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Fascial Expansion: Low Back Pain/Lumbar Pain

Updated: Apr 1


Fascial Expansion For Low Back Pain

Employing fascial expansions for managing low back pain offers an effective method that integrates current knowledge of fascia, kinematic chain connections, and fundamental aspects of acupuncture or traditional Chinese medicine.


Article Index:


 

Introduction


This article will investigate the merging of fascial layers and kinetic chains with acupuncture points B46, B23, B25, B40, SI3, SI4, and SI6, highlighting their capacity to considerably improve treatment outcomes for conditions such as Degenerative Disc Disease, Osteoarthritis, Sprains and Strains, and Lumbar Spinal Stenosis. To optimize results, this treatment approach should be combined with soft tissue and skeletal techniques in conjunction with a regimen of functional exercises.


Fascia


Fascia is often defined as "one interconnected tensional network that adapts its fiber arrangement and density according to local tensional demands." When fascial tension is in good balance, the fascia distributes force throughout the body, allowing us to store and release energy for propulsion. When fascial tension is out-of-balance, hypertensive, or restricted, fascia can become the source of multiple dysfunctions.




Fascia Anatomy in Low Back

Fascial Planes and the Lumbar Spine


Envision the interconnection of fascial planes as a complex kinetic chain, where each plane influences every other myofascial plane within the body's intricate network. Viewing the body through this lens allows us to comprehend how a restriction or imbalance in one specific area can resonate and affect multiple regions. It also illuminates the healing potential, as releasing restrictions in one myofascial plane may resolve problems in another fascial region. (Image from "Functional Atlas of the Human Fascial System", I highly recommend this text by Carla Stecco. Click on Image for link)


Addressing these restrictions is a multifaceted process, and various techniques can be employed, including acupuncture and hands-on manipulation (encompassing both soft tissue and skeletal procedures). The interconnected nature of the fascial system is particularly evident in the context of low back function. Below are five fascial planes whose condition and alignment can significantly impact the health and functionality of the lower back:"


Key Takeaways:

  • Interconnected Fascial Planes: The body's fascial planes are interconnected kinetic chain, influencing each other.

  • Impact of Restrictions: An imbalance or restriction in one area can affect multiple regions, demonstrating the complexity of this three demensional myofascial system.

  • Manual Therapy: Various methods, such as MSR, acupressure, acupunctures, soft tissue tools, and hands-on manipulation, can address these restrictions.

  • Relevance to Low Back Function: Releasing myofascial plane can profoundly affect the functionality of the lower back.


Primary fascial planes that need to be considered:


  1. Superficial Layer of the Deep Fascia of the Back: The superficial deep fascia layer envelops muscles such as trapezius, latissimus dorsi, and gluteus maximus, incorporating the posterior thoracolumbar fascia. It adheres to muscles, connecting to the cranium, ligamentum nuchae, and vertebrae C7-L4. In the neck, it combines with deep cervical fascia, and at the shoulder, links to the scapula and acromion.

  2. Intermediate Layer of the Deep Fascia of the Back: The intermediate deep back fascia layer includes rhomboids and serrati posterior muscles. The rhomboid fascia divides near the scapulae, with the superficial layer connecting to infraspinatus and supraspinatus fasciae, and the deep layer to serratus anterior fascia.

  3. Deep Layer of the Deep Fascia of the Back: This layer comprises the Thoracolumbar fascia’s anterior layer and fascia surrounding the erector spinae muscles.

  4. Thoracolumbar Fascia: The Thoracolumbar Fascia (TLF) has two layers. The posterior layer links latissimus dorsi, gluteus maximus, external oblique, and trapezius muscles, while the anterior layer connects paraspinal and quadratus lumborum muscles to the transversus abdominis. Coupling of gluteus maximus and contralateral latissimus dorsi through the TLF's posterior layer helps in trunk rotation and stabilizes the lower lumbar spine and sacroiliac joints. The layers fuse at the lumbar spine base, forming a fascial compartment for paraspinal muscles and maintaining spine and joint integrity.

  5. Iliopsoas Fascia: The iliopsoas fascia, a continuation of the transversus abdominis muscle fascia, separates from the transversalis and renal fasciae by loose connective tissue. The transversus abdominis fascia divides into two laminae: the posterior lamina forms the anterior layer of the TLF, and the anterior lamina covers iliopsoas and quadratus lumborum muscles. The iliopsoas fascia connects to various body parts and houses branches of the lumbar plexus. The fascia iliaca varies in thickness and connects to the iliac crest and pelvis.


 


Acupuncture Treatment of the Low Back

Acupuncture/Acupressure


In the realm of Traditional Chinese Medicine (TCM), acupuncture points, often referred to as acupoints or simply points, are specific locations on the body that are identified for their therapeutic potential. These points are strategically situated along pathways known as meridians or channels, believed to guide the flow of energy or "Qi" (pronounced "chi") throughout the body. Acupressure, a related practice, involves manually stimulating these same points to achieve therapeutic effects akin to those of acupuncture.


Within the framework of TCM, the stimulation of acupuncture points is seen as a method to restore equilibrium, regulate the circulation of Qi, ease pain, and foster healing within the body. This ancient understanding aligns with the broader goal of maintaining harmony and balance in the body's energy system.


Contemporary scientific research has shed light on the physiological basis of these practices. It has been found that acupuncture points often coincide with regions that have a high concentration of nerve endings, blood vessels, and lymphatic vessels, as well as areas with enhanced electrical conductivity. These discoveries suggest that stimulating acupuncture points may trigger physiological responses, such as the release of endorphins, neurotransmitters, and other substances that alleviate pain. Additionally, it may influence blood flow regulation and the immune response.


Acupuncture Techniques


When acupuncturists treat a patient, acupuncture needles are not just inserted; they are rotated and pulled back and forth until the acupuncturist feels a response in the tissue (sometimes called a tug response). When performing acupressure, we do the same thing: stimulate a region to activate the nervous system and release tension in a fascial network of interconnected tissue.


Specific Acupuncture Points


In Traditional Chinese Medicine (TCM), acupuncture points B46, B23, B25, B40, SI3, SI4, and SI6, are frequently used to alleviate low back pain. These points are typically identified using the Chinese measurement unit "cun," employed in acupuncture to pinpoint locations on the body. One cun is approximately the width of the patient's thumb at the knuckle, 1.5 cun matches the combined width of the index and middle fingers, and 3 cun is equivalent to the width of the patient's four fingers when placed together.


BL46 Acupuncture Point Image

BL46 (Pohu/Geguan):

  • Location: 3 cun lateral to the lower border of the spinous process of the 7th thoracic vertebra (T7). (Image TCM Wiki)

  • Function in TCM: Known to invigorate the circulation of Qi and blood in the back, often used to alleviate tension and pain in the upper and middle back, which can contribute to overall low back health.


BL23 Acupuncture Point Image

BL23 (Shenshu):

  • Location: Positioned 1.5 cun lateral to the lower border of the spinous process of the 2nd lumbar vertebra.

  • Function in TCM: A vital point for kidney health, B23 is believed to strengthen the lower back and knees, and it's commonly used to treat chronic low back pain.


BL25 Acupuncture Point Image

BL25 (Dachangshu):

  • Location: Found 1.5 cun lateral to the lower border of the spinous process of the 4th lumbar vertebra.

  • Function in TCM: Associated with the large intestine, this point is used to relieve low back pain by promoting smooth flow of Qi and alleviating stagnation.


BL40 Acupuncture Point Image

BL40 (Weizhong):

  • Location: Located at the midpoint of the popliteal crease (center of the back of the knee).

  • Function in TCM: This point is often used to treat acute low back pain, sciatica, and lumbar muscle strain by relaxing the tendons and muscles.


SI3 Acupuncture Point Image

SI3 (Houxi):

  • Location: Positioned at the proximal end of the 5th metacarpal bone, on the ulnar side of the hand.

  • Function in TCM: Known to benefit the neck and back, SI3 is used to alleviate stiffness and pain, including low back pain, by promoting the flow of Qi.



SI4 Acupuncture Point Image

SI4 (Wangu):

  • Location: Found at the junction of the base of the 5th metacarpal bone and the hamate bone, on the ulnar side of the hand.

  • Function in TCM: This point is used to strengthen the muscles and tendons of the back, aiding in the treatment of chronic low back pain.



SI6 Acupuncture Point Image

SI6 (Yanglao):

  • Location: Located 3 cun proximal to the dorsal wrist crease, between the ulna and radius bones.

  • Function in TCM: SI6 is known to alleviate pain and stiffness in the neck, shoulders, and back, including low back pain, by enhancing the circulation of Qi and blood.




Fascial Expansion Demonstration

Utilizing fascial expansions in Low Back pain management presents an effective strategy that merges contemporary insights in fascia, kinetic chain relationships, and core principles of acupuncture or traditional Chinese medicine. In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates using fascial expansions to treat Low Back Pain.


 

Conclusion


The intricate interplay between fascial planes, kinetic chains, and acupuncture points offers a deeper understanding of the body's biomechanics, particularly in low back pain. This article has delved into the multifaceted approach of integrating fascial knowledge with Traditional Chinese Medicine (TCM) techniques, highlighting specific acupuncture points such as B46, B23, B25, B54, SI3, SI4, and SI6.


When these acupuncture points are stimulated and integrated with myofascial treatment techniques, they promise to substantially enhance the therapeutic results for a range of low back ailments. These include conditions such as Degenerative Disc Disease, Osteoarthritis, Sprains and Strains, and Lumbar Spinal Stenosis."


The exploration of fascial layers and their connection to the lumbar spine reveals the complexity of the body's interconnected tensional network. This network allows for optimal force distribution and energy storage when in balance. When out of balance, it can become a source of dysfunction and pain. Techniques such as acupuncture, acupressure, hands-on manipulation, and functional exercises offer a holistic approach to restoring this balance.


 

DR. BRIAN ABELSON DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.


 


MSR Instructor Mike Burton Smiling

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References


  1. Bordoni, B., & Zanier, E. (2014). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 7, 299-310. doi: 10.2147/JMDH.S66724

  2. Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491. doi: 10.7326/0003-4819-147-7-200710020-00006

  3. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.

  4. Ernst, E., & White, A. R. (1998). Acupuncture for back pain: A meta-analysis of randomized controlled trials. Archives of Internal Medicine, 158(20), 2235-2241. doi: 10.1001/archinte.158.20.2235

  5. Findley, T., & Schleip, R. (2009). Fascia Research: Basic Science and Implications for Conventional and Complementary Health Care. Elsevier Health Sciences.

  6. Guimberteau, J. C., & Armstrong, C. (2015). Architecture of Human Living Fascia. Handspring Publishing.

  7. Kaptchuk, T. J. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill Education.

  8. Langevin, H. M., & Sherman, K. J. (2007). Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Medical Hypotheses, 68(1), 74-80. doi: 10.1016/j.mehy.2006.06.033

  9. Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record, 269(6), 257-265. doi: 10.1002/ar.10185

  10. Lee, J. H., Choi, T. Y., Lee, M. S., Lee, H., Ernst, E. (2013). Acupuncture for acute low back pain: A systematic review. The Clinical Journal of Pain, 29(2), 172-185. doi: 10.1097/AJP.0b013e31824909f9

  11. Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.

  12. Myers, T. (2014). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Elsevier Health Sciences.

  13. Oschman, J. L. (2000). Energy Medicine: The Scientific Basis. Churchill Livingstone.

  14. Schleip, R., & Müller, D. G. (2013). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies, 17(1), 103-115. doi: 10.1016/j.jbmt.2012.06.007

  15. Stecco, C., & Hammer, W. I. (2018). Functional Atlas of the Human Fascial System. Elsevier Health Sciences.

  16. Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455-474. doi: 10.1016/j.jpain.2017.11.005

  17. Wisneski, L. A., & Anderson, L. (2009). The Scientific Basis of Integrative Medicine. CRC Press.

  18. Xue, C. (2013). Acupuncture Energetics: A Clinical Approach for Physicians. World Scientific.


 
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1 comentario


Excellent integration of acupuncture points and fascial plane information, provided in nice practical, and usable manner. Very work reading for any practitioner.

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