Thoracolumbar Fascia, the Lati Dorsi and Low Back Pain
/There is no one size fits all approach to assessing and treating lower back pain. Each person deserves to be treated with curiosity and as open of a mind as possible. Of course, there are key characters like the psoas and quadratus lumborum, there is tension distributed into the low back via shortened hamstrings, and treating the glutes (especially glute medius) is often gold.
I want to shine a little light on the lat and its relationship with the thoracolumbar fascia (TLF) and how this relationship can contribute to pain in the lower back. This specific dynamic recently showed up treating an acute low back pain case.
About halfway through the treatment and after working through the layers of presenting tension patterns, TLF, tissues at the thoracolumbar junction, QL and glutes, there was an obvious pull going up the left posterior-lateral side. It was clear, as we followed it, that the tension was coming from the lat. It wasn’t exactly what I was expecting in an acute LBP case and yet it is a relationship I’m familiar with.
As we treated it, the person noted referrals through much of the pain pattern she was experiencing, including wrapping around the left ilium anteriorly.
Let’s Map It!
Latissimus dosi muscle (GREY’S ANATOMY)
Most of us are most familiar with the lat’s relationship with the scapula and humerus and see it as an arm/shoulder muscle. Absolutely true and relevant. And… did you know that histologically, the fibers of the TLF (one of the most important structures of the lower back when it comes to pain and myofascial relationships), originate from the lat and not the other way around.
The book says the lat attaches to the spinous processes and it does. Before it gets to them, it merges with the fibers of the TLF at its lateral border. So, if we include myofascial relationships into our understanding of muscle connections and don’t only focus on bony attachments and much different picture emerges.
It’s interesting to compare the Grey’s image of the lat with this highly schematic rendering of the bladder sinew channel from Chinese medical anatomy. Sinew channels are fascial channels related to the main meridian in Chinese medicine. They are an aspect of the Chinese medical anatomy framework. These pathways can give us insights into myofascial and energetic relationships in the body. Here we can see a link going from the main pathway up the back (which correlates with the posterior myofascial pathway) to the scapula very similar to how the lat connects.
The lat blends into the TLF and follows it inferiorly to the ilium. There are also some bony attachments. The lat then wraps around the ilium, sharing some myofascial relationship with the external oblique and attaches onto the inguinal ligament.
In this specific case the lat was a major source of tension along with the TLF. I can’t, nor do I care to know, which was the original source of tension, the body was simply very clear that this pathway was important to include in treatment.
BLADDER SINEW CHANNEL
(A MANUAL OF ACUPUNCTURE, PETER DEADMAN)
We worked at the scapular portion with broad myofascial contact connecting that aspect with the TLF. It was through this work that the patient experienced the referrals into the left ilium. As we continued including the lat fibers into treatment the tlf and other tissues of the lower back began to soften more.
Treatment continued, including the psoas and direct treatment of the transversus abdominus and obliques at the left ilium. However, it was including the lat that really opened the system up for more significant change.
The patient reported that the treatment combined with their at-home self-care with soft release balls and gentle stretching had them feeling 85% - 90% better the next day.
For more information, check out our Myofascial Release: Upper Body + Core curriculum.
