Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.

Immediate Effects of Myofascial Release on the Thoracolumbar Fascia and Osteopathic Treatment for Acute Low Back Pain on Spine Shape Parameters: A Randomized, Placebo-Controlled Trial

Background: Spine shape parameters, such as leg length and kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pathologies. This study examined the immediate effects of a myofascial release (MFR) technique on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in patients with acute low back pain (aLBP). Methods: This study was a single-blind randomized placebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blindedly assigned to three groups to be treated with MFR, OMT, or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, and lordotic angle) were measured before and after the intervention using video raster stereography. Results: Within the MFR group, fLLD reduced by 5.2 mm, p < 0.001 and kyphotic angle by 8.2 degrees, p < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, p < 0.001, and kyphotic angle by 8.4°, p = 0.007. Conclusion: MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving in Vivo and Ex Vivo Studies

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over decades, however these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting low back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies were: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in low back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Greater knowledge of fascial neurological components could impact LBP treatment.

Investigation of Reaction Forces in the Thoracolumbar Fascia during Different Activities: A Mechanistic Numerical Study

Spinal instability remains a complex phenomenon to study while the cause of low back pain continues to challenge researchers. The role of fascia in biomechanics adds to the complexity of spine biomechanics but offers a new window from which to investigate our spines. Specifically, the thoracolumbar fascia may have an important role in spine biomechanics, and thus the purpose of this study was to access the mechanical influence of the thoracolumbar fascia on spine biomechanics during different simulated activities. A numerical finite element model of the lumbar spine inclusive of the intra-abdominal and intra-muscular regions as well as the thoracolumbar fascia was constructed and validated. Four different loading scenarios were simulated while deformation, stress, pressure, and reaction forces between the thoracolumbar fascia and spine were measured. Model validation was accomplished through comparison to in vivo and ex vivo published studies. Force transmission between the thoracolumbar fascia and the spine increased 40% comparing kyphotic and squatting lifting patterns. Further, the importance of reciprocating paraspinal and intra-abdominal pressures was demonstrated. It was also found that tension in the thoracolumbar fascia remains even in a simulated prone position. This numerical analysis allowed for an objective interpretation of the loads conveyed through the thoracolumbar fascia in different positional or lifting scenarios. Based on validation studies, it would appear to be a viable experimental platform from which insight can be derived. The loads in the thoracolumbar fascia vary considerably based on simulated tasks and are linked to the pressures in the paraspinal and intra-abdominal regions.

Evidence of a new hidden neural network into deep fasciae

It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.

Practical measurement of changes in leg length discrepancy after a myofascial release on the thoracolumbar fascia in patients with acute low back pain. A pilot study.

Background: A relationship between leg length discrepancy (LLD), pelvic obliquity and acute low back pain (aLBP) is discussed in recent work. Myofascial release (MFR) techniques are probably one approach to tread aLBP. It is proposed to use anamnestic LLD survey in aLBP patients. The aim of this study is to evaluate a practical measurement of LLD and the feasibility of MFR in the setting of a randomized control trial (RCT).Methodology: In 12 subjects (7 female, 5 male) with aLBP and a LLD greater than 3 mm, a MFR technique was performed on the thoracolumbar fascia. At baseline, post-intervention and follow-up, LLD was measured with a cross-line laser, pain with the visual analogue scale (VAS) and finger floor distance (FFD). Patients completed a survey after follow-up to assess their acceptance of the study procedure. The therapist evaluated the methods in terms of practicability.Results: The cost on time and resources for the LLD measurement and the MFR treatment was low. The participants voted with medium to high acceptance for the study procedure. The LLD decreased by 5.00 mm after treatment and by 4 mm to follow-up. The minimum detectable changes were exceeded in 7 out of 12 cases after intervention and in 2 of 9 cases at follow-up. The VAS showed a reduction in pain of 17.50 mm to follow-up but not after treatment. The FFD revealed no clinically relevant differences.Conclusion: Measurement of LLD is applicable in daily practice in a manual therapy setting, but it cannot be assumed to be a valid method for an RCT. Valid methods such as video raster stereography are therefore recommended. A comprehen-sive RCT with an MFR arm to investigate the impact of this intervention on leg length is feasible.

The relationship between scapular endurance and core endurance in elite amputee football players

Background: Body structure constitutes a kinetic chain with thoracolumbar fascia and this chain may induce a relationship between scapular and spinal stabilizers. Amputee soccer players use crutches during the game and, considering that the crutch use may also activate different muscle groups, the possibility of the relationship between scapular and spinal stabilizers becomes important for organizing training programs. The aim of this study is to determine the relationship between scapular endurance and core endurance in elite amputee players. Material and methods: Fifteen male amputee national football team players took part in the study. The players’ scapular endurance was evaluated by a dynamometer, and the modified side bridge test was used to evaluate core endurance. Results: The relationship between scapular and core endurance was investigated via the Linear Regression Model. The analysis revealed a positive association between scapular endurance and core endurance (B: 0.501, β: 0.561, p: 0.029). Conclusions: This study shows the relationship between scapular and core endurance in amputee football players. Given the assumptions about scapular and core endurance weakness, including scapular muscle exercises along with core exercises in the training programs might be useful for improving performance.