Tag: pain

Rethinking Back Pain: The Role of Fascia

Today I want to talk about something I’ve seen as a primary source of pain in countless patients—yet it’s rarely mentioned in medical school or by most doctors. While I’m still exploring the best ways to keep fascia healthy over the long term—through stabilizing exercises, muscle balancing, and movement practices—I’ve consistently found that massage, cupping, and acupuncture can bring meaningful relief.

For now, let’s start with the basics: what fascia is, and more specifically, the type I most often hear patients describe as the exact spot of their pain—the thoracolumbar fascia.

What Is Fascia?

Fascia is a type of connective tissue in your body—it’s kind of like a full-body spiderweb made of collagen that surrounds and supports everything: muscles, bones, nerves, blood vessels, and organs. It’s not just passive packing material—it’s dynamic, sensitive, and deeply involved in how your body moves and feels.

🧠 Key Facts

  • Structure: Tough but flexible, fascia is made mostly of collagen fibers arranged in a multidirectional web.
  • Function: It holds things in place, transmits force, reduces friction, and allows structures to slide smoothly over each other.
  • Layers:
    • Superficial fascia: just beneath the skin, often containing fat.
    • Deep fascia: wraps around muscles and bones.
    • Visceral fascia: encases internal organs.

Fascia can get tight, stuck, or inflamed, contributing to pain and mobility restrictions—even far from the original source. It’s richly innervated, meaning it plays a major role in proprioception and pain perception. Manual therapies (like massage, myofascial release, or acupuncture) often aim to restore its glide and elasticity.

🧱 Thoracolumbar Fascia (TLF)

The thoracolumbar fascia (TLF) is a major fascial structure in your lower back—like a thick, multilayered tension bridge connecting your upper and lower body. It’s central to stability, movement, and force transmission, especially through your core and spine.

📍 Location

The TLF spans from the thoracic spine to the sacrum, stretching laterally to the ribs and hips, and includes three layers:

  • Posterior layer: Just under the skin and superficial muscles like the latissimus dorsi.
  • Middle layer: Between the deep back muscles (e.g., multifidus) and quadratus lumborum.
  • Anterior layer: Deepest, lying in front of quadratus lumborum and connecting to the psoas.

🏋️‍♂️ Function and Importance

  1. Core Stability:
    Acts like a natural weightlifting belt by anchoring key muscles:
    • Latissimus dorsi
    • Gluteus maximus
    • Transversus abdominis
    • Internal obliques
      These muscles create tension through the fascia to stabilize the spine.
  2. Force Transmission:
    Transfers power between upper and lower body—especially important in walking, running, lifting, and rotation.
  3. Back Pain:
    Adhesions or tension in the TLF can reduce mobility and contribute to chronic or mechanical low back pain.
  4. Sensory Function:
    Fascia is packed with sensory nerves. Dysfunction here doesn’t just feel tight—it can generate real pain and disrupt body awareness.

🔧 Clinical Implications

  • Manual therapies (massage, cupping, acupuncture) can reduce tension and improve glide between fascial layers.
  • Engaging muscles like the transversus abdominis through exercises (planks, dead bugs, etc.) strengthens the fascial tensioning system.
  • Dysfunction in the glutes, lats, or obliques can create asymmetrical pulls, affecting spinal mechanics via the TLF.

🧩 Summary

The thoracolumbar fascia acts as a central tension system for the torso, tying together posture, movement, stability, and sensation. If something’s off in your core, hips, or back, chances are the TLF is part of the story.

Back Pain Prevention – The 3 Exercises Spine Experts Trust

The McGill Big 3 are a trio of core stabilization exercises developed by Dr. Stuart McGill, a leading spine biomechanist. These exercises aim to build core endurance and protect the spine by training the muscles that support it — without placing excessive stress on the lower back.

They are especially popular in rehab, physical therapy, and strength coaching communities for people recovering from low back pain or looking to prevent it.

💪 The McGill Big 3

  1. Curl-Up
    • Target: Rectus abdominis (front of the core)
    • How to do it:
      • Lie on your back with one leg straight and the other bent (foot flat).
      • Hands go under your lower back to maintain a neutral spine.
      • Gently lift your head, shoulders, and chest slightly off the floor — just enough to engage the abs — then hold for 10 seconds.
      • Avoid flexing the spine like a crunch. Keep the neck in a neutral position.
    • Purpose: Builds abdominal endurance without stressing the spine via flexion.
  2. Side Plank
    • Target: Obliques and lateral stabilizers
    • How to do it:
      • Lie on your side with your elbow under your shoulder, legs straight, top foot in front of the bottom.
      • Lift hips to form a straight line from shoulders to feet.
      • Hold for 10 seconds (or longer, if trained), then switch sides.
    • Modifications: Beginners can bend knees or use a hand for assistance.
  3. Bird Dog
    • Target: Posterior chain (low back, glutes, shoulders)
    • How to do it:
      • Start in tabletop position (hands and knees).
      • Extend one arm forward and the opposite leg back.
      • Keep hips and shoulders square — no twisting.
      • Hold for 10 seconds, then switch sides.
    • Focus: Controlled movement, minimal spinal motion.

🔁 Programming Notes

  • McGill suggests: 3–5 reps per side, 10-second holds, multiple sets if needed.
  • Quality > quantity: These exercises emphasize stability and control, not brute strength or fatigue.
  • Often used as a warm-up or daily core routine, especially in rehab settings.

For more information and visuals visit:
https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/

The Basics of Physical Therapy: What I Tell My Patients Most Often

Disclaimer: With this and any other blog post, please note that nothing written here is a substitute for getting specifically tailored advice from a specialist/provider.

Much of the physical therapy information I share with patients comes from Dr. Aaron Horschig of SquatUniversity.com. While the information is geared towards lifters, I find his information to be well researched and widely applicable.

The main idea is that pain often comes down to mobility and stability issues that can be corrected over time with consistent use of proper stretches and stabilization exercises.

While specific evaluation of a patient is necessary to gear a treatment plan for someone, there are some broadly applicable themes for most cases.

Let’s look at the shoulder for instance. Stiffness and tightness around the shoulders might be due to stuck or spasmed muscles around the shoulder such as the trapezius (trap) or latissimus dorsi muscles (lats). Alternatively, you might be dealing with the very common issue of under-trained or underactive rotator cuff muscles, which are meant to stabilize the shoulder joint.

It’s entirely possible to have both going on at once. If so you might practice different mobility/stretching work for the shoulders first, or even a foam roller lat release. Then after your body is moving properly, you might practice some kind of external rotation stabilization exercise at the shoulder, making sure to pause for at least 5 seconds at the most challenging part of the movement.

Essentially certain prime movers/big muscles can often overpower our smaller stabilizer muscles.

So first we work to loosen up these overpowering muscles before getting the stabilizers to do the job they were meant for. It’s important to note that pure strength of the stabilizers is not the goal. We need the body to get into this subconscious habit of turning on the stabilizers when we move, not to just contract them strongly with specific exercises, and be ignored otherwise.

Often the progress is a combination of fast and slow. It’s fast because when you get the right combination of exercises, and properly mobilize and stabilize the shoulder joint, you can do relatively light weight pain-free movement immediately in some cases. However, the pain will likely return automatically without consistent effort to retrain the body into this new mode of movement.

Another common painful area that can respond well to physical therapy is the lower back. However, the lower back can be more complex to evaluate and treat. The root of the problem might originate all the way down at the foot—or anywhere in between, especially the ankles, knees, or hips.

The overall principles are the same though: evaluate which areas aren’t moving properly, and then what stabilizer muscles aren’t activating properly, loosen/move the former and train the latter, usually in a more static movement-resisting fashion.

There are a couple different options for making this information more specific to you. Squatuniversity.com has a ton of videos all over the internet you can search for that go over specific problem areas, so that’s an easy way to get started looking into your own challenges. You can always work directly with a physical therapist on these issues. I’m also happy to point you in the right direction during our sessions.

Feel free to send me a text at 919-809-9355 to get started.