Treatment for Lower Back Pain and Stiffness - Deep Front Myofascial Line
We covered in a previous post that low back pain causes 40% of absence from sickness in the NHS and it’s the most common reported musculoskeletal presentation worldwide.
Finding effective treatment for this presentation can be challenging, it’s usually untreated and most people end up putting up with it until it’s unbearable.
In order to understand how we can effectively treat low back pain and stiffness we must understand first how the body, and in particular the musculoskeletal system work, what principles does it follow? How is it organised as a system?
Before we get into answering these questions, let’s take a look at the anatomy of the lower back and pelvis.
Front view deep layers
Back view deep layers
Anatomy of the lower back and pelvis
Looking at the human body we can see that the pelvis/lower back area is the crossover area between lower and upper body.
The lumbar region includes five vertebrae, labeled L1 through L5 connecting at the end to the Sacrum and Coccyx. Both sides of the Sacrum we find the hip bones, creating a butterfly looking container that will provide room for the pelvic floor muscles. This lower back, pelvic area also hosts important vessels and nerves.
An incredible amount of muscles attach to the hip bones and lower back both from the upper body and lower body, creating just as many pulling vectors in different angles and directions.
This is one of the most important meeting points in our body making it an extremely interesting and complex area; it’s an incredibly functional area that allows for movement and stability and simultaneously for the same reason a very vulnerable area, very prone to imbalance.
We have the Erector spinae muscle group hugging the spine at the back together with the QL.
We have the Psoas and the iliacus hugging the spine at the front. This muscle, the Psoas major, is the only muscle in the body that crosses from upper body into lower body.
We have the transverse abdominal wrapping the whole area around, followed by the obliques.
We have the thigh muscles attaching to the hip bones from below.
Now that we have a picture of what our lower back and hips look like anatomically let’s go back to answering the questions we asked above, How is the musculoskeletal system organised?
Back to the Myofascial tissue, considering that this tissue is a single piece of fabric and considering that the musculoskeletal system works as a tensegrity structure, we can now understand how restrictions anywhere along its path can be felt and or cause imbalance in a completely opposite part of the body.
We can divide the body in 12 Myofascial lines:
- Superficial Front Line.
- Superficial Back Line.
- Lateral Line (two sides)
- Spiral Line.
- Arm Lines (four)
- Functional Lines (two – front and back)
- Deep Front Line.
These 12 lines can be seeing as tensile straps and slings within the whole musculoskeletal system. The structures (muscles and fascia) that are part of each of these Myofascial lines are even more deeply connected between them.
These lines serve as maps for soft tissue therapists and movement therapists to decipher imbalance and other symptoms (in this case lower back pain).
These lines of course crossover as well and interrelate with one another, which makes it sometimes a puzzle game for even the skilled therapist trying to figure out where the issue relays.
Out of all 12 lines we’ll be focusing on the Deep Front line due to it’s relevance and involvement in low back pain presentations.
How is the tissue organised
The Deep Front Line according to Tom Myers
The Deep Front Line, as described by Tom Myers, is one of the most crucial myofascial lines in the body.
This line runs deep within the body, connecting the inner arch of the foot, passing through the inner thigh, pelvic floor, deep abdominal muscles, and diaphragm, and continues upward through the deep muscles of the neck and head, finally ending inside the mouth.
This continuous line of internal muscles and fascia is responsible for our body’s core stability and postural support. It plays a vital role in functions such as breathing, swallowing, and stabilising the spine and pelvis. When there’s imbalance in the Deep Front Line, it can contribute to a variety of issues, including lower back pain.
For this reason understanding and addressing issues in the Deep Front Line can be key to treating lower back pain.
Important areas to focus within the Deep Front Line
The pelvic and lower back are areas where we very often find restrictions within the Deep Front Line, in particular iliopsoas muscle group, top of the ilium of the ilium (hip bone – both front and back) and QL/transverse abdominal area.
Our lifestyle, sitting for prolonged periods of time where the front line is shortened can contribute to restrictions developing on this line.
Weakness around the core and gluteal area can also result in imbalance in this Line that consequentially suffers the compressional forces resulting from this pattern.
Generally speaking presentations with a posterior or anterior pelvic tilt and/or shift either both sided or one sided will highly benefit from Myofascial release work done to this Line.
Myofascial release of the Deep Front Line can help restore balance, enhance movement efficiency, and release pain. This combined with functional-based exercise rehabilitation focused on decompressing this line, increasing core stability and addressing functionality is key to achieving better and long lasting results.
Looking at the whole picture
When dealing with a low back presentation and any musculoskeletal presentation we must have into consideration the whole body, history and psychosocioeconomical factors surrounding the person.
We must remember that the whole musculoskeletal system is interconnected and therefore assess it as a whole unit, looking for clues in the myfascial lines to guides us in the right direction. For this reason you might find your therapist working on a completely different part of the body than the symptomatic area.
Stress of course plays a major role in musculoskeletal health and for this reason must always be present in the therapist’s mind when creating a treatment plan for addressing lower back pain.
Having a healthy cardiovascular exercise routine is also a factor to consider and it plays a very important role in musculoskeletal health as well as strength based exercise.
Having into consideration all previous aspects that contribute towards a healthy musculoskeletal system is key to create an effective treatment plan for low back pain and any other musculoskeletal presentation.
The therapist must not only have a good skillset of techniques but also understand the bigger picture that comprises all aspects of the human being that’s in front of them.
References: Thomas W. Myers (2014), Anatomy trains – Myofascial meridians, 3rd edition, Elsevier Ltd.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.