It’s estimated that approximately 7.5% of the global population experiences at least one episode of low back pain each year, contributing significantly to healthcare costs and lost productivity. Most cases of low back pain are classified as non-specific, meaning there is no identifiable underlying pathology such as an infection, tumor, osteoporosis, or inflammatory disorder. Rather, non-specific low back pain results primarily from mechanical issues involving joints, muscles, and soft tissues in the lower back due to strains, muscular imbalances, deconditioning, stiffness, or poor movement patterns. One anatomical structure in the lower back that can significantly contribute to non-specific low back pain is the thoracolumbar fascia.

The thoracolumbar fascia comprises of several layers of richly innervated fibrous connective tissue in the lower back. These layers connect critical postural and core muscles to provide spinal stability and efficiently transfer forces between the spine, pelvis, and limbs. In a healthy individual, these fascial layers glide smoothly over each other during everyday movements, such as walking, bending, and twisting. However, excessive strain on the thoracolumbar fascia—due to repetitive motions without adequate rest, scar tissue from previous injuries, or loss of elasticity from aging or immobilization—can increase shear strain between these fibrous layers. Increased shear strain restricts normal fascial movement, making basic daily activities more challenging. Consequently, the body compensates by recruiting other muscles and joints, potentially placing additional strain on these tissues and resulting in inflammation, microtraumas, and eventually pain and functional disability.

A January 2025 study using ultrasound elastography compared thoracolumbar fascia shear strain between 32 patients with non-specific low back pain and 32 pain-free individuals. The researchers observed distinct differences in shear strain between groups. Specifically, the low back pain group demonstrated significantly reduced fascial gliding between layers, correlating directly with increased disability scores.

Findings during a physical examination that may suggest issues with the thoracolumbar fascia include contralateral arm-leg swing during walking, limited or uneven trunk rotation, altered movement sequencing during lumbopelvic flexion and extension, and positive findings during palpation, muscle activation testing, and myofascial shear testing. Some clinicians may also utilize ultrasound elastography either directly in-office or via specialist referral to quantify fascial dysfunction.

If restrictions or reduced mobility of the thoracolumbar fascia are identified, restoring fascial mobility through targeted treatment may be highly important in low back pain management. Chiropractors commonly utilize interventions such as manual therapy, myofascial release techniques, foam rolling, and targeted therapeutic exercises designed specifically to enhance movement, reduce fascial strain, and alleviate pain.