Deep Front Line

The Deep Front Line is one of several Fascial Lines proposed by Thomas Myers (SOURCE-1). As its name suggests this line lies deep of the Superficial Back Line , Superficial Front Line and Spiral Lines . While the extensive integration of deep tissues allows this line to operate in all three dimensions, only Diaphragm atic Breathing is a movement that is primarily and uniquely generated by this line (SOURCE-1). The Deep Front Line is predominantly associated with slower-twitch Muscle Fibre Types, which suggests a postural/ stabilising role (SOURCE-1).

Landmarks

The following lists bony and muscular landmarks that are integrated into the Deep Frontal Line from most proximal to distal (SOURCE-1):

Bone

• Occipital Bone

• Mandible

• Cervical Spine Transverse Processes

• Hyoid

• Posterior Surface of the Sternum and associated structures

  • Manubrium

  • Sternocostal Joints

  • Xiphoid Process

• Thoracic Spine Vertebral Bodies

• Lumbar Spine Vertebral Bodies and Transverse Processes

• Coccyx

• Ramus of Ischium

• Femur

  • Lesser Trochanter

  • Linea Aspera

  • Medial Epicondyle

• Superior/ Posterior portion of Tibia and Fibula

• Plantar Surface of Tarsal Bones / Toes

Muscle / Tendon

• Suprahyoids

• Infrahyoids

• Longus Capitis

• Longus Colli

• Scalenes

• Anterior Longitudinal Ligament

• Pericardium, Mediastinum, Parietal Pleura

• Diaphragm

• Iliopsoas

• Pectineus

• Femoral Triangle

  • Inguinal Ligament

• Adductor Brevis

• Adductor Longus

• Pelvic Floor

  • Levator Ani

• Adductor Magnus

• Popliteus

• Knee Joint Capsule

• Long Flexors of the Toes :

  • Tibialis Posterior

  • Flexor Digitorum Longus

  • Flexor Hallucis Longus

Scientific Support

As scientific understanding of Fascial 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 :

• Head/Neck - the soft-tissues contained within this section are united by the deepest layer of the Cervical Fascia, the Prevertebral Fascia (SOURCE-2+3+4). Specific to this line, the Prevertebral Fascia covers the Longus Capitis, Longus Colli and Scalenes and often fuses with the Anterior Longitudinal Ligament (SOURCE-4).

• Neck to Thorax / Core - the Anterior Longitudinal Ligament is a strap-like structure that descends the anterior surface of the Vertebral Column. The Diaphragm extends two musculotendinous pillars, known as Crura , that make their attachment on the superior segments of Lumbar Spine and often blend with the Anterior Longitudinal Ligament (SOURCE-5)

• Core to The Hip/Pelvis - the continuity from the Diaphragm to the Iliopsoas is established via a convegence of Fascial sheaths and ligaments in the posterior abdominal wall. The Medial Arcuate Ligament is a thickened band of Fascia that directly covers the Psoas Major and establishes contintuity with the Diaphragm by blending with the lateral margins of its Crura (vertebral attachments) (SOURCE-3+5). This continuity is reinforced by the Transversalis Fascia which covers Psoas Major and on its superior course splits into two layers at the Arcuate Ligaments. The anterior layer blends with the Arcuate Ligaments, uniting the Diaphragm with the Iliopsoas (SOURCE-6+8)

• The Hip/Pelvis to Thigh - the Iliopsoas is closely related to several tissues of the anterior hip which relay the Fascial continuity into the thigh. The anterior surface interacts with the Fascia Lata, the posterior surface with The Hip Joint Capsule and the medial border with Pectineus(SOURCE-3). Additionally, the inferomedial Fascia of Psoas Major is continuous with the Deep Fascia of the Pelvic Floor which extends to structures such as the Conjoint Tendon, Transverse Abdominals and Internal Obliques(SOURCE-9). The Pectineus and other muscles of the medial thigh (including Adductor Magnus, Adductor Longus and Adductor Brevis) span from the anterior Pelvis and converge to make extended attachment on the Linea Aspera which courses the thigh posterolaterally (SOURCE-3)

• Thigh to Lower Leg to The Foot - the continuity is relayed inferiorly by way of the Adductor Magnus which makes extensive distal attachments to sites including the Adductor Tubercle of the Medial Femoral Condyle and Linea Aspera (SOURCE-11). Inferiorly the Linea Aspera divides into Medial and Lateral Supracondylar Lines which form the superior and lateral boundaries of the Popliteal Fossa (SOURCE-3+10). The deep portion of this posterior compartment engulfs Popliteus and the more distal extrinsic flexors of the Toes such as Tibialis Posterior (SOURCE-3). The distal attachment of this muscle terminates the Deep Front Line at multiple sites on the plantar surface of The Foot (SOURCE-12)

Assessment

Observation

The following observations may be indicative of Deep Frontal Line dysfunction (SOURCE-2):Head/Neck

• Temporomandibular Joints Dysfunction

• Excessive Flexed or Extended Cervical Spine

  • Forward Head Posture

Thorax

• Restricted Breathing

Vertebral Column

• Misalignment of the Lumbar Spine

• Collapse of the Core

Pelvis

• Pelvic Floor Insufficiency

• Anterior Pelvic Tilt

Lower Extremity

• Genu Valgum or Genu Varum

• Foot - Pronation or Foot - Supination

• Altered Medial Longitudinal Arch of the Foot (heightened or reduced)

• Chronic Plantar Flexion

Palpation

Determining the direction and extent of Fascial 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

Treatment for Deep Frontal Line dysfunction emphasises restoring Fascial mobility, postural control and Core stability. In some instances the release of a single structure contained within the Deep Frontal Line forms an effective treatment, while in others the entire Fascial line may require attention.

Stretching

The folowing stretching techniques may be beneficial for dysfunction of the Deep Frontal Line:

• Bretzel 1.0 - wholebody technical stretch that incorporates anterior shoulder

• Bretzel 2.0 - variation with greater hip extension range

• Wheel Pose - full bridge variation that lengthens entire anterior chain

• 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

Myofascial Release

Myofascial Release of the following structures through Massage or self-guided means may be of benefit to those with Deep Frontal Line dysfunction, with specific techniques often discussed on their respective pages:

Practitioner-Guided

• Diaphragm - with patient supine in a sit-up like position, Fingers hook under the Ribs either side of the proximal Rectus Abdominals attachment

• Rectus Abdominals (posterior wall) - with the patient in a supine sit-up like position, the deeper layer of Abdominal Fascia may entered from its lateral borders with the Fingers of each hand (SOURCE-1). The patient can contract and relax the Rectus Abdominals to guide pressure (SOURCE-1)

• Pelvic Floor - a difficult and often contraindicated treatment that may require a specialist. With patient in supine sit-up like position, Fingers are sunk into the approximate midpoint between Pubic Symphysis and the Umbilicus (SOURCE-1). Pressure is directed posteriorly and then inferiorly to hook under the Pubis (SOURCE-1). Patient can add active movement by raising their Pubic Bone (SOURCE-1)

• Thigh - with the patient in a sit-up like position each Muscle of the Deep Frontal Line in the thigh may be treated with the Fingers (SOURCE-1):

  • Pectineus - pressure complimented by an eccentric muscle contraction, creating a press and stretch type effect

  • Iliopsoas - best accessed above the Inguinal Ligament and medial of the Anterior Superior Iliac Spine (SOURCE-1). Fingers sink deep from the lateral edge of the abdomen, obliquely towards the Vertebral Column . Confirmation may be made with active resisted Hip - Flexion which engages the muscles fibres

• Lower Leg - the Deep Posterior Compartment can be accessed (SOURCE-1):With either technique, the patient can actively oscillate between Plantar Flexion and Dorsiflexion whilst pressure is maintained.

  • Medially - Fingers sink immediately behind the shaft of the Tibia and anterior of the Soleus

  • Latreally - Fingers sink between Fibularis Longus / Fibularis Brevis and Soleus

Strengthening

The following Strength techniques can be used for the Deep Frontal Line:

• Deadbugs - cues appropriate core/ spinal engagement while lengthening Hip - Flexion / Thoracic - Extension

• Pallof Press - banded anti-rotation core exercise that emphasises the diagonal functional patterns

• Bottoms-Up Kettlebell Walk - isometric push/ stability exercise with or without perturbation

• Farmers Carry - upperbody/ Core isometric exercise with perturbation of walking

• Rope Climb - pull-up variation with entire load bestowed on alternating arm

• Psoas Sit-Ups - core exercise the emphasises length of the Iliopsoas

References

1. Myers, T. W. (2009). Anatomy trains: Myofascial meridians for manual and movement therapists (2nd ed.). Elsevier.

2. Sakamoto Y. (2012). Spatial relationships between the morphologies and innervations of the scalene and anterior vertebral muscles. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft, 194(4), 381–388. https://doi.org/10.1016/j.aanat.2011.11.004

3. Standring, S. (Ed.). (2016). Gray’s anatomy: The anatomical basis of clinical practice (41st ed.). Elsevier.

4. Feigl, G., Hammer, G. P., Litz, R., & Kachlik, D. (2020). The intercarotid or alar fascia, other cervical fascias, and their adjacent spaces – a plea for clarification of cervical fascia and spaces terminology. Journal of Anatomy, 237(1), 197–207. https://doi.org/10.1111/joa.13175

5. Harrison, G.R. (2005). The Anatomy and Physiology of the Diaphragm. In: Upper Gastrointestinal Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/1-84628-066-4_4

6. Li, H., Liang, J., Shao, P., Zheng, J., Shi, R., & Wang, Y. (2021). Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques. Journal of Pain Research, 14, 3837–3848. https://doi.org/10.2147/JPR.S347071

7. Goodall, R., Langridge, B., Onida, S., Ellis, M., Lane, T., & Davies, A. H. (2020). Median arcuate ligament syndrome. Journal of Vascular Surgery, 71(6), 2170–2176. https://doi.org/10.1016/j.jvs.2019.11.012

8. Li, H., Shi, R., & Wang, Y. (2021). A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block. Journal of Pain Research, 14, 961–967. https://doi.org/10.2147/JPR.S306696

9. Siccardi, M. A., Tariq, M. A., & Valle, C. (2023). Anatomy, bony pelvis and lower limb: Psoas major. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/sites/books/NBK535418/

10. Ahmed, S. I., Bareeqa, S. B., Khan, R. N., & Samar, S. S. (2019). Morphometric features of Linea aspera on dry femur bones. JPMA. The Journal of the Pakistan Medical Association, 69(4), 474–477.

11. Jeno SH, Launico MV, Schindler GS. Anatomy, Bony Pelvis and Lower Limb: Thigh Adductor Magnus Muscle. [updated 2023 oct 24]. In: StatPearls [internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534842/

12. Corcoran, N. M., & Varacallo, M. A. (2023). Anatomy, bony pelvis and lower limb: Tibialis posterior muscle. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539913/