10/05/2025
What if I told you, "it depends, it depends, it depends"... 😂😵🫥
Just published 🔥
Role of Latissimus Dorsi–Thoracolumbar Fascia Complex Stretching on Pain and Pain-Related Parameters in Patients With Chronic Low Back Pain: A Randomised Clinical Trial
▶️ Chronic low back pain (CLBP) is among the most prevalent musculoskeletal disorders worldwide, affecting up to 80% of the population at some point in their lives (Shokri et al., 2023). Despite its widespread burden, approximately 90% of cases are considered non-specific, with no clear pathological cause (Maher et al., 2017). The thoracolumbar fascia (TLF), a connective tissue complex spanning the lumbar region and linking the pelvis to the shoulders, has gained attention as a potential contributor to pain due to its biomechanical role and rich nociceptive innervation (Willard et al., 2012; Wilke et al., 2017). Structural alterations such as increased TLF thickness have been correlated with higher pain severity in CLBP patients (Bell et al., 2018).
▶️ The latissimus dorsi (LD) integrates with the superficial lamina of the TLF, forming a myofascial continuity that influences lumbar stability and load transfer (Abe et al., 2021). Experimental and clinical evidence suggests that fascial stretching may restore connective tissue mobility and reduce nociceptive drive (Langevin et al., 2009; Stecco et al., 2011). However, the role of specific LD–TLF complex stretching in CLBP remains poorly defined. To address this gap, Ulug et al. (2025, https://pubmed.ncbi.nlm.nih.gov/41035304/) conducted a randomized clinical trial examining the effects of LD–TLF complex stretching in addition to conventional physiotherapy on pain, sensitivity, and disability in patients with CLBP.
🤸 The Latissimus Dorsi–Thoracolumbar Fascia Complex Stretching (s. figure)
In this study, the intervention targeted the LD–TLF connection indirectly to influence fascial load transfer and mobility. The stretching protocol lasted 4 weeks, with patients performing 10 daily repetitions of two specific exercises, each held for 20–30 seconds:
a) Seated passive arm raise with thigh elevation – elevating the arms cranially with concurrent caudal passive stretching of the LD–TLF complex, enhancing longitudinal fascial elongation.
b) Hip flexion with feet on stool (30 cm) – designed to stretch both the gluteus maximus and the posterior layer of the TLF by promoting lumbar flexion while maintaining pelvic support.
These exercises were integrated into a standard physiotherapy program (Williams exercises, ultrasound, and heat) and administered by an experienced physiotherapist.
📈 Findings
Compared with physiotherapy alone, LD–TLF stretching significantly improved:
🎯 Pressure pain thresholds (PPTs) at L1, L3, and the 12th rib (p < 0.001).
✅ Pain sensitivity questionnaire (PSQ scores), showing reduced generalized pain perception.
🌟 Pain-related interference in daily life (BPI scores, i.e. average pain mean difference (pre-post) 4.0 (3.5–4.5) vs. 2.1 (1.6–2.5)) and disability (i.e. ODQ mean differences (pre-post): 28.1 (24.-32.1) vs. 5.2 (3.1–7.2)), with sig. greater reductions than in controls.
🧩 Conclusion and Limitations
The study demonstrated that LD–TLF complex stretching, when combined with conventional physiotherapy, provides additional benefits in reducing pain, improving pressure pain thresholds, and lowering disability in CLBP patients.
❎However, several limitations must be considered. The study did not directly measure structural or biomechanical changes in the TLF, leaving uncertainty about whether improvements were mediated by fascial remodeling. Imaging techniques such as ultrasound elastography were not applied, and thus the assumed fascial effects remain speculative. Moreover, the relatively small sample size (n = 30) may restrict the generalizability of the results. Finally, the composite and resilient nature of the TLF raises questions about whether stretching alone can produce lasting tissue modifications. Furthermore, the lack of a sham fascial intervention restricts the control for non-specific effects. The physiotherapy protocol does not correspond to current best practice guidelines. Future studies with larger cohorts, advanced imaging, and mechanistic analyses are warranted to validate and expand upon these findings.
