Fascial Expansion: Low Back Protocol
Updated: 2 days ago
Employing fascial expansions for managing low back pain is incredibly effective. This method integrates current knowledge of fascia, kinetic chain connections, and principles of acupuncture and traditional Chinese medicine, offering a complementary approach to treatment. Additionally, understanding the role of fascial continuity in force transmission and structural support can further enhance therapeutic outcomes, providing a deeper insight into the interconnected nature of musculoskeletal health.
Article Index:
Introduction
This article will explore the integration of fascial layers and kinetic chains with acupuncture points B46, B23, B25, B40, SI3, SI4, and SI6, emphasizing their significant potential to enhance treatment outcomes for conditions like Degenerative Disc Disease, Osteoarthritis, Sprains and Strains, and Lumbar Spinal Stenosis. For optimal results, this approach should be combined with soft tissue and skeletal techniques, along 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.
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.
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
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.
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.
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.
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.
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/Acupressure
In Traditional Chinese Medicine (TCM), acupuncture points, or acupoints, are specific locations on the body known for their therapeutic potential. These points are strategically situated along meridians or channels that guide the flow of energy, or "Qi" (pronounced "chi"), throughout the body. Acupressure, a related practice, involves manually stimulating these points to achieve similar therapeutic effects.
Stimulating acupuncture points in TCM is believed to restore equilibrium, regulate Qi circulation, alleviate pain, and promote healing. This ancient approach aims to maintain harmony and balance within the body's energy system.
Contemporary scientific research supports the physiological basis of these practices. Acupuncture points often coincide with regions dense in nerve endings, blood vessels, and lymphatic vessels, and areas with enhanced electrical conductivity. Stimulating these points may trigger physiological responses such as the release of endorphins, neurotransmitters, and other pain-relieving substances, and may also influence blood flow regulation and immune responses.
Acupuncture/Pressure Techniques
In acupuncture, needles are not merely inserted into the skin; they are rotated and manipulated until the acupuncturist perceives a response in the tissue, often referred to as a "tug response." Similarly, acupressure involves more than just moving the tissue around the acupuncture point. It requires considering the exact location, surrounding anatomical structures, and direct fascial connections. The practitioner must palpate for any restrictions in the surrounding area that may be connected to the local acupuncture point being treated.
The acupuncture point is treated with various motions, including clockwise and counterclockwise rotations and fascial kneading of the soft tissue. This often involves rolling the tissue and moving it in multiple directions. While focusing on specific points, it is also essential to consider the fascial kinetic web and the larger kinetic chain that affects the entire body. This technique aims to activate the nervous system, modulate immune function, and release tension within the interconnected fascial network, ultimately alleviating discomfort through precise, targeted stimulation. Understanding the principles of tensegrity further highlights the interconnectedness and dynamic balance of the fascial system.
Specific Acupuncture Points
In Traditional Chinese Medicine (TCM), acupuncture points BL46, BL23, BL25, BL40, SI3, SI4, and SI6 are commonly used to alleviate low back pain. These points are located using the "cun" measurement, where one cun is 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 the width of the four fingers together.
Both acupuncture and acupressure stimulate the nervous system to release tension within the fascial network, promoting healing and pain relief. Western medicine recognizes these techniques' effectiveness, as they often align with areas dense in nerve endings, blood vessels, and lymphatic vessels. This convergence highlights the interconnectedness of TCM and Western medicine in understanding and utilizing the body's natural responses for therapeutic purposes.
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. In Western medical terms, saying that an acupuncture point "invigorates the circulation of Qi and blood in the back" means it helps to enhance blood flow, reduce muscle tension, and improve overall circulation and tissue health in the back area.
Contraindications: BL 46 (Geshu) should be used cautiously or avoided during pregnancy, in the presence of local skin infections, recent thoracic surgery, severe bleeding disorders, or severe respiratory conditions.
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. In Western medical terms, "a vital point for kidney health" refers to a key area targeted to support the function of the kidneys, potentially influencing urinary function, fluid balance, and blood pressure regulation.
Contraindication: BL 23 (Shenshu) should be used cautiously or avoided during pregnancy, in the presence of local skin infections or recent lumbar surgery, and in patients with severe bleeding disorders or extreme fatigue.
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. In Western medical terms, "promoting smooth flow of Qi and alleviating stagnation" refers to improving circulation and reducing muscle tension or inflammation to enhance overall tissue health and function.
Contraindications: BL 25 (Dachangshu) should be used cautiously or avoided during pregnancy, in the presence of local skin infections or lumbar spine injuries, and in patients with severe bleeding disorders or extreme fatigue.
BL 40 (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.
Contraindications: BL 40 (Weizhong) should be avoided or used with caution in cases of local skin infections, varicose veins, DVT, and excessive bleeding tendencies, and care is needed during pregnancy and in severely weakened patients.
SI 3 (Houxi):
Location: Positioned at the ulnar side of the hand, in the depression proximal to the head of the fifth metacarpal bone, at the junction of the red and white skin.
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.
Contraindications: SI 3 (Houxi) acupuncture point should be used with caution or avoided during pregnancy, in the presence of local infections, severe hemorrhagic disorders, or extreme fatigue. Additionally, care is advised for patients with neuralgic conditions or individual sensitivity to stimulation.
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.
Contraindications: SI 4 (Wangu) should be used cautiously or avoided in the presence of local skin infections, severe bleeding disorders, acute hand or wrist injuries, and extreme fatigue. While generally safe, practitioners should exercise caution when treating pregnant women with this point.
SI6 (Yanglao):
Location: Located in the depression on the radial side of the styloid process of the ulna, when the palm is facing the chest.
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. In Western medical terms, "enhancing the circulation of Qi and blood" refers to improving blood flow, reducing inflammation, and promoting better oxygen and nutrient delivery to tissues, which can help in healing and reducing pain.
Contraindications: SI 6 (Yanglao) should be avoided or used with caution in the presence of local skin infections, acute injuries or fractures near the wrist, severe bleeding disorders, and extreme fatigue. While generally safe, practitioners should exercise caution when treating pregnant women with this point.
Fascial Expansion Demonstration
Fascial Expansion: MSR Low Back Protocol
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
Integrating fascial expansions with principles of acupuncture and Traditional Chinese Medicine (TCM) offers an incredibly effective approach for managing low back pain. This method leverages current knowledge of fascia, kinetic chain connections, and TCM to provide a comprehensive treatment strategy. Understanding the role of fascial continuity in force transmission and structural support can further enhance therapeutic outcomes, highlighting the interconnected nature of musculoskeletal health.
This innovative approach, which combines fascial work with the strategic stimulation of acupuncture points, underscores the importance of addressing the body as a whole. By appreciating the intricate connections within the body's fascial network, we can achieve better treatment outcomes for conditions like Degenerative Disc Disease, Osteoarthritis, Sprains and Strains, and Lumbar Spinal Stenosis. This comprehensive understanding and treatment methodology pave the way for more effective and holistic patient care.
References
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
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
Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A Manual of Acupuncture. Journal of Chinese Medicine Publications.
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
Findley, T., & Schleip, R. (2009). Fascia Research: Basic Science and Implications for Conventional and Complementary Health Care. Elsevier Health Sciences.
Guimberteau, J. C., & Armstrong, C. (2015). Architecture of Human Living Fascia. Handspring Publishing.
Kaptchuk, T. J. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. McGraw-Hill Education.
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
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
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
Maciocia, G. (2015). The Foundations of Chinese Medicine: A Comprehensive Text. Elsevier Health Sciences.
Myers, T. (2014). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Elsevier Health Sciences.
Oschman, J. L. (2000). Energy Medicine: The Scientific Basis. Churchill Livingstone.
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
Stecco, C., & Hammer, W. I. (2018). Functional Atlas of the Human Fascial System. Elsevier Health Sciences.
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
Wisneski, L. A., & Anderson, L. (2009). The Scientific Basis of Integrative Medicine. CRC Press.
Xue, C. (2013). Acupuncture Energetics: A Clinical Approach for Physicians. World Scientific.
Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
MSR is not responsible for decisions made or actions taken solely on the basis of this educational content. For complete information about website use, third-party links, privacy, and legal terms, please review the MSR Terms of Use, Privacy Policy, and full website disclaimer.
DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
Join Us at Motion Specific Release
For Healthcare Practitioners
Motion Specific Release integrates assessment, clinical reasoning, manual therapy, exercise, and patient education within one adaptable approach to musculoskeletal care.
MSR Pro and MSR courses support different parts of that learning process:
Structured Clinical Education: MSR courses connect applied anatomy and biomechanics with orthopedic and neurological assessment, myofascial procedures, fascial expansions, joint mobilization, manipulation, and rehabilitation.
Hands-On Skill Development: Live training provides opportunities to refine palpation, patient positioning, force application, and clinical decision-making through practice and direct feedback.
MSR Pro Clinical Library: Members receive access to more than 200 MSR procedures, downloadable and fillable clinical forms, examination resources, rehabilitation progressions, and exercise-prescription materials.
Extensive Video Resources: More than 800 videos support examination, treatment procedures, exercise rehabilitation, and clinical application.
Patient Education: A library of 50 condition articles helps practitioners explain common musculoskeletal problems and provide patients with practical information.
Continued Development: Resources are updated as MSR courses and clinical education continue to evolve.
Videos and articles can introduce concepts, but hands-on proficiency develops through deliberate practice, feedback, and experience. MSR is designed to help practitioners connect technique with clinical reasoning and adapt care to the individual rather than apply the same protocol to everyone.
Explore MSR Pro | View Online and Live Courses
Comments