Can the thoracolumbar fascia cause or contribute to lower back pain and inflammation?
Thoracolumbar Fascia
Tissue behind the spinal column, positioned at both the lower back and mid-back levels, is connected to the thoracolumbar fascia, also called the lumbodorsal fascia or LF. The fascia is a thick connective tissue that covers and supports all the body’s muscles, bones, tendons, ligaments, and organs. The fascia also contains nociceptive nerve endings, also known as free nerve endings, that arise from the central nervous system, i.e., the brain and spinal cord, which may be responsible for some forms of back pain and stiffness caused by injury or inflammation.
Anatomy
The thoracolumbar fascia is divided into three layers:
Many of the back muscles attach to the thoracolumbar fascia. The erector spinae muscle group, known as the paraspinals, runs longitudinally down the spine. They are attached to the thoracolumbar fascia and the bony spine. The lumbar part of the posterior layer of the thoracolumbar fascia extends from the lowest rib to the top of the hip bone or the iliac crest. On the same path, it connects with the transverse abdominal muscle. The thoracolumbar fascia connections help bridge the back muscles to the abdominal wall muscles. The latissimus dorsi, a large back muscle that bears and moves the body’s weight with the arms and shoulders, is also connected to the thoracolumbar fascia, with the fibers extending outward from the fascia. The front part of the thoracolumbar fascia, or anterior layer, covers a muscle called the quadratus lumborum. This muscle bends the trunk to the side, helps maintain a healthy posture, and is often focused on muscle-related lower back pain.
What the Fascia Does
The thoracolumbar fascia, examined from the back of an anatomical drawing or diagram, is diamond-shaped. Its shape, large size, and central location uniquely position it to unify and synchronize the upper body’s movements with the lower body’s. The fascia’s fibers are very strong, enabling the tissue sheath to lend support (Willard, F. H. et al., 2012) . The tissue is also flexible, enabling it to help circulate forces of movement and contralateral movements as the back muscles contract and relax. An example is walking.
Back Pain
Scientists and doctors don’t know for sure, but it’s possible that the thoracolumbar fascia may contribute to lower back pain. A study found that the fascia may generate back pain based on: (Wilke, J. et al., 2017)
Sustaining micro-injuries and/or inflammation, which are often related, may cause signal changes in the free nerve endings in the fascia. Nerve endings acquire information from the outer areas of the body, like skin and other fascia, and relay it back to the central nervous system. The theory is that when the fascia close to the skin becomes injured, damaged, and/or backed up with inflammatory chemicals and substances, it is communicated as pain and other sensations back to the brain and spinal cord.
After a back injury, tissues tighten and stiffen. Some studies of patients with back pain noted alterations in their thoracolumbar fascia.
Injuries tend to stimulate nerves, which can lead to increased sensitivity.
Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Sciatica, Causes, Symptoms, and Tips
References
Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of anatomy, 221(6), 507–536. https://doi.org/10.1111/j.1469-7580.2012.01511.x
Wilke, J., Schleip, R., Klingler, W., & Stecco, C. (2017). The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review. BioMed research international, 2017, 5349620. https://doi.org/10.1155/2017/5349620
Individuals may discover a lump, bump, or nodule under the skin around their lower back, hips, and sacrum that can cause pain by compressing nerves and damaging the fascia. Can knowing the conditions linked to them and their symptoms help healthcare providers determine a correct diagnosis and develop an effective treatment plan for them?
Painful Bumps, Nodules Around Low Back, Hips, and Sacrum
Painful masses in and around the hips, the sacrum, and the lower back are lumps of fat or lipomas, fibrous tissue, or other types of nodules that move when pressed on. Some healthcare providers and chiropractors, in particular, use the non-medical term back mice (In 1937, the term was used to describe lumps associated with episacroiliac lipoma) to describe the bumps. Some healthcare professionals argue against calling the masses mice because it is not specific and could lead to misdiagnoses or incorrect treatment.
Most show up in the lower back and hip area.
In some cases, they protrude or herniate through the lumbodorsal fascia or the network of connective tissue that covers the deep muscles of the lower and middle back.
Other lumps can develop in the tissue under the skin.
Today, many conditions are associated with back mice lumps, including:
Iliac crest pain syndrome
Multifidus triangle syndrome
Lumbar fascial fat herniation
Lumbosacral (sacrum) fat herniation
Episacral lipoma
Related Conditions
Iliac Crest Pain Syndrome
Also known as iliolumbar syndrome, iliac crest pain syndrome develops when a tear in the ligament occurs.
The ligament band connects the fourth and fifth lumbar vertebrae with the ilium on the same side. (Dąbrowski, K. Ciszek, B. 2023)
Causes include:
Tearing the ligament from repeated bending and twisting.
Trauma or fracture of the ilium bone caused by a fall or vehicle collision accident.
Multifidus Triangle Syndrome
Multifidus triangle syndrome develops when the multifidus muscles along the spine weaken and diminish function or ability.
These muscles can atrophy, and intramuscular fatty tissue can replace the muscle.
The lumbodorsal fascia is a thin fibrous membrane covering the back’s deep muscles.
Lumbar fascial fat herniation is a painful mass of fat that protrudes or herniates through the membrane, gets trapped and inflamed, and causes pain.
The causes of this type of herniation are currently unknown.
Lumbosacral (Sacrum) Fat Herniation
Lumbosacral describes where the lumbar spine meets the sacrum.
Lumbosacral fat herniation is a painful mass like lumbar facial herniation in a different location around the sacrum.
The causes of this type of herniation are currently unknown.
Episacral Lipoma
Episacral lipoma is a small painful nodule under the skin that primarily develops over the top outer edges of the pelvic bone. These lumps occur when a portion of the dorsal fat pad protrudes through a tear in the thoracodorsal fascia, the connective tissue that helps hold the back muscles in place. (Erdem, H. R. et al., 2013) A healthcare provider may refer an individual to an orthopedist or orthopedic surgeon for this lipoma. An individual may also find pain relief from a massage therapist familiar with the condition. (Erdem, H. R. et al., 2013)
Symptoms
Back lumps can often be seen under the skin. They are typically tender to the touch and can make sitting in a chair or lying on the back difficult, as they often appear on the hip bones and sacroiliac region. (Bicket, M. C. et al., 2016) The nodules may:
Be firm or tight.
Have an elastic feel.
Move under the skin when pressed.
Cause intense, severe pain.
The pain results from pressure on the lump, which compresses the nerves.
Damage to the underlying fascia can also cause pain symptoms.
Diagnosis
Some individuals do not realize they have nodules or lumps until pressure is applied. Chiropractors and massage therapists often find them during treatments but do not diagnose the abnormal fatty growth. The chiropractor or massage therapist will refer the patient to a qualified dermatologist or medical professional who can perform imaging studies and a biopsy. Determining what the lumps are can be challenging because they are non-specific. Healthcare providers sometimes diagnose the nodules by injecting them with a local anesthetic. (Bicket, M. C. et al., 2016)
Differential Diagnosis
The fatty deposits can be any number of things, and the same applies to the sources of nerve pain. A healthcare provider may further diagnose by ruling out other causes, which can include:
Sebaceous Cysts
A benign, fluid-filled capsule between the layers of skin.
Subcutaneous Abscess
A collection of pus beneath the skin.
Usually painful.
It can become inflamed.
Sciatica
Radiating nerve pain down one or both legs that is caused by a herniated disc, bone spur, or spasming muscles in the lower back.
Liposarcoma
Malignant tumors can sometimes appear as fatty growths in the muscles.
Liposarcoma is typically diagnosed by biopsy, where some tissue is removed from the nodule and examined for cancer cells. (Johns Hopkins Medicine. 2024)
An MRI or CT scan may also be performed to determine the exact location of the nodule.
Painful lipomas are also associated with fibromyalgia.
Treatment
Back nodules are usually benign, so there’s no reason to remove them unless they’re causing pain or mobility problems (American Academy of Orthopedic Surgeons: OrthoInfo. 2023). However, they should be examined to make sure they are not cancerous. Treatment usually involves injected anesthetics, such as lidocaine or corticosteroids, as well as over-the-counter pain relievers like NSAIDs.
Surgery
If pain is severe, surgical removal may be recommended. This involves cutting out the mass and repairing the fascia for lasting relief. However, removal may not be recommended if there are many nodules, as some individuals can have hundreds. Liposuction may be effective if the lumps are smaller, more extensive, and comprise more fluid. (American Family Physician. 2002) Complications of surgical removal can include:
Scarring
Bruising
Uneven skin texture
Infection
Complementary and Alternative Treatment
Complimentary and Alternative Medicine treatments like acupuncture, dry needling, and spinal manipulation can help. Many chiropractors believe back nodules can be successfully treated with complementary and alternative therapies. A common approach uses acupuncture and spinal manipulation in combination. A case study reported that anesthetic injections followed by dry needling, which is similar to acupuncture, improved pain relief. (Bicket, M. C. et al., 2016)
Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive therapies and functional rehabilitation procedures focused on restoring normal body functions after trauma and soft tissue injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.
Beyond the Surface
References
Dąbrowski, K., & Ciszek, B. (2023). Anatomy and morphology of iliolumbar ligament. Surgical and radiologic anatomy : SRA, 45(2), 169–173. https://doi.org/10.1007/s00276-022-03070-y
Seyedhoseinpoor, T., Taghipour, M., Dadgoo, M., Sanjari, M. A., Takamjani, I. E., Kazemnejad, A., Khoshamooz, Y., & Hides, J. (2022). Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 22(4), 660–676. https://doi.org/10.1016/j.spinee.2021.10.018
Erdem, H. R., Nacır, B., Özeri, Z., & Karagöz, A. (2013). Episakral lipoma: Bel ağrısının tedavi edilebilir bir nedeni [Episacral lipoma: a treatable cause of low back pain]. Agri : Agri (Algoloji) Dernegi’nin Yayin organidir = The journal of the Turkish Society of Algology, 25(2), 83–86. https://doi.org/10.5505/agri.2013.63626
Bicket, M. C., Simmons, C., & Zheng, Y. (2016). The Best-Laid Plans of “Back Mice” and Men: A Case Report and Literature Review of Episacroiliac Lipoma. Pain physician, 19(3), 181–188.
American Academy of Orthopedic Surgeons: OrthoInfo. (2023). Lipoma. https://orthoinfo.aaos.org/en/diseases–conditions/lipoma
American Family Physician. (2002). Lipoma excision. American Family Physician, 65(5), 901-905. https://www.aafp.org/pubs/afp/issues/2002/0301/p901.html
For individuals looking to improve their spinal health, can understanding the anatomy of the intervertebral foramen help in injury rehabilitation and prevention?
Intervertebral Foramen
The intervertebral foramen, aka neural foramen, is the opening between the vertebrae through which spinal nerve roots connect and exit to other body areas. If the foramina narrows, it can place added pressure on the nerve roots near and around them, causing pain symptoms and sensations. This is known as neuroforaminal stenosis. (Sumihisa Orita et al., 2016)
Anatomy
The vertebrae comprise the spinal column.
They protect and support the spinal cord and most of the weight placed on the spine.
Foramen is the singular form, and foramina is the plural form.
Structure
The body is the large, round part of the bone that makes up each vertebra.
The body of each vertebra is attached to a bony ring.
Stenosis can occur in the spinal canal, known as central canal stenosis, and the foramina.
Pain brought on by neuroforaminal spinal stenosis and arthritis-related bone growth/bone spurs/osteophytes that are present in one or more foramen rub against the nerve root that passes through the space, causing radicular pain.
Pain accompanied by other sensations, like tingling or numbness, is known as radiculopathy. (Young Kook Choi, 2019)
The main symptom is pain.
Numbness and/or tingling can present depending on the injury.
Neurogenic claudication occurs as a result of ischemia or a lack of blood circulation to the nerves and typically presents with a heaviness in the legs.
It is typically associated with central stenosis rather than foraminal stenosis.
Most individuals with spinal stenosis feel better when flexing or bending forward and worse when arching their backs.
Stenosis treatment aims to relieve pain and prevent nerve symptoms from occurring or worsening. Conservative treatments are recommended and can be highly effective.
These include:
Myelopathy in the neck and/or upper or mid-back (myelopathy symptoms are spinal cord related and occur in central canal stenosis) (Cleveland Clinic. 2021)
Intense incapacitating pain
Different surgical techniques include:
Decompression laminectomy – entails removing the buildup of bone in the spinal canal.
Spinal fusion – when there is instability of the spine or severe foraminal stenosis.
Orita, S., Inage, K., Eguchi, Y., Kubota, G., Aoki, Y., Nakamura, J., Matsuura, Y., Furuya, T., Koda, M., & Ohtori, S. (2016). Lumbar foraminal stenosis, the hidden stenosis including at L5/S1. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 26(7), 685–693. https://doi.org/10.1007/s00590-016-1806-7
American Academy of Orthopaedic Surgeons. (2020). Spine Basics (OrthoInfo, Issue. https://orthoinfo.aaos.org/en/diseases–conditions/spine-basics/
American Academy of Orthopaedic Surgeons. (2021). Lumbar spinal stenosis (OrthoInfo, Issue. https://orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis/
Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. https://doi.org/10.3344/kjp.2019.32.3.147
Lee, S. Y., Kim, T. H., Oh, J. K., Lee, S. J., & Park, M. S. (2015). Lumbar Stenosis: A Recent Update by Review of Literature. Asian spine journal, 9(5), 818–828. https://doi.org/10.4184/asj.2015.9.5.818
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. https://doi.org/10.1136/bmj.h6234
“Various problems with the sacrum make up or contribute to a significant portion of lower back problems. Can understanding the anatomy and function help prevent and treat back injuries?”
The Sacrum
The sacrum is a bone shaped like an upside-down triangle located at the base of the spine that helps support the upper body when sitting or standing and provides pelvic girdle flexibility during childbirth. It comprises five vertebrae that fuse during adulthood and connect to the pelvis. This bone takes and endures all of the body’s pressure and stress from everyday activities and movements.
Formation
Humans are born with four to six sacral vertebrae. However, fusion does not take place in all sacral vertebrae simultaneously:
Fusion starts with the S1 and S2.
As the individual gets older, the overall shape of the sacrum begins to solidify, and the vertebrae fuse into a single structure.
The process usually starts in the mid-teens and finishes in the early to mid-twenties.
It is believed to start earlier in females than males.
The sacrum in a female is wider and shorter and has a more curved top or the pelvic inlet.
The male sacrum is longer, narrower, and flatter.
Structure
The sacrum is an irregular bone that makes up the back/posterior third of the pelvic girdle. There is a ridge across the front/anterior portion of the S1 vertebra known as the sacral promontory. Small holes/foramen on both sides of the sacrum are left over after the vertebrae fuse together. Depending on the number of vertebrae, there can be three to five foramen on each side, though there are usually four. (E. Nastoulis, et al., 2019)
Each anterior foramen is typically wider than the posterior or dorsal/backside foramen.
Each sacral foramina/plural of foramen provides a channel for the sacral nerves and blood vessels.
Small ridges develop between each of the fused vertebrae, known as transverse ridges or lines.
The top of the sacrum is called the base and is connected to the largest and lowest of the lumbar vertebrae – L5.
The bottom is connected to the tailbone/coccyx, known as the apex.
The sacral canal is hollow, runs from the base to the apex, and serves as a channel at the end of the spinal cord.
The sides of the sacrum connect to the right and left hip/iliac bones. The attachment point is the auricular surface.
Right behind the auricular surface is the sacral tuberosity, which serves as an attachment area for the ligaments that hold the pelvic girdle together.
Location
The sacrum is at the level of the lower back, just above the intergluteal cleft or where the buttocks split. The cleft starts at around the level of the tailbone or coccyx. The sacrum is curved forward and ends at the coccyx, with the curvature being more pronounced in females than males. It connects to the L5 lumbar vertebra by way of the lumbosacral joint. The disc between these two vertebrae is a common source of low back pain.
On either side of the lumbosacral joint are wing-like structures known as the sacral ala, which connect to the iliac bones and form the top of the sacroiliac joint.
These wings provide stability and strength for walking and standing.
Anatomical Variations
The most common anatomical variation applies to the number of vertebrae. The most common is five, but anomalies have been documented, including individuals with four or six sacral vertebrae. (E. Nastoulis, et al., 2019)
Other variations involve the sacrum’s surface and curvature, where the curvature differs widely between individuals.
In some cases, the first and second vertebrae do not fuse and remain separately articulated.
Failure of the canal to completely close during formation is a condition known as spina bifida.
Function
Studies on the sacrum are ongoing, but some proven functions include:
It serves as an anchor point for the spinal column to attach to the pelvis.
It provides stability for the body’s core.
It acts as a platform for the spinal column to rest on when sitting.
It facilitates childbirth, providing pelvic girdle flexibility.
It supports upper body weight when sitting or standing.
It provides extra stability for walking, balance, and mobility.
Conditions
The sacrum can be a main source or focal point for lower back pain. It is estimated that 28% of men and 31.6% of women aged 18 years or older have experienced low back pain in the past three months. (Centers for Disease Control and Prevention. 2020) Conditions that can cause sacrum pain symptoms include.
Sacroiliitis
This is a common condition of sacroiliac/SI joint inflammation.
A doctor only makes the diagnosis when all other possible causes of pain have been ruled out, known as a diagnosis of exclusion.
About half of all chordomas form in the sacrum, but the tumors can also develop elsewhere in the vertebral column or at the base of the skull. (National Library of Medicine. 2015)
Spina Bifida
Individuals can be born with conditions that affect the sacrum.
Spina bifida is a congenital condition that can arise from the malformation of the sacral canal.
Unlocking the Secrets of Inflammation
References
Gruss, L. T., & Schmitt, D. (2015). The evolution of the human pelvis: changing adaptations to bipedalism, obstetrics and thermoregulation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 370(1663), 20140063. https://doi.org/10.1098/rstb.2014.0063
Nastoulis, E., Karakasi, M. V., Pavlidis, P., Thomaidis, V., & Fiska, A. (2019). Anatomy and clinical significance of sacral variations: a systematic review. Folia morphologica, 78(4), 651–667. https://doi.org/10.5603/FM.a2019.0040
Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 36(8), 370–375.
It is a common scenario, whether sitting or standing when we need to bend down or forward, and suddenly there is a sharp sting on one side of the low back. The sensation can cause the knees to buckle. So we stand up slowly to assess the condition and realize it is almost impossible to stand completely straight and even harder to bend forward. So we sit back down to try and relieve the pressure. It helps a little, but the injury has caused the back muscles to spasm and get tighter and tighter. When we try to get up, there can be one big or several mild to severe electrical shock sensations traveling through the back. A severely over-rotated vertebrae could be the cause and require chiropractic care, massage, and/or decompression therapy.
Over Rotated Vertebrae
The spinal column is made of 26 interconnected vertebrae. When in motion, each vertebra moves, and as the torso rotates, the spine must rotate as well. The spine can move in several ways, including:
Bending
Rounding forward.
Extending or arching backward.
Twisting
Tilting sideways uses some of the same muscles when twisting.
Although the spine can move in various directions, there are limits to how far it can and should go. For example, when bending forward to lift an object, an individual can unknowingly over-extend and over-rotate vertebrae. This is where the risk of injury increases. A rotational injury of the spine occurs when the torso turns too far, and the spinal cord can’t handle it. This can stretch the ligaments in the spine to the point of snapping, causing the facet joints to dislocate. Ligament strains and facet dislocations are two of the most common rotational spine injuries.
Complications
An over-rotated vertebrae injury can also lead to complications that include.
Chronic Pain
Spinal nerve damage can lead to chronic pain conditions.
Mobility Problems
Mobility problems are common following an injury of the spine.
This comes from damage to the nerves that innervate the legs, causing weakness and coordination problems.
Pressure Ulcers
Numbness following a spine injury can cause individuals not to notice pressure ulcers developing.
These can lead to infections and could require hospitalization.
Individuals accumulate tension and/or weakness in the oblique abdominal muscles and other trunk muscles that can lead to chronic tightness and weakness, affecting movement and decreasing the range of motion.
Chiropractic Treatment Plan
Depending on the time and severity of the injury, a personalized treatment plan may consist of the following:
Chiropractic mobilization to release the spasms and reset the spine.
Rest
Facet Syndrome Treatment
References
Janssen, Michiel M A, et al. “Pre-existent vertebral rotation in the human spine is influenced by body position.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 19,10 (2010): 1728-34. doi:10.1007/s00586-010-1400-3
Kruger, Erwin A et al. “Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends.” The Journal of spinal cord medicine vol. 36,6 (2013): 572-85. doi:10.1179/2045772313Y.0000000093
Passias, Peter G et al. “Segmental lumbar rotation in patients with discogenic low back pain during functional weight-bearing activities.” The Journal of bone and joint surgery. American volume vol. 93,1 (2011): 29-37. doi:10.2106/JBJS.I.01348
Shan, X., Ning, X., Chen, Z. et al. Low back pain development response to sustained trunk axial twisting. Eur Spine J 22, 1972–1978 (2013). https://doi.org/10.1007/s00586-013-2784-7
The sacrum and coccyx are part of the vertebral spinal column and could contribute to low back pain. They are not like the other bones in the spinal column. The sacrum, also known as the sacral vertebra, sacral spine, and S1 is a large, flat triangular-shaped bone that is between the hip bones and below the last lumbar vertebra known as L5. The coccyx, known as the tailbone, is positioned below the sacrum.
The sacrum and coccyx are made up of smaller bones that fuse and grow into a solid bone mass by the age of 30. The sacrum is composed of 5 fused vertebrae known as S1-S5 and 3 to 5 smaller bones that fuse creating the coccyx. Both are weight-bearing bones and are integral to walking, standing, and sitting functions.
Sacrum and the Lumbosacral Spine
The sacrum forms the back of the pelvis. Along with the coccyx and the two sacroiliac joints make up the pelvic girdle. S1 is at the top of the sacrum and connects to the last lumbar vertebrae L5. Together they create the lumbosacral spine. Where they join forms the lumbosacral curves known as lumbar lordosis and lumbar kyphosis.
The curvature works to support the upper body, weight/force distribution maintains spinal balance and flexibility. Lordosis is the inward curve of the spine, but too much can cause swayback that can be associated with spondylolisthesis. Loss of this curve can cause spinal imbalance and can lead to Flatback syndrome.
Kyphosis is the outward curve of the spine. The location of the sacrum at the intersection of the spine and pelvis means it has an important role in the movement of the low back and hips. The sacrum�s joints help to bear weight and help stabilize the spinal column along with the ligaments, tendons, and muscles help support/stabilize joint movement.
Lumbosacral joint
Joint L5 and S1connect the lumbar spine to the sacrum. The pressure at this meeting point can be massive as the curve of the spine shifts from the lordotic forward curve to a kyphotic backward curve. The L5-S1 region bears weight, absorbs, and distributes the upper body�s weight when moving and resting. Disc herniation and spondylolisthesis are more common at L5-S1 for this reason.
Sacroiliac joints
The sacroiliac joints connect the sacrum to the left and right sides of the pelvis. The range of movement of the sacroiliac joints is minimal compared to other joints like the knees. However, the joints are essential for walking, standing, and stabilization of the hips. Sacroiliitis and sacroiliac joint dysfunction are two spinal disorders related to the joints. Other spinal disorders related to the sacral spine include:
The coccyx commonly known as the tailbone is just below the sacrum. It is smaller than the sacrum and has an important weight-bearing function. It helps supports weight while sitting.An example is leaning back while sitting. This motion and position increase the pressure/weight on the coccyx. An injury in this area can cause tailbone pain. Inflammation of the coccyx�s connective tissue that results in tailbone pain that gets worse when sitting is a common symptom. A traumatic event like a fall or auto accident that causes a tailbone fracture can also cause this pain.
Sacral and Coccygeal Nerves
The spinal cord ends at L1-L2, which branches out into the cauda equina, which is a bundle of nerves that looks like a horse’s tail. In the sacrum, there are sacral nerves known as the sacral plexus. Plexus means a network of nerve structures. The sacral and lumbar plexus compose the lumbosacral plexus. This is where the sciatic nerve, which is the largest nerve in the sacral plexusconverges into the band. Sciatic nerve compression causes a combination of symptoms known as sciatica. It is very well known for causing low back and leg pain.
The coccygeal nerve serves the tailbone. There are five sacral nerves numbered S1 through S5 and are part of the spinal cord.
S1 supports groin and hip function
S2 the back of the thighs
S3 the middle of the buttock area
S4 and S5 the anus and vagina
Injury or trauma to the sacral spine can cause mild stress fractures to severe bone fractures. These fractures can cause sacral nerve compression and intense pain. Symptoms include:
A doctor or chiropractor, physical therapist are excellent sources for information to help prevent sacrum and coccyx pain. These medical professionals will utilize a patient’s medical history, recommend lifestyle changes and injury prevention guidelines.
If at risk of developing osteoporosis then a bone mineral density test could be recommended.
Proper posture must be maintained. Avoid slouching as this places added pressure on the lumbosacral spine and the sacroiliac joints.
Proper body mechanics when engaging in any activity needs to be observed.
Use legstrength to lift objects.
Avoid twisting while lifting or holding heavy objects, as this can cause sprain, strain, or serious injury of the lower spine.
Put on the seat belt. Auto accidents are a major cause of spine trauma. Exercise restraint when driving or riding in any vehicle even a golf cart.
Sciatica Pain Relief
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
The spinal/vertebral column extends from the skull to the pelvis and consists of individual bones known as vertebrae. It is what holds the body upright, allows the body to bend, twist, and is the conduit for major nerves running from the brain to the rest of the body. The vertebrae are grouped into four regions. They are the:
�
SpinalTerminology
Number of Vertebrae
Area of Body
Abbreviation
Cervical
7
Neck
C1-C7
Thoracic
12
Chest
T1-T12
Lumbar
5-6
Low back
L1-L5
Sacrum
5 fused vertebrae
Pelvis
S1-S5
Coccyx
3
Tailbone
None
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Cervical Vertebrae
The cervical spine breaks down into two parts. The upper cervical C1 and C2, and the lower cervical C3 through C7. The C1 vertebrae are known as the Atlas and the C2 the Axis. The Occipital Bone is a flat bone that forms the back of the head.
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Atlas
The Atlas is the first cervical vertebra and is abbreviated as C1. This vertebra supports the skull. It appears different from the other spinal vertebrae, as it resembles a ring and is made up of two masses joined at the front and back by the anterior and posterior arches. �
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Axis
The Axis is the second cervical vertebra and is abbreviated C2. It is a tooth-like process that projects upward. It is referred to as the odontoid process or dens, which is Latin for tooth. It provides a kind of pivot and collar that allows the head along with the atlas to rotate.
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Thoracic Vertebrae
The thoracic vertebrae become larger from T1 through T12. What makes the thoracic spine unique is that it is the only vertebrae that support the ribs and is made up of pedicles, spinous processes, and large neural passageways that help reduce nerve compression. Unfortunately, not everyone has a large intervertebral foramen, which can cause compression. �
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Vertebral Body
Spinous Process
Transverse Facet
Pedicle
Foramen
Lamina
Superior Facet
The thoracic vertebrae are attached to the ribs. However, at T11 and T12, the ribs are not attached and are called floating ribs. The region of the spine’s range of motion is limited because of the rib/vertebrae attachments and the long spinous processes. �
Lumbar Vertebrae
The lumbar vertebrae increase in size from L1 through L5. These are the vertebrae that take the body’s weight along with any loading force that can create biomechanical stress. The pedicles are longer and wider than the thoracic spine pedicles, and the spinous processes are horizontal and more square. The neural passageway is large but nerve root compression is very common due to disc herniation from poor posture, prolonged sitting, improper lifting, etc. �
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Vertebrae’s Purpose
The vertebrae range in size with the cervical region being the smallest. The lumbar low back region is the largest. The vertebral bodies of the spinal column are what bear the weight. The body’s upper weight is dispersed through the spine to the sacrum and pelvis. Thee natural curves in the spine provide resistance, flexibility by distributing the body’s weight, and axial loads/forces sustained when in motion. Vertebrae are made up of many elements critical to the overall function of the spine. This includes the intervertebral discs and facet joints. Functions of the spinal/vertebral column include: �
Protection
Spinal Cord Internal Organs
Attachment
Ligaments Muscles Tendons
Support Structure
Head Shoulders Chest Connect Upper and Lower body Balance
The sacrum is located behind the pelvis. It consists of five bones that are abbreviated S1 through S5. They are fused together in a triangular shape. The sacrum fits between the hipbones and connects the spine to the pelvis. The last vertebra L5 moves with the sacrum. Right below are five more bones that are also fused together and they form the Coccyx or tailbone.
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Intervertebral Discs
The intervertebral discs make up a quarter of the spinal/vertebral column’s length. There are no discs between the Atlas, Axis, and Coccyx. Discs are not connected to the body’s vascular system and so depend on the endplates to disperse essential minerals and nutrients. The cartilaginous layers keep the discs in place. They are fibrocartilaginous cushions that function as the spine/body’s shock absorbers. They protect the vertebrae, brain, nerves, etc. There is some vertebral motion that the discs allow but individual disc movement is limited. Significant motion is possible when the discs work together. �
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Annulus Fibrosus and Nucleus Pulposus
Intervertebral discs are made up of an annulus fibrosus and a nucleus pulposus. The annulus fibrosus is a strong radial structure made up of lamellae. Concentric sheets of collagen fibers connect to the endplates. These sheets are positioned at various angles. The annulus fibrosus encapsulates the nucleus pulposus. �
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Both are made up of water, collagen, and proteoglycans. However, the larger amount of water and proteoglycans are in the nucleus pulposus. Proteoglycan molecules are essential because they attract and retain water. The nucleus pulposus consists of a hydrated gel-like substance that resists compression. The amount of water in the nucleus changes throughout the day. This depends on the activity or non-activity. All in all proper care and maintenance of the spinal/vertebral column is vital to general health and overall well-being.
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Dr. Alex Jimenez�s Blog Post Disclaimer
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