resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
January, 2015, Vol. 15, Issue 01
The Body's Load-Sharing Hub: The Thoracolumbar Fascia
By Leon Chaitow, ND, DO
Have you ever wondered why you swing your arms when walking? It's largely due to kinetic energy being stored and released in the thoracolumbar fascia (TLF), as forces from the lower body transfer upwards - and vice-versa.
Consider, for example, direct mechanical force-transmission from the lower extremity to the pelvis and the trunk, as load (tension) is transferred between the hamstrings, the sacro-tuberous ligament and gluteus maximus, and on to the contralateral latissimus dorsi, by means of forces transmitted via the superficial and deep layers of the TLF.
Because of their direct connections to the TLF, this transferred load also directly influences the behavior of the erector spinae muscles, as well as external and internal obliques, transversus abdominis and serratus posterior inferior ... and more. Any dysfunctional situations, in any of these (or anything they connect to and with), has the ability to alter the function of all the other listed muscles, with unpredictable symptoms emerging relating to either restriction, pain or motor control, or all of these.
The "load-transfer" process involves a virtual spring-loading of the amazing TLF junctional area, the hub, where forces from the lower body, upper body, abdominal area and the trunk are spread and shared. This virtual hub contains some remarkable features where distribution of load is even more concentrated – such as the Lumbar Interfascial Triangle (LIFT) - which is discussed later in this article.
Therapists Need To Know About The TLF
How might awareness of these links help your work to be more effective? Quite simply - manual therapists (and those working with movement/exercise methods) who understand the multiple connections formed, via the TLF, can focus their methods more appropriately.
For example, a painful knee can - in many cases - be shown to be connected to gluteus maximus dysfunction, which may itself be being negatively influenced by inappropriate load reaching it from the contralateral latissimus dorsi – which is itself being influenced by myofascial events in pectoral and cervical structures.
Stecco et al (2014) describe their findings following 12 successive dissections: "In all (12) subjects gluteus maximus presented a major insertion into the fascia lata, so large that the iliotibial tract could be considered a tendon of insertion of the gluteus maximus ... [explaining] ... transmission of the forces from the thoraco-lumbar fascia to the knee ... possibly explaining why hypertonicity of gluteus maximus could cause an iliotibial band friction syndrome (IBFS) or, more generally, knee pain."
Sliding And Gliding Between Fascial Layers
Each layer of dense fascia is separated from the layers above and below by a thin layer of loose connective tissue that permits the different deeper layers to slide on each other. This allows the multiple directions of force, generated by different muscular orientations, to be transmitted smoothly.
Where unexplained musculoskeletal dysfunction exists (restriction, or pain for example) it is possible that reduction in the sliding/gliding function between the different fascial layers that make up the TLF, might be causing it to fail in its efficient transmission of load/force.
When it is healthy and operating normally, this remarkable structure, (the TLF) structurally and functionally connects the legs to the arms, the abdominal muscles to the low back muscles, the hamstrings to the neck, the gluteal muscles to the arms – simultaneously transferring forces in multiple directions, while also allowing sliding and gliding functions between its various layers of deep and superficial fascia and muscle. It therefore deserves the focused attention of all manual therapists – for when it is not functioning well due to trauma, inflammation, overuse, misuse, disuse and or age - a variety of symptoms can emerge – ranging from back pain to poor motor-control and balance problems.
Helene Langevin and her colleagues (2011) have shown that reduction of fascia's gliding potential in the thoracolumbar area (described technically as "reduced thoracolumbar shear strain"),is strongly associated with increased thickness of some fascial layers in the TLF, and in males in particular, this seems to predispose to low back pain. This gender-bias between a free sliding motion of fascia in the TLF, the thickness (or "densification") of some connective tissue layers, and low back pain, remains unexplained. Note: Some of the main reasons for fascial dysfunction are discussed later in this article.
As previously mentioned, the thoracolumbar fascia (TLF) integrates forces deriving from connective tissues, as well as numerous active muscular structures that attach to the fascial layers, including aponeurotic and fascial structures that separate paraspinal muscles from the muscles of the posterior abdominal wall.
The superficial posterior layer of the TLF is mainly an aponeuroses of latissimus dorsi and serratus posterior inferior, while deep to this is sheath that encapsulates the paraspinal muscles that support the lumbosacral spine.
Where this sheath meets the aponeurosis of transversus abdominus, it forms a seam-like ridge (known as as a raphe [pronounced "rafe" – see illustration of the TLF]. This dense septum is the junction of the structures anterior and posterior to the spine - where the Lumbar Interfascial Triangle (LIFT) is formed.
The LIFT is a remarkable structure (a "roundhouse" in Tom Myers terminology) that helps to distribute load from the abdominal and extremity muscles into, across, and from, the TLF.
Inferiorly, all the layers of the TLF fuse, to merge with the posterior superior iliac spine, and the sacrotuberous ligament, (which links directly to the hamstring group) - assisting in support of the lower lumbar spine and sacroiliac joint, and sharing load with the lower extremity.
Load reaching the LIFT from the abdominal muscles, latissimus dorsi, the lower extremity and pelvic muscles, are therefore appropriately distributed, in order to assist in stabilizing the spine, trunk and pelvis.
Strain Transmission During Stretching
Research has now explained more about how muscular forces are transferred – largely via fascia – to surrounding and distant tissues. For example, Franlklyn-Miller and colleagues (2009) have shown that when the hamstring group of muscles are stretched – as in straight-leg raising – whatever the degree of force being used in that stretch is multiplied greatly – so that 240% of that load reaches the iliotibial band, and 145% of the load transfers to the same-side low back, via the TLF.
The evidence is quite clear therefore – that the use of the word isolated in conjunction with the word stretching is difficult to justify. We need to learn more about which tissues are affected when stretching or compression is used – where load transfers to – and from - and where dysfunction might be coming from when we identify it!
The TLF As a Sensory Center
The thoracolumbar fascia is a richly innervated, with marked differences in the distribution of the nerve endings, over various fascial layers: The superficial fascia contains a dense presence of sensory mechanoreceptors (such as Pacini receptors and Ruffini endings). Substance P-positive free nerve endings—assumed to be nociceptive—are exclusively found in these layers. "The finding that most sensory fibers are located in the outer layer of the fascia, and the subcutaneous tissue, may explain why some manual therapies that are directed at the fascia and the subcutaneous tissue (e.g. fascial release) are often painful."
How Fascial Problems Start
Fascial dysfunction may result from slowly evolving trauma (disuse, overuse and misuse), or sudden injury (abuse) leading to inflammation and inadequate remodeling (such as excessive scarring or development of fibrosis):
The more manual therapists know about and understand structures such as the TLF the more they will be able to understand their patient's symptoms, and be able to help them towards recovery from pain and restriction.
New Book on Fascial Dysfunction
In my new book, Fascial Dysfunction: Manual Therapy Approaches, I have explored and explained fascia's multiple roles in the body, as well as the ways fascial dysfunction starts and develops – based on translation of the avalanche of scientific research that is emerging.
In addition, the book contains guides to assessment protocols (including a chapter by Tom Myers), as well as chapters that examine a wide range of fascia-focused treatment approaches - involving contributions from approximately 20 leading experts.
In a future article, I will focus attention on which manual approaches have demonstrated evidence of efficacy.
Click here for more information about Leon Chaitow, ND, DO.
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