The Lateral Line is one of several Fascial Lines proposed by Thomas Myers (SOURCE-2). This pair of fascial continuities extend the lateral contours of the body, from head to toe. The Lateral Line is suited to transverse body movements and mediates forces between both the Superficial Front Line and Superficial Back Line (SOURCE-2). The lines of either side serve as antagonist to one another during motions that involve lateral flexion of the trunk ( Thoracic - Lateral Flexion and Lumbar - Lateral Flexion ) and/or Hip - Abduction .
The following lists bony and soft-tissue landmarks that are integrated into the Lateral Line from most proximal to distal (SOURCE-2).
Occipital Bone - Occipital Ridge/ Mastoid Process of Temporal Bone
1st + 2nd Ribs
Iliacus - Crest, ASIS, PSIS
Lateral Condyle of the Tibia
Head of the Fibula
Bases of the 1st and 5th Metatarsal Bones
Anterior ligament of head of Fibula
Lateral Crural Compartment:
As scientific understanding of Fascia l structures is still in its infancy, the sophisticated and interrelated Fascial Lines discussed by Thomas Myers are yet to gain full support of the literature. With this said, there is growing evidence of myofascial continuities that reflect some of the relations described by Fascial Lines :
Fibularis Longus and Fibularis Brevis to Iliotibial Band - the deep fascia of the lower leg, known as the Crural Fascia , envelops Fibularis Longus and Fibularis Brevis and is continuous superiorly with the lateral thickening of the Fascia Lata (SOURCE-1+3). Additionally, both of these segments share attachments to sites such as the Head of Fibula (SOURCE-3)
Iliotibial Band to Gluteus Maximus and Tensor Fasciae Latae - the distal Tendons of both Muscles converge near the Greater Trochanter of Femur with a lateral thickening of the Fascia Lata to form the Iliotibial Band (SOURCE-1+3)
Gluteus Maximus and Tensor Fasciae Latae to Abdominal Obliques - these tissues share both direct and indirect continuations. Layers of the Abdominal Fascia which contain the Abdominal Obliques are continuous with the corresponding Fascia l layer over the thigh and Gluteal’s (SOURCE-3). The External Obliques , for example, have been described to blend with the Fascia Lata (SOURCE-1). These structures are also indirectly linked through their shared attachment on the Iliac Crest. Additionally, the Thoracolumbar Fascia is anatomically and functionally linked with the Internal Obliques in the Lumbar Spine region and makes extensive attachment to the Iliac Crest and Sacrum (SOURCE-3+5)
Abdominal Obliques to Intercostals - whille a meta-analysis failed to identify specific mention of a Fascia l continuity, these structures are anatomically linked through their attachments (SOURCE-1). For the Internal Obliques , fibres that arise from the Posterior Iliac Crest are attached to the lower three to four Ribs and their Cartilage s, where they merge with the attachments of the Intercostals (SOURCE-3). The fibres that arise from the Anterior Iliac Crest blend with the Anterior Aponeurosis which also attaches to the Cartilage of Ribs seven to nine (SOURCE-3). Conversely, fibres of the External Obliques arise from the external surfaces and inferior borders of the lower eight Ribs (SOURCE-3). Additionally, the Endothoracic Fascia extends to the Transversalis Fascia which is closely related to the Obliques (SOURCE-8)
Intercostals to Splenius Capitis and Sternocleidomastoid - whille the same meta-analysis failed to identify specific mention this Fascia l continuity, the concept of a multi-layered axial continuation involving both deep and superficial fascial sheaths between the neck and Thorax is well documented (SOURCE-1+3+5+6+7+8). The deep connection is established by direct continuation of the Prevertebral Fascia , which contains the deep neck muscles, as the Endothoracic Fascia which lines the Innermost Intercostals (SOURCE-5+8). Additionally, the Superficial Layer of Cervical Fascia envelops the Sternocleidomastoid which is inferiorly continuous with the Pectoral/ Axillary Fascia (SOURCE-6+7)
The following observations may be indicative of a Lateral Line dysfunction (SOURCE-2):
One side appears elongated or contracted to compared to the other
Shoulder
Glenohumeral Joint Restriction
Torso
Compressed Lumbar Spine - suggests bilateral restriction
Lower Extremity
Restricted Hip - Adduction Muscles or Contractures of the Hip - Abduction Muscle s
Restrcited Dorsiflexion
If able, a patient can perform a Dead Hangs from a pull-up bar. If one Lateral Line is more restricted than the other, the lowerbody will fall to that side (SOURCE-2).
Determining the direction and extent of Fascia l restriction can be done with a light pressure over a desired segement and applying a superficial glide. The region and direction of greater soft-tissue resistance would suggest fascial restriction.
Treatment for Lateral Line dysfunction emphasises restoring Fascia l mobility and specifically lateral flexion to improve the body’s ability to stabilise and counterbalance. In some instances the release of a single structure contained within the Lateral Line forms an effective treatment, while in others the entire Fascia l line may require attention.
The folowing stretching techniques may be beneficial for dysfunction of the Lateral Line:
Seated Thoracic Rotation with Breathing - large lateral flexion and rotation range coupled with breathing
Door Frame Neck Stretch - self-guided neck stretch with several variations
Bent Over Lat Stretch - accessible active stretch with large GH Joint - Flexion or Horizontal GH Joint - Adduction range
Swimmers Oblique Extensions - exercise that may be used to lengthen entire Lateral Line through large body-wide lateral-flexion range
Bretzel 2.0 - variation with greater hip extension range
Dead Hangs - whole body traction for Pull and Push muscles with large overhead range
Supported Lateral Flexion Stretch - lengthens entire lateral side of body
Myofascial Release of the following structures through Massage or self-guided means may be of benefit to those with Lateral Line dysfunction, with specific techniques often discussed on their respective pages:
Practitioner-Guided
Splenius Capitis - with client lying supine, the practitioner grasps the Occipital Bone with one hand and reaches under the neck with the opposing hand to sink its Fingers between the proximal Sternocleidomastoid and Upper Trapezius (SOURCE-2)
Sternocleidomastoid - a glide is typically applied in line with its fibre orientation towards their proximal attachment (SOURCE-2). Pressure must be directed superiorly to avoid compression of the Carotid Artery or Jugular Vein (SOURCE-2). Patient or practitioner may add contralateral Cervical - Rotation to exacerbate fascial lengthening (SOURCE-2)
Intercostals - the superficial fascia responds well to superficial glides while the underlying Intercostals may require more targeted pressure (SOURCE-2). Fingers are appropriately sized to sink into the Intercostal spaces interspersed between the Ribs and with pressure may follow their contour (SOURCE-2). For Ribs 2 and 3, this same technique may be applied near the axilla to follow their contour superiorly (SOURCE-2). Breathing may enhance treatment (SOURCE-2)
Abdominal Obliques - Fingers hook under the superficial Abdominal Fascia and draw it either (i) superomedially to emphasise Internal Obliques or (ii) superolaterally to target the External Obliques (SOURCE-2)
Gluteus Maximus - for Lateral Line dysfunction the Gluteus Maximus and other Gluteal’s may be released with The Elbow or knuckles, typically directing glides away from the Greater Trochanter of Femur in the direction of Fascia l restriction (SOURCE-2)
Tensor Fasciae Latae - unlike the other gliding techniques for this line, the TFL more closely reflects a deep tissue release, often performed with the practioners elbow (SOURCE-2). Points of particular relevance may be its tendinous attachments to the Iliac Crest or anterior Femur Head or the muscle belly between these two points
Iliotibial Band - a superficial glide may be applied along the length of the lateral thigh in the direction of restriction, typically using the blade of the forearm or knuckles. The relevance of myofascial release techniques and Stretching for the ITB is often challenged, with some papers arguing clinical techniques are insufficient to elongate such a rigid tissue or evoke lasting tissue change (SOURCE-9+10). However, these studies often exhibit varying levels of rigor, frequently relying on small sample sizes, single treatments and healthy subjects over symptomatic patients (SOURCE-9+10). Additionally, the metrics used to evaluate these techniques fall subject to the stawman fallacy, failing to address the true clinical goal of myofascial intervention - restoring fascial mobility. The ITB should not be conceptualised as a Tendon , rather a dense thickening of the Fascia Lata (SOURCE-11). This perspective forms the basis for the crucial clinical problem that the ITB can become adherent to neighbouring structures such as the Vastus Lateralis which restricts the bands ability to glide between Fascia l layers. Therefore, while mechanical elongation of the ITB may be minimal, myofascial release techniques may still be beneficial by reducing adherence, decreasing neural tone and restoring fascial mobility
Fibularis Longus / Fibularis Brevis - a superficial glide may be applied along the length of the Muscle in the direction of resistance. Thomas Myers advocates lifting the Tibialis Anterior from the Fibularii before treatment is applied and foot motion depending on the direction of resistance (SOURCE-2):
Foot - Pronation - inferiorly directed pressure
Foot - Supination - superiorly directed pressure
Self-Guided
Thoracic - Extension over a Foam Roll
Iliotibial Band Foam Roll
The following Strength techniques can be used for the Lateral Line:
Initial Phase:
Side Plank - isometric anti-lateral flexion force
Moving Side Plank - low-to-moderate lateral flexion range with bodyweight
Pallof Press - less direct but requires Lateral Line stability
Middle Phase:
Copenhagen - isometric contraction of Obliques and Adductors
Farmers Carry - whole body exercise that emphasises core/ anti-rotation
Suitcase Carry - anti-lateral flexion/ rotation resistance with Gait
Bottoms-Up Kettlebell Walk - isometric push/ stability exercise with or without perturbation
Russian Twist - isotonic core exercise with high trunk rotation range
Later Phase:
Dual KB Russian Twist - Russian Twist variation that typically utilises greater load and better emphasises Thoracic - Extension
Uneven Obliques - moderate-to-high lateral-flexion range of motion under moderate-to-high load
Swimmers Oblique Extensions - high lateral-flexion range of motion under low load
GHR Oblique Rotations - orientates Vertebral Column perpendicular to gravity, creating substantial resistance to Rotation
KB Windmill - isotonic exercise that emphasises lateral flexion, shoulder stability and the Anterior Sling
Kneeling Landmine Press - anti-lateral flexion stabilisation
Split Stance Landmine Press - anti-rotation and anti-lateral flexion stabilisation
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