The thoracolumbar fascia is a structure in the lower back that is comprised of layers of densely packed collagen and elastic fibers separated by loose connective tissue that allow the deep stabilizing muscles in the lower back to move independently of the superficial muscles used for twisting and bending forward and backward. When adhesions form in the fascia, movement can become restricted, which can lead to pain and disability in the lower back and nearby parts of the body. A January 2023 study that included 131 adults—68 with low back pain—revealed a 25-30% reduction in thoracolumbar fascia elasticity among those with low back pain. This suggests that improving the function of the thoracolumbar fascia is essential in the management of low back pain. So, what can your doctor of chiropractor do to improve the elasticity of these important tissues?
The most common technique used to address adhesions in the thoracolumbar fascia is a manual therapy technique called myofascial therapy or myofascial release. Myofascial release is a hands-on treatment in which a doctor of chiropractic applies pressure with their hands, elbow, or a tool to stretch the muscles to knead out trigger points or adhesions that may inhibit the ability of the muscles to slide against one another during normal movements. In the last thirty years, various forms of myofascial therapy have been developed and disseminated to healthcare professionals who apply hands-on care, which includes doctors of chiropractic. In addition to care provided in the office, patients may also be instructed on self-myofascial release, which may include the use of a foam roller, for example.
In 2021, two systematic reviews—studies that pool data from previously published studies—concluded that myofascial therapy is effective for reducing disability and pain in patients with low back pain. More recently, a 2023 study that included 48 patients with low back pain found that those treated with a single session of myofascial therapy experienced a significant decrease in pain and thickness of the thoracolumbar fascia, in addition to a reduction in stiffness in the erector spinae muscles and thoracolumbar fascia. Follow-up examinations after the treatment showed the benefits persisted two and seven days later.
In many cases, there are many contributing factors to a patient’s low back pain that must all be addressed to achieve a satisfactory result. This starts with a thorough examination to understand the patient’s unique situation and extends to a multimodal approach that incorporates several treatment methods to reduce pain and improve mobility in the lower back, which can include myofascial treatment to break down adhesions in the thoracolumbar fascia to allow for proper movement. In fact, an October 2022 study found that a multimodal chiropractic treatment plan that included spinal manipulation, education, exercise, self-management advice, and myofascial therapies led to improvements in pain, disability, and thoracolumbar fascia mobility in women with chronic low back pain.