Chapter 11

The lumbar fasciae and segmental

control
P. J. Barker, C. A. Briggs

OVERVIEW
CHAPTER CONTENTS
T he middle and posterior layers of lumbar fasciae encapsu­
Overview 141 late the paraspinal muscles and provide attachment for
Anatomy and biomechanics 141 muscles converging from the back, limbs and abdominal
Anterior layer of lumbar fascia 141 wall. It has been proposed that these fasciae support the
Middle layer of lumbar fascia 142 lumbar spine and sacroiliac joint via several mechanisms.
Bony and ligamentous attachments 142 T his chapter presents current evidence from anatomical,
Fibre orientation 142 biomechanical, electromyographic (EMG) intra-abdominal
Features and stiffness 142 (lAP) and intramuscular pressure studies. It incorporates
Muscle attachments 143 these with proposed functions of fasciae and in particular
Tensile effects of muscle attachments 143 with models of segmental control. T he magnitude of forces
Posterior layer of lumbar fascia 144 involved and roles in different planes are discussed, with
Bony and ligamentous attachments 144 reference to directions for future research and low back
Fibre orientation 144 pain management.
Features and stiffness 144
Muscle attachments 145 ANATOMY AND BIOMECHANICS
Features of attached muscle regions 145
T he lumbar fasciae are arranged in three layers. The ante­
Tensile effects of muscle attachments 145
rior layer (ALF) is thin and membranous while the middle
Segmental control 146
and posterior layers (MLF, PLF) are more fibrous. The latter
Comparative features of the middle and posterior
two attach to lumbar transverse and spinous processes
layers of the lumbar fasciae 146
(respectively), collectively enclosing the paraspinal mus­
Related muscles 147
cles. All three layers meet and fuse at the lateral raphe,
Attachments and classification 147
between the twelfth rib and iliac crest (Farfan 1995).
General EMG activity 147
Attachments at this raphe include fascicles from transver­
Local regional EMG activity 147
sus abdominis (TrA), internal oblique (10) and external
Global regional EMG activity 148
oblique (EO) as well as latissimus dorsi (LD) (Barker et al
Biomechanical roles of the lumbar fasciae 148
2004, Bogduk & Macintosh 1984, Bogduk et al 1998, Tesh
Longitudinal tension generation 148
1986, Vleeming et a11995) (Fig. 11.1).
Hydraulic amplifier effect 148
Lumbar fasciae are also termed 'thoracolumbar ' fasciae,
Lumbar segmental control 148
although only the posterior layer extends above the level of
Load transfer across the midline 148
the twelfth rib and correctly deserves this name. Even 'fas­
Sacroiliac stability 149
cia' may be an inappropriate classification for these tissues
Proprioception 149
(Bogduk 1997, Gallaudet 1931), since the MLF and PLF
Magnitude of segmental forces 149
blend medially with vertebral ligaments and form aponeu­
Planar stability 150
rotic attachments for TrA and LD, so might also be consid­
Coronal stability 150
ered ligamentous or tendinous (Bogduk 1997).
Sagittal stability 150
Transverse stability 150
Anterior layer of lumbar fascia
Fascial disruption 151
Conclusion 151 The anterior layer of lumbar fascia (ALF) covers quadratus
lumborum (QL), joins the MLF laterally at the lateral raphe
142 FOUNDATION SCIENCES FOR MANUAL THERAPY

Figure 11.1 The lumbar fasciae in cross-section at L4 and L2. Note 10's attachment to the lateral raphe below L3 and EO's attach ment to
it above L3. Reprod uced from Barker and Briggs 1999 Spine 24 (17) : 1757-1764 with permission from Lippin cott, Williams Et Wilkins.
Key: EO = external oblique; 10 = internal oblique; TrA = transversus abdominis; LD = l atissimus dorsi; QL = quad ratus l u mborum; Ps = psoas;
Mf = mul tifidus; ALF = anterior lumbar fascia; MLF = middle l u m ba r fascia; PLF = posterior l u mbar fascia.

and inserts medially on the anterior surface of each lumbar
transverse process. It is thin (0.1 mm), membranous (Barker et
al 2004b) and may blend with the fascia over psoas laterally.
The ALF displays thickenings superiorly and laterally.
The lateral arcuate ligament is the superior thickening, pro­
viding attachment for the diaphragm and covering the
upper part of QL. A second thickening passes vertically
between the tip of the twelfth rib and the iliac crest. The
remainder of the ALF lacks fibres and its capacity for tensile
transmission appears to be minimal.
Middle layer of lumbar fascia
with fascicles from the mid-region of TrA (Barker et al
2004b, Urquhart et a12004). At the lateral raphe, a few fibres
of the MLF may be reflected posteriorly to join the deep
lamina of the PLF, encircling the lateral border of erector
spinae (Tesh et al 1987). Since fibre orientation indicates the
directional stiffness of a tissue (Hukins 1984, 1985; Minns et
al 1973), the MLF is likely to be stiffer transversely.
Features and stiffness
The width of the MLF, from transverse processes to lateral
raphe, is only 2-3 cm, the aponeurosis of TrA extending

Bony and ligamentous attachments

The middle layer of lumbar fascia (MLF) arises from the
iliac crest and posterior iliolumbar ligament, attaching
superiorly to the medial part of the twelfth rib and lumbo­
costal ligament (Bogduk & Macintosh 1984, Williams et al
1995). Here, QL is tightly enclosed between the lumbocostal
ligament and lateral arcuate ligament (Poirier 1901).
Medially, the MLF attaches to the outer edge of each lum­
bar transverse process (Barker et a12004b, Breathnach 1965,
Sharpey et al 1867, Tesh et al 1987) and the intertransverse
ligaments. Laterally, the MLF has only muscular attach­
ments, of which the most extensive is to TrA (Fig. 11.2).

Fibre orientation
Fibres of the MLF radiate laterally from the tips of lumbar
transverse processes. Superolateral fibres are short (-2 cm),
angled up to 30 degrees above the horizontal before joining
inferolateral fibres from the transverse process above, to Figure 11.2 The middle layer of lumbar fascia. Note the thi.<;k
form fibrous 'arches' between the processes (Barker et al attachments of the MLF to tran sverse p rocesses, the extensive TrA
2004b, Tesh et al 1987, Testut & Latarjet 1948) (see Fig. 11.2). aponeu rosis a n d that MLF fibres are angled m o re towards horizon­
The majority of fibres are directed inferolaterally (approxi­ tal inferiorly. Reproduced with permission from Barker et al 2004b.
mately 10-25 degrees below horizontal) and are continuous Key: TrA = transversus abdominis; MLF = middle l u mbar fascia.
 The lumbar fasciae and segmental control 143

beyond this for 5-6 cm (Barker et al 2004a, 2004b) (see Fig.
11.2). The average thickness of the MLF varies greatly, being
more than 50% thicker at its attachments to the transverse
processes than between them (0.62:0.40 mm; Barker et al
2004b). These attachments are aligned primarily horizon­
tally and may avulse the transverse process tips during
contraction of TrA (Marshall 2001). Avulsion of the
processes has been observed in dissections by traction on
the MLF, confirming its capacity to transmit loads to the
vertebral column (Barker et al 2004b). In unembalmed
cadavers, .transverse tensile loads of up to 50 N have been
applied to TrA without the muscle or MLF tearing; how­
ever, their maximum capacity is likely to be greater than
50 N (Barker et a12004a).
Although mechanical testing of the MLF on isolated
segments is difficult (Tesh 1986), early anatomical texts
referred to it as the strongest layer of lumbar fascia
(Davies-Colley 1894, Sharpey et al 1867) and limited in
vitro tests support this. In an unembalmed cadaver, Tesh
(1986, 1987) inserted a balloon confined (by rigid horizon­
tal dividers) to the lumbar region of the abdomen, then
applied lateral flexion torques while varying the pressure
in the balloon. Increasing the pressure (from 60 to 120
mmHg) was noted to right the trunk against applied lat­
eral flexion force, requiring a proportional increase in
restraining force necessary to retain lateral flexion. T his
force was up to 14.5 Nm or equivalent to 40% of the
moment produced by body weight in extreme lateral flex­
ion. If the position was sustained and both pressure and
lateral flexion torque removed, then the pressure re­
raised, the cadaver moved back to the neutral position.
The force was attributed to tension generation in the MLF
(Tesh 1986, Tesh et al 1987).
The MLF possesses thickenings via which it may trans­
mit loads to the vertebral column. Although its stiffness has
not been quantified, its tensile capacity is likely to be
greater horizontally. The capacity of the MLF to resist loads
in the coronal plane, at end of range lateral flexion, may be
up to 14.5 Nm.
Tensile effects of muscle attachments
Raster photography, a technique to indicate tensile trans­
mission between muscles and fascia by comparing move­
ment of fascial markers against a reference grid, was
described by Vleeming et al (1995). Tension was applied
to fascial attachments to simulate the effect of muscle
contraction.
A similar technique was employed to determine the area
of fascial movement following tensile loading of the lateral
abdominal muscles and MLF in unembalmed cadavers
(Barker et al 2004a). Tension on the attachment of TrA dis­
placed more than double the area of fasciae than tension on
10 or EO (Fig. 11.3) and resisted higher applied tension
before failure. A strain gauge inserted into the MLF and PLF
at their vertebral (13) attachments indicated tension applied
to TrA was transmitted more effectively to the MLF, its ten­
sile force being almost twice that of the PLF and transmitted
direct to vertebrae rather than across the midline (Barker et
a12004a) (see Fig. 11.3). Tesh's work (Tesh 1986) indicates the
MLF is also most likely to transmit tensile forces generated
from within TrA, since the intra-abdominal balloon pressure
was sustained even when the PLF was incised. Mathemati­
cal calculations (Barker et al 2004a) indicate that during
maximum contraction, the MLF may withstand a transverse
hoop tension of 48 N per segment.
TrA therefore appears to be the only muscle that can
transmit tension via the MLF to all lumbar vertebrae, its
fascicles being attached and well aligned with fibres of the
MLF throughout this region. TrA is the primary muscle
attachment of the MLF, which in turn appears well struc­
tured to operate as this muscle's principal aponeurosis of
origin.
70
60
50

1'"
40

30
�
Muscle attachments
20
The MLF is attached to fascicles of TrA, LD (Bogduk &
10
Macintosh 1984), EO and 10 (Barker et a12004a, Bogduk &
Macintosh 1984, Vleeming et al 1995). EO attaches to it 0
LD TrA GM 10 EO TrA2 102 E02
above the level of the transverse process of L3, 10 below
Posterior layer Middle layer
this level and TrA to the full length of the lateral raphe
(Barker et a12004a). The attachments of LD, 10 and EO are D Area D Tensile force
relatively small and muscular (Gallaudet 1931) and fasci­
Figure 11.3 Fascial area and tensile forces. The areas of PLF and MLF
cles of 10 and LD oriented almost perpendicular to fibres
displaced and tensile forces developed in fasciae with 10 N applied
of the MLF. Other muscles including QL, iliocostalis lum­ tension to attached muscles. 'Tensile force' indicates the transverse
borum and the diaphragm have small attachments to the component of tensile force at L3. Reproduced from Barker and Briggs
MLF. By contrast, the attachment of TrA is extensive and 1999 Spine 24 (17): 1757-1764 with permission from Lippincott,
aponeurotic laterally (Testut & Latarjet 1948), with fasci­ Williams 8: Wilkins. Key: PLF = posterior lumbar fascia; MLF = middle
cles being directly continuous with fibres of the MLF lum bar fascia; LD = latissimus dorsi; TrA = transversus abdominis; GM
(Barker et al 2004b). = gluteus maximus; 10 = internal oblique; EO = external oblique.
144 FOUNDATION SCIENCES FOR MANUAL THERAPY
L

Posterior layer of lumbar fascia

The posterior layer of lumbar fascia (PLF) surrounds the

paraspinal muscles and consists of two laminae, which are
progressively fused below T12 (Barker & Briggs 1999,
Bogduk & Macintosh 1984). Figure 11.4 illustrates these two
laminae with their fibre directions and attachments.

Bony and ligamentous attachments

The PLF attaches to lumbar and thoracic spinous processes,
supraspinous and interspinous ligaments, the posterior
superior iliac spine and posterior part of iliac crest as well
as the ilium on the opposite side (Bogduk & Macintosh
1984, Tesh et al 1987). It is also reported to be continuous
inferiorly with the long dorsal sacroiliac and sacrotuberous
ligaments (Vleeming et al 1996, 1995), while its deep lamina
attaches superolaterally at each rib angle (Barker & Briggs
1999). Fibres from the superficial lamina of the PLF cross
the midline at all lumbar levels (Tesh et al 1987) although
midline attachments become less evident below L3
(Bogduk & Macintosh 1984, Vleeming et aI1995).
Each interspinous ligament, via its sagittally oriented
fibres, attaches the deep lamina of the PLF to the anterior
upper border of the spinous process below. Its primary
function has been proposed to anchor the PLF to the spine
(Aspden et al 1987, Hukins et a11990b) or to limit anterior
shear forces on vertebrae (Farfan 1995, Tesh et al 1987).
Lamellae within the spinous processes are also aligned in
the sagittal plane (Gallios & Japiot 1925). However, the PLF
itself approaches the spinous processes from a posterolat­ Figure 11.4 The posterior layer of lumbar fascia. The PLF: muscu­
eral angle, which varies with contraction of the paraspinal lar attach ments of deep (left) and superficial (right) laminae.
muscles (Tesh 1986). Reproduced from Barker and Briggs 1999 Spine 24 (17): 1757-1764
The midline lumbar attachments of the PLF are variable with permission from Lippincott, Wil l iams Et Wilkins.
and may require paraspinal muscle contraction for effective Key: See = splenius cervicis; SPI = serratus posterior inferior;

tensile transmission to the interspinous ligaments and spin­ Bi = biceps fem oris; Tz = trapezius; Rh = rhom boids; GM = gluteus
maximus.
ous processes.

Fibre orientation
The superficial lamina of the PLF appears cross-hatched
below T 12. This has been attributed to fibres aligning
superolaterally with LD and inferolaterally with the con­
tralateral gluteus maximus (GM), (Vleeming et al 1995),
although since the laminae are fused, exact origins are dif­
ficult to trace (Bogduk & Macintosh 1984). Serratus poste­
rior inferior and TrA also have fascicles closely oriented
with fibres of the PLF (see Fig. 11.4) so its fibre directions
may be partly attributed to these muscles (Barker et al
2004a). Fibres in the deep lamina are predominantly super­
olateral (Bogduk & Macintosh 1984).
Fibre angles of the PLF are generally measured with the
spine in extension and are cited here with reference to a
horizontal axis. Barker & Briggs (1999) reported angles
and/ or presence of fascial fibres at alternate vertebral lev­
els throughout the PLF in 20 cadavers. Superolateral fibres
in the superficial lamina become more transverse in the
upper lumbar spine, oriented almost 40 degrees above the
horizontal at L5 and 30 degrees at Ll. At T9 they lie trans­
versely, then are oriented increasingly inferolaterally to
become continuous with the rhomboid muscles (see Fig.
11.4). In the lumbar region, inferolateral fibres (20 degrees
below horizontal) cross the above fibres to create a hatched
appearance (Barker & Briggs 1999).
The lattice formed by PLF fibres is thus more Closely ori­
ented towards a horizontal axis. Fibres in the deep lamina
above T12 are consistently directed superolaterally at
20 degrees above the horizontal but decrease at T4, above
which this lamina becomes more membranous (Barker &
Briggs 1999).
Features and stiffness
The average thickness of the PLF (0.52 mm) is comparable
with that of the middle layer (0.55 mm; Barker et aI2004b).
Thickened fascial bands have been described in the PLF
(Bogduk & Macintosh 1984) but regional differences are

only minor (0.56 mm) at the spinous processes compared
with between them (0.53 mm; Barker & Briggs 1999). The
increase in thickness at vertebral attachments (6%) is slight
compared with that observed in the middle layer (55%;
Barker et a12004b).
Both laminae of the PLF diminish in thickness and
fibrosity in the thoracic region, yet the region of the super­
ficial lamina between LO and rhomboid attachments can
vary considerably (Barker & Briggs 1999). This lamina ends
freely at the upper border of rhomboid minor while the
deep lamina remains thin throughout the thoracic region,
attaching superiorly to splenius cervicis (Barker & Briggs
1999) and fascia overlying the splenii (Bogduk & Macintosh
1984). The deep lamina thus forms an enclosed compart­
ment that runs the length of the spine, surrounding the
paraspinal and splenius muscles. Dye injection studies sup­
port this (Peck et al1986).
The width of the PLF, from spinous processes to lateral
raphe, is approximately 7 cm (Barker et al 2004a) per side.
It lies approximately 7 cm behind the instantaneous axis of
rotation for flexion, with almost double the moment arm of
most posterior ligaments (Tesh 1986, Tesh et al 1987).
Mechanical testing using samples of PLF indicates it may
be up to four times stiffer transversely than longitudinally,
and three times stiffer transversely than in an oblique
(inferolateral) direction (Tesh 1986). Consistent with other
connective tissues, stiffness of the PLF increases with defor­
mation (Tesh 1986, Yahia et al1993).
Transverse stiffness of samples of PLF has been reported
at up to 113 MPa, which is relatively unimpressive com­
pared with other fasciae (Tesh 1986). T his, however, may be
an underestimate, since isolated samples tend to be weaker
than entire intact tissues with in situ attachments (Adams
1995, Adams & Green 1993). During maximal IAP and with
contraction of the paraspinal muscles, the PLF has been
estimated mathematically to withstand a maximum trans­
verse ('hoop') tension of 90 N at each segment (Tesh 1986),
although subsequent analysis indicates this tension is more
correctly attributed to the MLF (Barker et al 2004a). Tests
applying sub-failure tension to attached fascicles of TrA
indicate the PLF is likely to withstand at least 50 N tension
(Barker et a12004a).
The numeric stiffness of the PLF is uncertain, but its
transverse stiffness is up to four times greater than its lon­
gitudinal stiffness. Small tensile loads applied to muscle
attachments are easily transmitted via the lumbar fasciae to
vertebrae (Barker et al 2004a) and may play a role in influ­
encing segmental movement around the neutral position.
Muscle attachments
The PLF receives the same attachments via the lateral raphe
as the MLF (see Fig. 11.1A, B) as well as attachments from
many extrinsic back muscles. These are illustrated (see Fig.
11.4) from superiorly to inferiorly, using combined findings
of dissection and tensile studies (Barker & Briggs 1999,
Bogduk & Macintosh 1984, Vleeming et al 1995).
The lumbar fasciae and segmental control 145
In the thoracic region, the superficial lamina is
attached to the rhomboids up to the level of T2 and to the
lowest fascicles of trapezius at T11/12. The superficial
lamina is also attached to LO, via an oblique aponeurotic
junction above the iliac crest, and the contralateral GM,
via fibres crossing the midline below L4. Inferiorly it is
attached to ipsilateral fascicles of GM between the poste­
rior superior iliac spine and the median sacral crest, at
S2-4 levels.
T he deep lamina is attached superiorly to the lower
border of splenius cervicis. Here, serratus posterior supe­
rior (SPS) overlies the deep lamina without attaching to it
and is, in turn, located deep to the rhomboids. SPS thus
separates the two laminae of the PLF without attaching to
either, while by contrast, at upper lumbar levels, serratus
posterior inferior (SPI) is entirely continuous with the
deep lamina. T he deep lamina attaches laterally to the
mid-region of TrA and to part of EO above L3 and part of
10 below it. This lamina also has variable inferior attach­
ments to the lumbar erector spinae aponeurosis (below L5;
Hutchinson & Oall 1994) and the sacrotuberous ligament,
which may provide indirect attachment to biceps femoris
(Vleeming et al 1989).
Features of attached muscle regions
Most attachments to the PLF consist of groups of adjacent
fascicles rather than entire muscle bellies, the exceptions
being SPI and rhomboid muscles. All attachments have
varying fascicle directions, lengths, moment arms and
cross-sectional areas and consequently different vectors
and capacities for stiffness or torque generation (Bergmark
1989).
Attaching fascicles of LO and GM are relatively long,
directed superolaterally towards the axilla and inferolater­
ally towards the iliotibial tract, respectively. SPI has shorter
fascicles, passing superolaterally toward the lower four
ribs. Attaching fascicles of EO and TrA are relatively long
and pass anteroinferiorly; those of EO almost vertically to
the anterior iliac crest and those of TrA to the rectus sheath.
10's attached fascicles are comparatively short, passing
superolaterally to the lower three to four ribs (Williams et al
1995) (see Fig. 11.4).
Cross-sectional areas of the muscle attachments vary
considerably. LO, TrA, SPI, EO and 10 are generally thin,
broad muscles, with fascial attachments of LO and TrA
being the most extensive. Bogduk et al (1998) reported
fibres of LO had insufficient cross-sectional area to pro­
duce torque via the PLF at the sacroiliac joint (Bogduk et
al 1998), but the attachment of GM appears to have a more
substantial cross-sectional area (P. J. Barker, unpublished
work, 2003).
Tensile effects of muscle attachments
Vleeming et al (1995) applied 50 N tension to attachments
of the PLF in embalmed cadavers, reporting that both
LO and GM transmitted tension to the posterior layer of
 146 FOUNDATION SCIENCES FOR MANUAL THERAPY
L

lumbar fascia contralaterally, LD up to 2 cm and GM up to PLF tension and L3I4 movement (sagitlal) 20N lateral
tension on PLF
4 cm past the midline. Traction to 5PI and EO, biceps 250

femoris and trapezius and gluteus medius produced vari­

g
able, limited or no fascial displacement, respectively. Barker Q)
200 Zero tension
� on PLF
et al (2004a) performed a similar study in unembalmed .E
OJ 150
E
cadavers using a lower (10 N) applied tension and found 0>

:Jl
greatly increased tensile transmission, with every muscle "0
.S! 100
Ci. Zones of
tested (LD, GM, TrA, 10, EO) producing fascial movement a.
«

and tensile force (see Fig. 11.3). 50

Most extensive PLF displacement resulted from tension

0
on LD and TrA, bilaterally between T12 and 51, while ten­ 0 2 3 4 6 7 8
sion on GM and 10 caused fascial displacement below L3 Spinous process distraction (mm)

and tension on EO above it. Tension on both obliques often Figure 11.5 The effect of PLF tension on sagittal segmental
produced only unilateral displacement (Barker et al 2004a). movement. Typical load deformation cu rve taken from the L3-4
Transverse tensile force in the PLF was also found to be segment d u ri n g sagittal rotatio n . Note that with 20 N ap plied lat­
greatest when tension was applied to LD and TrA, with up eral tension to the PLF, the cu rve moves to the left, its gradient

to 50% of applied tensile force being transmitted to the fas­ in dicating an increased stiffness in early sagittal displacemen t but

cia adjacent to the L3 spinous process (Barker et al 2004a) n o change at the end of the range. Adapted from Tesh 1986.
Key: PLF posterio r l umbar fascia.
(see Fig. 11.3).
=

Two studies by Tesh (1986) concur that TrA transmits

tension to the PLF. During inflation of a lumbar intra­
abdominal balloon, markers on the PLF were noted to
move laterally and if incised longitudinally, the edges of the
incision sprang apart, indicating the PLF was transmitting
tension. Tesh's concurrent CT study indicated that a
Valsalva manoeuvre (performed in supine) drew the PLF
anteriorly. Contraction of the paraspinal muscles has also
been proposed to generate transverse tension in the PLF
(Carr et al 1985, Farfan 1973, Gracovetsky et al 1977, Tesh et
al 1987), with staining techniques indicating this mecha­
nism may transmit tension to both supraspinous and inter­
spinous ligaments (Tesh 1986).
A study of the PLF which perhaps has the greatest
implications for segmental stability was also performed
by Tesh (1986). T he effects of applying lateral fascial ten­
sion on segmental sagittal rotation were investigated.
Lateral tension of 20 N was applied direct to the PLF, via
grips to simulate contraction of the lateral abdominal
muscles, then segments were loaded in sagittal rotation
via distracting their spinous processes. When lateral ten­
sion was applied, resistance to sagittal rotation increased
from the onset of loading and throughout early range at
all segments (Tesh 1986), so that additional sagittal force
(e.g. 20 N) was required to achieve the same spinous
process distraction (e.g. 1 mm; Fig. 11.5). Transverse load­
ing of the PLF effectively stiffened the motion segment in
the initial stage of flexion, without altering the final stiff­
ness (Tesh 1986).
The PLF has extensive attachments to LD and TrA.
Tensile and staining tests indicate that every muscle attach­
ment is capable of generating some tension in the PLF and
so via it may contribute to spinal stability (Bogduk &
Macintosh 1984). Transverse tension in the PLF can increase
segmental stiffness to sagittal plane rotation in early range
(Tesh 1986).
SEGMENTAL CONTROL
Comparative features of the middle and posterior
layers of the lumbar fasciae
Both MLF and PLF are capable of transmitting tension from
TrA to all lumbar vertebrae, with fibres of the middle layer
being directly continuous with TrA fascicles laterally and
thickened at their attachments to the transverse processes,
medially. From the lateral raphe, the MLF provides a rela­
tively short, direct route to vertebrae that generates almost
double the transverse tension of the PLF when tension is
applied to TrA. The MLF also appears to be the primary fas­
cial restraint for tension generated within TrA (via an intra­
abdominal balloon) and may resist substantial lateral
flexion torques. It is, therefore, well structured to transmit a
wide range of tensile loads from TrA, from one or both sides.
By contrast, the PLF's multiple fibre orientations indicate
its suitability for tensile transmission from several attached
muscles. Fibres in the PLF are not consistently oriented
with fascicles of TrA and it forms a less direct route from
TrA, which has been shown to transmit less tensile force
(Barker et a12004a) to vertebrae. Although the PLF is stiffest
in the transverse direction, its vertebral attachments are rel­
atively inconsistent, unthickened and mobile in the absence
of paraspinal contraction. The MLF may consequently pro­
vide a more efficient route for TrA to influence segmental
movement than the PLF.
Despite this, application of transverse tension to the PLF
has been shown to increase resistance to inner range seg­
mental movement in the sagittal plane (Tesh 1986).

Whether a similar stabilizing effect may be produced via
the MLF remains to be demonstrated.
Related muscles
Attachments and classification
Functionally, spinal muscles may be classified as either
'global' or 'local' (Bergmark 1989). Global muscles attaching
to the spine, including GM or LD, are generally superficial
and responsible for generating large torques, whereas local
muscles such as multifidus are deeper, with segmental
attachments that generate small torques but are more
important in influencing intersegmental movement.
Although not originally classified (Bergmark 1989), TrA's
anatomy (Barker et al 2004b, Urquhart et a12004), and EMG
activity (Hodges & Richardson 1997b) are consistent with a
local function (Richardson et aI1999). T he lumbar fasciae are
related to muscles from both groups as well as some that are
classified as part local and part global. T hese include QL, 10
and certain regions of the erector spinae (Bergmark 1989).
10 was considered to be a partly local muscle due to its
attachment to the lumbar fasciae (Bergmark 1989) and so
EO might similarly be allocated to both categories. Both
obliques are, however, primarily attached to the ribcage
and pelvis, so better suited to act as global trunk rotators.
Local and global muscles may respond differently to low
back injury, with wasting and/or dysfunction documented
in the former and excessive levels of co-contraction pro­
posed to develop in the latter (Richardson et aI1999).
General EMG activity
In healthy subjects, collective EMG findings reveal that
local muscles such as TrA and the deep fascicles of multi­
fidus are active prior to the prime movers for limb move­
ments, in all directions and at various speeds (Hodges &
Richardson 1997a, 1997b, 1998, Moseley et al 2002). T heir
onset does not vary with the direction of limb movement, in
contrast with onsets of adjacent muscles (Hodges &
Richardson 1996, Moseley et al 2002) and their subsequent
contraction is more tonic (sustained and submaximal) in
nature (Hodges et al 1999, Richardson et aI1999).
From these findings, pre-contraction of TrA has been
hypothesized to limit excess intersegmental movement
occurring either via the lumbar fasciae or IAP generation
(Hodges & Richardson 1997b). Tension from TrA may be
transmitted via the MLF and PLF to the processes of lum­
bar vertebrae, 'anchoring' them during perturbations to the
spine to help prevent excessive movement and potential
segmental injury (Hodges & Richardson 1997b). Lumbar
multifidus is relatively bulky (Macintosh et al 1986), so
might also influence intersegmental movement by increas­
ing tension in the overlying PLF. Only some of its fascicles,
however, demonstrate an early onset of contraction, so its
effect on vertebrae via the PLF is likely to be less efficient at
limiting segmental movement than its direct compressive
action (Hodges & Richardson 1996, Moseley et aI2002).
The l umbar fasciae and segmental control 147 ]
T he MLF and PLF thus provide mechanisms via which
(primarily) TrA may influence segmental control. T heir effi­
ciency depends on the effectiveness of contraction of TrA,
which requires optimum motor control (Hodges &
Richardson 1996, McGill & Norman 1993).
Local regional EMG activity
Regions of muscles that have different fascial attachments
may also have different functions. To clarify the effect of
each muscle, EMG activity within the relevant (attached or
enclosed) muscle region must be considered.
T he middle fascicles of TrA, which originate between
the iliac crest and lower border of the costal margin, are
those typically recorded from in EMG studies (Cresswell
et al 1992, Hodges & Richardson 1997b, 1998, Hodges et
al 1999). T he contraction onset of TrA is noted to be
delayed relative to the onset of the prime mover in sub­
jects with low back pain (Hodges et al 2001) and the
subsequent contraction becomes more phasic in nature
(Hodges & Richardson 1996, Hodges et al 2001). TrA's
contraction prior to limb movement has invariably been
reported unilaterally, although studies performed on dif­
ferent sides and during bilateral limb movement consis­
tently show this feature (Hodges & Richardson 1997b,
Hodges et al 1999), indicating the contraction may occur
bilaterally.
Additional activity in middle fascicles of TrA has been
noted during trunk and pelvic rotation, with greater (uni­
lateral) activity in ipsilateral trunk rotation and opposite
pelvic rotation (Cresswell et aI1992). TrA's lowest fascicles
may behave in a more tonic fashion than its middle fascicles
throughout limb movements (Hodges et aI1999).
Only the posterior fascicles of 10 and EO attach to ver­
tebrae via the MLF and PLF. T hese fascicles are proposed
to have the greatest capacity for stiffness generation
(Bergmark 1989, Mirka et al 1997). However, electrode
placement in most EMG studies of the obliques allows
recording from fascicles either at or anterior to the mid­
axillary line (Carman et al 1972, Davis & Mirka 2000,
Hodges & Richardson 1997b, Mirka et a11997), above the
region where EO's fascicles attach to the fasciae and ante­
rior to fascicles of 10 with a fascial attachment. T he pro­
posed local function of these fascicles thus remains to be
clarified.
T he deep fascicles of lumbar multifidus have been
shown to demonstrate an early onset of contraction prior to
prime movers for limb movements and are thought to
influence vertebral movement by their direct (compressive)
action (Moseley et al 2002). In addition, multifidus may
sometimes be active bilaterally during rotation (Donisch &
Basmajian 1972).
Via both the MLF and PLF, an isolated, submaximal con­
traction of TrA may subtly increase stiffness of lumbar seg­
ments prior to trunk perturbations. Bilateral contraction
of TrA is required for a symmetric fascial influence on
segmental movement.
 148 FOUNDATION SCIENCES FOR MANUAL THERAPY
[
Global regional EMG activity
Anterior fascicles of EO and IO appear to behave predomi­
nantly in a global fashion. Each has an onset of contraction
more specific to the direction of limb movement, with sub­
sequent activity being more phasic (Hodges et al 1999,
Richardson et al 1999). Subjects suffering low back pain
may recruit fascicles of 10 differently during drawing in of
the abdominal wall (O'Sullivan et al 1997a). 10 has also
been noted to demonstrate an early onset of contraction
prior to some limb movements, but not as early or as con­
sistently as TrA (Hodges & Richardson 1997c, Richardson et
al 1999). 10 and EO are also recruited unilaterally as ago­
nists for trunk rotation (Carman et al 1972) and bilaterally
for flexion or to stabilize leg movements (Floyd & Silver
1950).
During gait and trunk rotation, fascicles of LD and GM
that attach to the PLF are reported to contract contralater­
ally in an alternating phasic fashion (Mooney et al 2001)
and may generate oblique tension across the PLF (Vleeming
et al 1995). The paraspinal muscles may also generate ten­
sion in the PLF during contraction, for example during
resisted extension or anti-gravity flexion (Donisch &
Basmajian 1972, Floyd & Silver 1955).
While tension in the MLF is primarily influenced by
contraction of TrA, the PLF may be more influenced by con­
traction of global, phasic muscles. This puts the MLF at an
advantage for segmental stability.
Biomechanical roles of the lumbar fasciae
Longitudinal tension generation
The PLF has the largest moment arm of all extensor tissues
(Tesh 1986) and has been proposed to oppose flexion
moments in several ways. Although initially thought to
generate passive longitudinal tension (Gracovetsky et al
1981), its fibres are not well oriented for this, possessing a
relatively small vertical component (Barker & Briggs 1999,
Bogduk & Macintosh 1984, McGill & Norman 1988, Tesh et
a11987, Vleeming et aI1995). Similar to a lattice, lateral ten­
sion generated by abdominal wall muscles might increase
longitudinal tension in the PLF. T his has been simulated in
cadavers and a small amount of lumbar extension noted
(Fairbank & O'Brien 1980). Initially the axial 'gain' was pre­
dicted mathematically to be up to 5:1 (Gracovetsky et al
1985), but subsequent studies indicate gains of less than 1:1,
even if the effects of lumbar flexion on fibre angles are
incorporated (Tesh et aI1987). Fasciae appear to contribute
to spinal support more effectively by generating transverse
than longitudinal tension.
Hydraulic amplifier effect
By enclosing paraspinal muscles and restricting radial
expansion, the PLF may increase longitudinal tension in
these muscles, enhancing their contraction and the exten­
sion moment generated by them. This is known as the
hydraulic amplifier effect (Aspden 1992, Farfan 1973,
Gracovetsky et aI1977). Intramuscular pressure recordings
(Styf & Lysell 1987) support restriction by fascia, with
mathematical analysis (based on behaviour of non-vis­
coelastic materials) indicating it may increase the effective­
ness of the paraspinals by up to 30% (Hukins et aI1990a).
Lumbar segmental control
From the neutral position of the lumbar spine, each seg­
ment can move within a region of minimal resistance from
surrounding tissues, known as the neutral zone (Panjabi
1992b). Control of this zone is thought to provide a better
indication of spinal instability than physiologic range of
movement (Panjabi 1992b, Panjabi et aI1989). Surrounding
tissues can be classified into active, passive and neural con­
trol subsystems, and deficiency in any one has been pro­
posed to permit excess movement, resulting in pain and
disability (Panjabi 1992a).
The MLF and PLF may limit lumbar segmental move­
ment by transmitting tension from contraction of TrA
(Hodges & Richardson 1997b). Tesh's (1986) work (Tesh
1986) supports this theory, since applying lateral tension to
the PLF effectively moved the segmental load deformation
curve to the left, reducing the neutral zone (see Fig. 11.5).
Although rarely performed, lumbar fasciectomy may result
in a sensation of instability (S. N. Bell, personal communi­
cation, 2002) that is consistent with this proposal.
Lateral tension on the MLF was not tested but might be
predicted to have a similar effect on segmental neutral zone
movement and perhaps be more effective at transmitting
tension from TrA in the transverse plane (Barker et al
2004a). T he MLF and PLF are passive components in this
mechanism, reliant on a relatively isolated bilateral, sym­
metrical contraction of TrA (and/or multifidus) to be effec­
tive. EMG findings collectively indicate that, in vivo, such a
fascial mechanism is likely to precede trunk perturbations
from the neutral position in the sagittal and coronal planes
(Cresswell et al 1992, Hodges & Richardson 1997b, 1998,
Moseley et aI2002).
Changes in onset of TrA observed with low back pain
(Hodges & Richardson 1996, 1998, Hodges et a12001) sup­
port this model of segmental stability, as do the results of
rehabilitation aimed at retraining its motor control Gull &
Richardson 2000). Decreases in pain and functional disabil­
ity have been noted in patients with spondylolysis and
spondylolisthesis as well as reduced recurrence of injury in
patients with first episode low back pain. Improvements
following motor control retraining have been sustained for
more than 2 years (Hides et a12001, O'Sullivan et aI1997b).
All of this provides considerable support for a role of TrA
(and the MLF and/or PLF) in segmental control.
Load transfer across the midline
In noting that tension on LD and GM caused displacement
of markers on the PLF bilaterally, Vleeming et al (1995) pro­
posed that this layer may assist load transfer across the
midline, particularly during activities involving 'contralat-

eraIlimb extension or trunk rotation, such as swimming or
walking.
Loose midline attachments of the PLF may enable some
forces to be distributed across, rather than entirely to, the
lumbar spine and sacroiliac joint. T his proposal is sup­
ported by findings of tension studies (Barker et al 2004a,
Vleeming et a11995) and the co-contraction of contralateral
GM and LD during gait and trunk rotation (Mooney et al
2001). Relatively low tensile loading has been noted to pro­
duce contralateral tension in the PLF (Barker et al 2004a,
Vleeming et al 1995), indicating this layer has a greater
capacity for contralateral tensile transmission tension, but
potentially a reduced capacity for restraining movement of
vertebrae, via the spinous processes.
Sacroiliac stability
The PLF lies directly behind the sacroiliac joint (SIJ), so ten­
sion in it can contribute to active force compression at the
SIJ (Vleeming et aI1995). A functional relationship between
the SIJ and PLF (with its attached muscles; particularly GM)
is supported by several studies.
BiomeG1.anical analysis of LD indicates that it may pro­
duce a limited effect (via the PLF) at the SIJ (Bogduk et al
1998). Tensile testing studies similarly indicate the effects of
LD and TrA may only extend via the PLF to fascial markers
at Sl (Barker et al 2004a, Vleeming et aI1995). By contrast,
the fascial attachment of GM is thicker, more proximal to
the SIJ and oriented perpendicular to its articular compo­
nents (Dijkstra et aI1989), displacing markers as low as S3
(Barker et aI2004a).
Surface EMG studies indicate GM displays a greater sig­
nal amplitude than LD during gait and trunk rotation
(Mooney et al 2001) and contraction of GM corresponds
with a greater increase in SIJ stiffness (Wingerden et al
2001). T he level of attachment of GM and the PLF also cor­
responds with the level at which pelvic belts are placed
(Vleeming et aI1992) to brace the SIJ for effective relief of
peripartum pain (Mens et aI1996). However, management
regimes for sacroiliac dysfunction based on associations
between GM and LD have given varied results (Mens et al
2000, Mooney et al 2001), while TrA is emerging to play a
more important role in SIJ stiffness.
Richardson et al (2002) proposed that compression of
the SIJ is produced by TrA's anterior iliac attachments,
which are direct rather than via the lumbar fasciae. Pelvic
belt placement, previously thought to simulate the effect of
GM and the PLF posteriorly, might more correctly simulate
the effect of TrA's fascicles anteriorly (Richardson et al
2002). T he deep fascicles of multifidus also appear appro­
priate to contribute to stability of the SIJ via their anatom­
ical features (Macintosh et al 1986) and EMG behaviour
(Moseley et aI2002).
It is, therefore, increasingly evident that the lumbar fas­
ciae and their attachments may be less important in sus­
taining SIJ stability than the anterior fibres of TrA. During
certain activities, GM and LD may be recruited in a phasic
The l umbar fasciae and segmental control 149
fashion to provide additional posterior compression via the
PLF.
Proprioception
T he PLF and MLF may play a proprioceptive role in lumbar
stability (Barker & Briggs 1999). Attached to ligaments and
muscles as well as containing mechanoreceptors (Yahia et al
1992), they are closely related with each of Panjabi's pas­
sive, active and neural subsystems (Panjabi 1992a). T he fas­
ciae may form functional interfaces between these
structures at a segmental level. Feedback from mechanore­
ceptors on the status of tension in related muscles and liga­
ments may be incorporated by the neural subsystem and
tension in muscles modified to help prevent excess seg­
mental movement (Panjabi 1992a).
If this mechanism is disrupted, proprioceptive feedback
will be altered. A reduction in trunk proprioception and
resultant sensation of instability following lumbar (PLF)
fasciectomy (S. N. Bell, personal communication, 2002) is
consistent with this. Histological studies report innervation
of the PLF to be deficient in patients with chronic low back
pain (Bednar et aI1995), which might similarly reduce pro­
prioceptive feedback and segmental control. Proprioceptive
deficiency is in keeping with reports of patients with low
back pain having difficulty achieving preferential contrac­
tion of TrA (Richardson et al 1999) and highlights the
importance of persisting with motor control retraining and
incorporation into functional tasks (O'Sullivan et aI1997b)
to avoid recurrence of injury.
Magnitude of segmental forces
Just two degrees of axial rotation has been reported to pro­
duce microtrauma of the intervertebral disc (Farfan et al
1970) and very small amounts (3%) of muscle contraction
have been predicted capable of restoring segmental stabil­
ity (Cholewicki & McGill 1996). Although limitation of neu­
tral zone movement is now recognized as important in
injury prevention (Cholewicki & McGill 1996, Panjabi
1992b), the stabilizing effects of TrA and/ or lumbar fasciae
have traditionally been discounted owing to their small
capacity for force generation or transmission.
TrA's early onset of contraction enables it to act briefly
and in relative isolation (together with MLF, PLF and deep
multifidus) on the lumbar segments. Its small cross-sec­
tional area (Richardson et a11999) is well suited to generate
small tensile loads and the fasciae are well structured to tol­
erate these. Fascial tensile forces are noted to increase with
applied tension on TrA up to 10 N, but not proportionally
above this (Barker et aI2004).
T he low forces applied to fascia by Barker et al (2004a)
and Tesh (1986) support the proposed capacity of fasciae to
influence movement at all segments via an early onset, sub­
maximal contraction of TrA. Although Tesh's study (Tesh
1986) simulated only about 20% of the maximum (90 N) lat­
eral tension estimated by the author to be generated in the
150 FOUNDATION SCIENCES FOR MANUAL THERAPY
PLF, this was sufficient to reduce neutral zone movement
(see Fig. 11.5). The findings support the basis for exercises
incorporating submaximal contraction of TrA (Richardson
& Jull 1995, Richardson et al 1999) for management and
prevention of low back pain.
Of interest, Tesh himself did not consider the effects of
fascial tension to be adequate to influence segmental move­
ment (Tesh 1986). In view of subsequent research recogniz­
ing the importance of limitation of the neutral zone (Panjabi
1992b) and the potential importance of an early onset of
TrA contraction (Hodges & Richardson 1996), the effects,
although relatively small, may still be significant.
P lanar stability
Attachments to transverse and spinous processes (Farfan
1975), along with obliquely oriented fibres, permit the MLF
and PLF to resist movement in all three movement planes.
Vertebral processes maximize their leverage on segmental
movement, providing the fasciae with approximately 7 em
moment arms (Tesh 1986) in the neutral position.
Contraction of TrA prior to trunk perturbations has also been
proposed to influence segmental neutral zone movement in
multiple planes (Hodges & Richardson 1997b).
Coronal stability
From their intra-abdominal balloon experiments, Tesh and
colleagues (Tesh 1986, Tesh et a11987) proposed that if suffi­
cient tension was generated (e.g. by TrA contraction) during
lateral flexion, the MLF could contribute to segmental coro­
nal plane stability by generating greater longitudinal tension
Figure 11.6 The MLF i n l a tera l flexion. Asymmetry i n MLF fi b re
a n g les d u ri n g latera l flexi o n creates a co rrective moment. Ada pted
from Tesh et al 1987.
Key: MlF = m i d d l e l u m ba r fascia.
on the convex side (Tesh et al 1987). The asymmetry was
hypothesized to create a corrective moment that tended to
approximate the transverse processes on that side (Fig. 11.6).
It was therefore suggested that the MLF contributes increas­
ingly to stability during trunk lateral flexion, while the PLF
was able to be cut without affecting pressure (Tesh 1986).
The study indicated a tendency for tension from TrA and
the MLF to return the spine to the neutral position (Tesh et
a11987), but did so using pressures associated with a strong
contraction of TrA (120 mmHg) and from end of range lat­
eral flexion rather than from the neutral position (in which
fascial fibre angles would be symmetrical). Although
indicative of a significant role for the MLF in the coronal
plane, its application to segmental neutral zone motion is
less clear than concurrent studies in the sagittal plane gen­
erating submaximal fascial tension (Tesh 1986) and requires
further investigation. EMG studies do, however, indicate an
onset of contraction of TrA prior to coronal trunk perturba­
tions, so both MLF and PLF are likely to affect (inner range)
coronal plane stability to some extent. Fibre angles dictate
that this tensile effect will be more substantial in the trans­
verse plane.
Sagittal stability
Since both spinous and transverse processes lie behind the
instantaneous axis of rotation for flexion, the PLF and MLF
may both contribute to sagittal plane stability, the PLF more
so due to a longer moment arm. Tension on the PLF may be
transmitted to vertebrae via the supraspinous and inter­
spinous ligaments, helping to limit sagittal rotation and
shear movements respectively (Farfan 1995).
Tesh's experiments (Tesh 1986) provide compelling evi­
dence to support the role of the PLF in limiting segmental
neutral zone movement in the sagittal plane (see Fig. 11.5).
Fascial tension increased inner range stiffness during test­
ing of all lumbar segments from four cadavers and the dif­
ference was reproducible if tension was detached then
reapplied. The MLF has not been similarly tested, but has
been shown to transmit lateral tension loads effectively
(Barker et al 2004). EMG behaviour of TrA during sagittal
trunk perturbations and with low back pain (Hodges &
Richardson 1996) is consistent with such an (inner range)
stabilizing role for both the MLF and PLF. Tensile transmis­
sion from TrA to the MLF may also help explain Kaigle et
aI's finding, in an in vivo porcine model, that removal of
lumbar transverse processes (following facet joint injury)
resulted in an increase in the neutral zone range for seg­
mental sagittal rotation (Kaigle et al 1995).
Transverse stability
Very little axial rotation occurs in the lumbar spine owing
to the orientation of facet joints (Bogduk 1997). Accurate
testing of this movement is consequently difficult and no
known studies have quantified the effects of fasciae on seg­
mental rotation. However, minimal movement may be
required to produce injury in this plane (Gracovetsky &
Farfan 1986, Hickey & Hukins 1980) and twisting is com-
 The l umbar fasciae and segmental control 15 1

monly implicated in low back injury (Kelsey et al 1984, loads from IrA to all lumbar vertebrae. Although the MLF
Marras et al 1993, 1995, Mundt et al 1993). Appropriately may provide a more effective and isolated route, to date
timed influences on the neutral zone may be particularly only the PLF has been demonstrated to limit segmental
crucial for preventing injury in this plane. neutral zone movement (in the sagittal plane). EMG studies
Although EMG behaviour of IrA has not been reported in healthy subjects indicate an early onset of contraction of
in response to limb movements in the transverse plane, IrA occurs prior to trunk perturbations in several direc­
movements in sagittal and coronal planes are likely to gen­ tions, and under these circumstances both MLF and PLF are
erate alternating rotary demands in the transverse plane predicted to limit excess intersegmental movement occur­
(Hodges & Richardson 1997b). On this basis, one might pre­ ring in all planes.
dict, IrA also demonstrates an early onset of contraction Disruption of the early contraction onset of IrA, as
prior to transverse trunk peturbations. observed with low back pain, will eliminate this fascial
Anatomical and transverse loading studies indicate IrA influence on the neutral zone and is likely to increase pre­
and the MLF and PLF are well structured to resist tension in disposition to injury. The MLF and PLF also provide a
the transverse plane (Barker et al 2004a, 2004b, Iesh 1986). mechanism for continuous proprioceptive feedback from
Their effect on segmental movement might be expected, each lumbar segment, with disruption of innervation possi­
from fibre directions and the results of stiffness testing, to be bly contributing to reduced segmental control in patients
several times the magnitude of those observed in the sagit­ with chronic low back pain.
tal plane, and effected on a smaller range of motion. In addition to its segmental roles, the PLF has more
global effects during activities that recruit its attached or
enclosed global muscles and these may contribute to com­
Fascial disruption
pression across the SIJ and lumbar spine as well as increase
The lumbar fasciae are frequently disrupted by injury or the effectiveness of paraspinal muscle contraction (respec­
surgery. The MLF may be torn when its attachments are tively). Such global roles are effected on an underlying
avulsed (Marshall 2001) and the PLF is routinely cut during requirement for restriction of segmental movement, influ­
lumbar spine surgery, lumbar fasciectomy or taking bone enced by local muscle activity and transverse fascial tension
grafts from the iliac crest. The contribution of the relevant from IrA. Further work elaborating the effects of MLF and
fascia(e) to segmental control is then compromised and one PLF on segmental movement and the consequences of fas­
might expect the resultant deficiency to increase the indi­ cial disruption may provide greater insight into their roles
vidual's chance of low back injury. Io date, however, this in segmental control.
has not been reported, with management of the above con­
ditions being largely symptomatic (Howarth & Petrie 1964).
It has been suggested that reattachment of the PLF to
midline structures following surgery (Crock & Crock 1988)
or the use of horizontal incisions (Aspden 1992) during anterior layer of lumbar hydraulic amplifier effect
spinal surgery may help to minimize rehabilitation time fascia lumbar segmental stability
and impairment of spinal stability. During iliac crest bone middle layer of lumbar load transfer across the
grafts, an incision through the midline rather than iliac fascia midline
attachments of the PLF, followed by reattachment, has been posterior layer of lumbar sacroiliac stability
reported to reduce postoperative pain over the harvest site fascia proprioception
(Hutchinson & DaIl 1994). Further research into disruption lumbar fasciae planar stability
of these mechanisms and the effects of surgical intervention muscle attachments coronal stability
is required. local muscles sagittal stability
global muscles transverse stability
biomechan ical roles disruption
CONCLUSION
longitudi nal tension segmental stability
The MLF and PLF are particularly well structured for trans­ generation magnitude of forces
verse tension and capable of transmitting even small tensile

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