Oral Presentation: Physical Exam (PE) Maneuvers Suggestive for Thoracolumbar Fascia (TLF) Involvement in Chronic Low Back Pain (cLBP)

Document Type

Presentation

Publication Title

Journal of Bodywork and Movement Therapies

Abstract

Introduction: The TLF is intimately involved in spinal stability, load distribution, and muscular coordination.1 Recent research implicates alterations in TLF integrity, thickness, and glide motion in cLBP patients.2 Additionally, the Lumbar Interfascial Triangle (LIFT) and Lateral Intermuscular Septum of the Thigh (LIST) have been identified as regions susceptible to defects in lumbopelvic fascia contributing to the appearance of PE weakness.3,4 Reliable PE maneuvers to assess TLF-related dysfunctions in cLBP remain underexplored. This study aims to test PE maneuvers that may implicate TLF dysfunction (glide impairment or defects) as a potential cause of cLBP. Methods: 18–50-year-old men and women had bilateral baseline physical examinations from 28 no LBP (nLBP), 5 acute LBP (aLBP), and 32 cLBP subjects. To assess for TLF glide impairment, subjects underwent a prone active straight leg raise (pASLR, n=130) and when painful, an add-on TLF posterior layer pre-stress maneuver to assess for pain relief. To assess for LIFT and/or LIST dysfunction, subjects underwent a prone hip extension strength (pHES, n=130) and prone hip external rotation strength (pHES, n=130) test and when weak (< 5/5), an add-on LIFT/LIST pre-stress maneuver to assess for strength improvement. TLF study approved by VCOM IRB 10/13/2023, protocol #: 2023-154 Results: Positive pASLR relieved by posterior-layer TLF traction (pre-stress) had a high positive predictive value (PPV, 89%) and sensitivity (89%) for cLBP vs nLBP, and was 5 times more likely to correlate to any form of glide impairment (passive or active) regardless of pain status, but was neither sensitive nor specific for detecting passive glide impairment alone in cLBP. Positive pHES was 3 times and positive pHERS was 1.5 times more likely in cLBP vs nLBP, while both positive pHES and pHERS relieved by LIFT/LIST prestress had very high sensitivities (94% and 100%) to predict cLBP. The LIFT/LIST prestress maneuver restored full strength to initial pHES and/or pHERS weakness in 34 out of 35 subjects (97%) regardless of pain status. Conclusion: Pain with pASLR which was improved with an add-in TLF pre-stress maneuver appears to be a promising exam maneuver that needs further study. Though LIFT and LIST dysfunction induced weakness can be found in all pain statuses, pre-stress maneuvers to LIFT and/or LIST strongly suggest that those often relate to a fascial mediated weakness and not a true neurologic weakness. Limitations include inter-examiner differences and patient pain perceptions. Ongoing recruitment will evaluate further baseline and post-treatment PE changes to confirm these PE maneuvers’ effectiveness in predicting TLF involvement in cLBP symptoms.

DOI

10.1016/j.jbmt.2025.11.135

Publication Date

7-2026

ISSN

1360-8592

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