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of anatomy. 2012 Dec;221(6):507-36.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512278/ (accessed 14.2.2022)
  2. ↑ Askinglot What is thoracolumbar fascia?Available: https://askinglot.com/what-is-thoracolumbar-fascia(accessed 14.2.2022)
  3. ↑ George T, De Jesus O. Physiology, Fascia.2021 Available: https://www.ncbi.nlm.nih.gov/books/NBK568725/(accessed 14.2.2022)
  4. ↑ 4.0 4.1 Wilke J, Schleip R, Klingler W, Stecco C. The lumbodorsal fascia as a potential source of low back pain: a narrative review. BioMed research international. 2017 May 11;2017.
  5. ↑ Kenhub Thoracolumbar fascia Available:https://www.kenhub.com/en/library/anatomy/thoracolumbar-fascia (accessed 14.2.2022)
  6. ↑ 6.0 6.1 Education Institute Throacaolumbar fascia Available from: https://www.youtube.com/watch?v=TS2lT_gFlus (last accessed 25.5.2019)
  7. ↑ IMAIOS TLF Available: https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Thoracolumbar-fascia (accessed 14.2.2022)
  8. ↑ IMAIOS Nuchal fascia Available:https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Nuchal-fascia (accessed 14.2.2022)
  9. ↑ The thoracolumbar fascia: anatomy, function and clinical considerations. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R.J Anat. 2012 Dec;221(6):507-36
  10. ↑ Determination of safe load. Gracovetsky S Br J Ind Med. 1986 Feb; 43(2): 120–133
  11. ↑ Gracovetsky S, Farfan H F, Lamy C. The mechanism of the lumbar spine. Spine 1981; 6: 249-62.
  12. ↑ 12.0 12.1 The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. LRSpine (Phila Pa 1976). 1995 Apr 1; 20(7):753-8.
  13. ↑ 13.0 13.1 Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH: Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. In Fascia research ii. Edited by Huijing PA, Hollander AP, Findley T, Schleip R. Elsevier, Munich; 2009
  14. ↑ Chris Centeno TLF injury causing back pain Available from: https://www.youtube.com/watch?v=AqMQrXttxVE (last accessed 25.5.2019)
  15. ↑ Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2021 Jan 1;56:102616.
  16. ↑ GÜNEŞ, Musa; YANA, Metehan. Acute effects of thoracolumbar fascia release techniques on range of motion, proprioception, and muscular endurance in healthy young adults. Journal of Bodywork and Movement Therapies, 2023, 35: 145-150.

 

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