Thoracolumbar Fascia: The Diamond in our Work - By Jo Wortley

Author: Jo Wortley - Director & Tutor at the College of Bowen Studies, and Therapist at Suffolk Bowen Therapy based in Bury St Edmunds.

Thoracolumbar Fascia: The Diamond in our Work

Anyone who has attended one of my Fascia Bowen CPD courses knows how animated I get when I start talking about Thoracolumbar Fascia (TLF).  It is one of the coolest and visually beautiful parts of the human anatomy in my opinion. This flat diamond-shaped white sheet of tendinous tissue with a pearlescent sheen, binds muscle to other muscles and bone.  Only with a scalpel, a great deal of patience and under the bright lights of the dissection room, it is possible to genuinely appreciate its beauty.  In the dissection room it also becomes blindingly obvious that what we see in an anatomy book is simply a two-dimensional adaptation of what a person may look like beneath the skin.  In reality the proportions and location of muscle, fascia, viscera and bone varies massively from one form to another, and the two-dimensional interpretation of the TLF simply cannot portray the three-dimensional reality and significance of this structure.  By the end of this article you will understand some of the properties of TLF, but more importantly realise why making moves over this structure is essential in every Bowen treatment.

There is a huge amount of information available specifically about the properties and functions of the various types of fascia.  To find out more about this subject, further reading will be required.  As you will discover some authors will have opposing views, as it is only in relatively recent years that any real research and study has been carried out to learn more about this incredible organ.  I will provide a brief overview for the purpose of explaining TLF, which is formed from a combination of aponeurotic sheets and fascia.  To prevent any confusion, I will continue to refer to TLF using it’s traditional terminology of ‘fascia’.  ‘Fascia’ is generally defined as connective tissue composed of irregularly arranged collagen fibres.  Its structure allows it to withstand stress from multiple directions and act as a shock absorber, whereas ‘aponeurotic sheets’ have a regular arrangement of collagen fibres, providing strength to withstand force in certain directions, whilst rendering it vulnerable in others.  The deep fascia of the musculoskeletal system which I am referring to here, provides structure, shape and support, surrounding the bones, muscles, tendons and any aponeurosis.  It also very wet, which allows adjacent structures slide against one another to facilitate movement.  TLF essentially acts as a ‘girdle’ assisting in the postural stability of the body.  Visualise this ‘girdle’ being made not of woven fabric, but of multiple strands of connective tissue, each strand pulled taut in the same direction, the fibres side by side, stretching from one anatomical structure to another to create a tensional sheet.  These flat ‘sheets’ of fascia overlay one another to create an incredibly strong structure which is referred to as an ‘aponeurosis’.

The posterior view of TLF displays this diamond shape I mentioned earlier, and as the name implies provides the connection between the thoracic structures and the three large lumbar muscles (iliocostalis, longissimus and multifidus) which it wraps around. TLF is three-dimensional and is known to have three distinct layers. The upper section of this fascial ‘diamond’ attaches to the thoracic muscles, including latissimus dorsi and serratus posterior inferior.  The middle layer wraps around the erector spinae muscles, forming a cylinder which extends from the sacrum to the base of the skull.  There is also an attachment along the lateral edge of TLF with the abdominal muscles – including transversus abdominis, internal obliques, quadratus lumborum and psoas, whilst the lower portion of the ‘diamond’ thickens and firmly attaches to the posterior iliac crests, the sacrum, ischial tuberosities and the glutes.  So we can see that the TLF girdle plays a significant role in posture – both static and during movement, as well as load transfer and respiration.   In addition to attaching the thoracic structures to the lumbar structures, it connects the latissimus dorsi and gluteus maximus, thus functionally linking the arm with the leg. Thus, the TLF ‘girdle’ is not simply a diamond shaped piece of fascia, but a complex arrangement of multi-layered fascial planes and aponeurotic sheets.

So far I have focussed on the mechanical properties of the TLF however, it’s way cooler than that!  Work carried out by Robert Schleip and his team revealed that TLF is also a sensory organ.  They discovered the existence of nociceptors (pain receptors) within the TLF, suggesting that it is a possible source of low back pain.  In addition, most of the neurons received input from the skin and other deep tissues including the lower back, abdominal wall, hip and leg, which may explain the diverse nature of lower back pain in our clients.  In fact, fascia could be a more important pain source than the muscles of the lower back or other soft tissues.   In addition, research shows that the TLF exhibits a high density of mechanoreceptors including Ruffini (which respond to skin stretch) and Vater-Paccini corpuscles (which respond to deep pressure and high frequency vibration).  The presence of these receptors suggests that the TLF could be involved not only in the control of the lumbar spine, but afferent (sensory) proprioceptive information, i.e. implicit information about joint position and movement.  In clients with chronic pain, proprioception is impaired, and studies indicate that connective tissue structures in the painful body parts exhibit pathological changes.  Lying on top of and connected to the Thoracolumbar fascia is of course the skin and the underlying superficial fascia – which has a whole array of other properties and functions, which due to time constraints I’m not going to go into now.

In summary, the proprioceptive ability and numerous attachments to the TLF could go some way to explain how it is possible to achieve such dramatic change in our clients with just a few, very specific Bowen moves.  It is the most stress-loaded part of the body and as such stores an incredible amount of potential energy. It is clear to see that making Bowen moves over the thoracolumbar fascia has the potential to affect our clients breathing, movement, posture and pain.  Bowen Therapists are taught to address this area before any other part of the body, in every single Bowen session.  When we make Bowen moves over TLF it has initiates the same response as a conductor tapping his baton at the beginning of an orchestral symphony – the body is alert and paying attention.  So where might the best place be, to make a Bowen move that will affect the largest number of attachments? Right in the middle:  Ladies and Gentlemen, please show your appreciation for the Bottom Stoppers!

 

References:

Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R (2012) Journal of Anatomy: The thoracolumbar fascia: anatomy, function and clinical considerations

Schleip R, Findley TW, Chaitow L, Huijing P (2012) Fascia: The Tensional Network of the Human Body 95-100 Churchill Livingston Elsevier.

Kopeinig, C., Gödl-Purrer, B. & Salchinger, B. Fascia as a Proprioceptive Organ and its Role in Chronic Pain - a Review of Current Literature. Saf Health 1, A2 (2015). https://doi.org/10.1186/2056-5917-1-S1-A2

Bio.libratexts.org (2019) 36.2A Somatosensory Receptors

 

Further reading:

Fascia the Tensional Network of the Human Body. (2012) Schleip R, Findley TW, Chaitow L, Huijing P

 

Jo is a Bowen Therapist and Bowen Tutor, based in Bury St Edmunds, Suffolk.  Find her at Suffolk Bowen Therapy in Bury St Edmunds.