SPINE Volume 29, Number 2, pp 129138
2004, Lippincott Williams & Wilkins, Inc.
Tensile Transmission Across the Lumbar Fasciae in
Unembalmed Cadavers
Effects of Tension to Various Muscular Attachments
Priscilla J. Barker, BAppSc (Physio), Christopher A. Briggs, PhD, and Goce Bogeski, BSc (Hons)
Study Design. Traction was applied to muscles attach-
ing to the posterior and middle layers of lumbar fascia
(PLF, MLF). Effects on fasciae were determined via tensile
force measures and movement of markers.
Objectives. To document tensile transmission to the
PLF and MLF when traction was applied to latissimus
dorsi (LD), gluteus maximus (GM), external and internal
oblique (EO, IO), and transversus abdominis (TrA) in un-
embalmed cadavers.
Summary of Background Data. A previous study on
embalmed cadavers applied traction to muscle attach-
ments while monitoring fascial movement but did not test
TrA or the MLF.
Methods. The PLF and MLF were dissected then
marked on eight unembalmed cadavers. A strain gauge
was inserted through fascia at L3; 10N traction was ap-
plied to each muscle attachment while photographs and
tension measures were taken. Movement of fascial mark-
ers was detected photographically. Fascial widths were
also measured.
Results. Tension was clearly transmitted to fascial ver-
tebral attachments. Tensile forces and fascial areas af-
fected were highest for traction on LD and TrA in the PLF
and for TrA in the MLF. Movement of PLF markers from
tension on LD and TrA occurred bilaterally between T12
and S1. Effects from other muscles were variably bilateral,
with those from GM and IO occurring below L3 and those
from EO occurring above L3. Tensile forces were rela-
tively high in the MLF and its width was less than half that
of the PLF.
Conclusions. Low levels of tension are effectively
transmitted between TrA and the MLF or PLF. Via them,
TrA may influence intersegmental movement. [Key
words: lumbar fascia, tension, strain, transversus abdo-
minis, spinal stability] Spine 2004;29:129 138
The lumbar fasciae and their attaching muscles are pro-
posed to support the spine by various mechanisms.1 8
Dissection studies have documented muscular attach-
ments and anatomic features of the fasciae, yet biome-
chanical investigation of these has been limited. Electro-
From the Department of Anatomy & Cell Biology, University of Mel-
bourne, Victoria, Australia.
Acknowledgment date: October 29, 2002. First revision date: May 28,
2003. Acceptance date: June 5, 2003.
Supported by the Department of Anatomy & Cell Biology and an
Australian Physiotherapy Association (Victorian Branch) minor
scholarship.
The manuscript submitted does not contain information about medical
device(s)/drug(s).
Professional Organization funds were received in support of this work.
No benefits in any form have been or will be received from a commer-
cial party related directly or indirectly to the subject of this manuscript.
Address correspondence to Priscilla J. Barker, BappSc, Department of
Anatomy & Cell Biology, University of Melbourne, Parkville, Victoria
3010 Australia; e-mail: p.barker@unimelb.edu.au.
myographic (EMG) findings suggest that transversus
abdominis (TrA) may contribute to the control of seg-
mental movement, potentially via the lumbar fasciae.6
This highlights the need to clarify the segmental attach-
ments of TrA, related muscles and lumbar fasciae, as well
as their capacity to transmit tension to vertebrae.
The middle (MLF) and posterior layers of lumbar fas-
ciae (PLF) enclose the paraspinal muscles, fusing at the
lateral raphe where they provide attachment for TrA and
part of internal oblique (IO)2,7 (Figure 1). The raphe has
also been reported to provide attachment for part of
external oblique (EO)8 and latissimus dorsi (LD).2,9
The MLF forms thickened fascial bands at its attach-
ments to lumbar transverse processes.7,10 Tesh et al7,11
used intra-abdominal balloons confined to the lumbar
region in an attempt to apply tension to the MLF indi-
rectly. They found that increasing pressure in the balloon
affected the position of the trunk in the coronal plane,
straightening it against considerable force. The authors
attributed this response to tension in the MLF (and TrA).
However, coronal plane testing was only performed in
one cadaver,11 and no direct measurements of fascial
tension were taken.
A factor that may influence transverse tension gener-
ation in the MLF and PLF (e.g., from contraction of the
lateral abdominal muscles) is fascial width, i.e., from
vertebral processes to lateral raphe. The widths of lum-
bar fasciae have not been comprehensively documented
in a single sample. Existing descriptions from dissec-
tions12 and CT scans from three young adult males11
indicate that widths of the MLF and PLF may be similar,
each approximately 9 cm per side.11,12 However, the
transverse processes are clearly closer to the lateral raphe
than the spinous processes (Figure 1), emphasizing the
need to further investigate fascial widths.
Existing dissection studies describe the PLF compris-
ing two laminae2,8 that are increasingly fused below L1.1
Figure 2 presents a composite view of the muscular at-
tachments of the posterior layer.
Vleeming et al8 attempted to simulate the effect of
muscle contraction on the PLF in three embalmed cadav-
ers. Using grips they applied up to 50 N tension to tra-
pezius, LD, gluteus maximus (GM), EO, IO and serratus
posterior inferior. Raster photography, a technique
involving sequential photographs taken with and with-
out applied tension and compared against a reference
grid, was used to determine movement of fascial markers
in response to applied tension. Their results indicated
that both LD and GM transmitted tension to the PLF
129
130 Spine Volume 29 Number 2 2004

Figure 1. Lumbar fasciae: Typical depiction in cross section.

Adapted from Williams et al.29 ALF, MLF, PLF anterior, middle
and posterior layers, respectively, of lumbar fascia; TrA trans-
verse abdominis; IO internal oblique; EO external oblique.

contralaterally: LD up to 2 cm past the midline and GM

up to 4 cm.8
Vleeming et al8 proposed that LD and GM may act
together during contralateral limb movements (e.g.,
swimming, running, or walking) to support the lumbar
spine and increase force closure at the sacroiliac joint.
Their study was, however, limited to embalmed speci-
mens, which are reported to poorly represent tissue bio-
mechanics in vivo.13 Furthermore, the attachment of
transversus abdominis (TrA) to the lumbar fasciae was
not tested, nor did the study document the segmental
levels affected when tension was applied on each muscle
attachment.8
The attachments of TrA (and/or IO) are of increasing Figure 2. The posterior layer of lumbar fascia. Muscular attach-
clinical interest. Intramuscular EMG studies indicate ments of the superficial (left) and deep (right) laminae. Adapted
that TrA has a relatively early onset of contraction before from existing studies.1,2,8 SCe splenius cervicis; Rh rhom-
trunk perturbations and rapid multidirectional limb boids; Tz trapezius; LD latissimus dorsi; SPI serratus
movements6,14,15 when compared with EO and IO. This posterior inferior; IO internal oblique; TrA transversus abdo-
minis; EO external oblique; GM gluteus maximus; Bi biceps
onset is reported to be delayed in patients with chronic femoris.
low back pain.15,16 Selective contraction of TrA before
limb movements has been proposed, via its fascial at-
tachments, to restrict excess lumbar intersegmental attachments of LD, GM, EO, IO, and TrA to the PLF
neutral zone17 movement and reduce the occurrence and/or MLF in unembalmed cadavers; 2) to document
of segmental injury.6,15 These mechanisms are discussed the effects on fasciae when tension was applied to these
in detail elsewhere.18 Clinical studies on the effect of muscles, with reference to segmental levels; and 3) to
specific exercise training of TrA (IO) in patients with document the widths of the MLF and PLF.
low back pain support the proposed importance of these Materials and Methods
muscle(s).19,20 Author groups differ, however, on the
Sample Characteristics. Eight unembalmed cadavers were
proposed mechanism. TrA is primarily proposed to con-
examined (6 female, 2 male). They had been refrigerated at 5
trol segmental movement,6 but IO may also play a role.20 C from within 48 hours of death for 7 to 36 days (average 23
Determining relative tensile forces generated in the days) before dissection. They were of mean age 83 years (range
fascia by applying tension to its attached muscles may 73101 years) and generally of slight build, of mean weight 56
help clarify the potential roles of muscles and fascia in kg (range 40 75 kg), with the two males being the heaviest.
support of the lumbar spine and sacroiliac joint. The One female cadaver had a surgical scar (for laminectomy) on
aims of this study were as follows: 1) to review muscular the left between L1 and L5.

Dissection, Clamping, and Testing Sequence. The cadav-
ers were positioned prone and their backs dissected, inferiorly
to the upper gluteal region and laterally to the abdominal wall
muscles. Muscles were separated so that each could glide inde-
pendently when traction was applied. The part of GM that
inserts into the PLF (~7 cm wide, between the posterior supe-
rior iliac spine and S3) was divided from the remainder of the
muscle (by two slits parallel with its fascicles) so that the
clamps could grip it separately. Similarly, divisions were made
to isolate the central part of the LD attachment (~7 cm wide,
closest to L3), so that it could fit into the clamp grips. The
cadaver was secured (with rope) firmly to the table at T6 and
S4, and tension was applied to several muscle attachments of
the PLF. Muscles were tested in the order LD or GM, then EO,
IO, and TrA, with the obliques being incised laterally, reflected
and preserved for testing at the MLF. The MLF was accessed by
incising the PLF and removing underlying paraspinal muscles,
but preserving the lateral raphe and its muscle attachments.
Before testing, the extent of both fascial layers was marked
with dots using a permanent marker, as were their vertebral
attachments.
Tensile Force Measures. A buckle strain gauge21 consisting
of Entran semiconductor strain gauges (ESB-020350, Entran
Devices Inc.; Fairfield, NJ) mounted on an E-shaped force
transducer was used in connection with a cathode ray oscillo-
scope (type 502 Dual Beam Oscilloscope, Tektronix Inc., Bea-
verton, OR) and then calibrated. The buckle strain gauge was
calibrated, using a rubber band and digital hand-held spring
balance (accuracy 0.1 N: Shimpo F GC-50, 500 N force Dig-
ital Force Gauge, Testequip 2000; Osaka, Japan) from 0 to 10
N (at 1 N intervals). The output, representing tensile force, was
recorded in millivolts. The average of these calibration values,
performed on both sides at 10 N, was later used to convert the
fascial tensile force measures in approximate Newtons.
Two small horizontal slits were made 3 to 5 mm apart in the
lumbar fasciae at L3 and the prongs of the buckle threaded
through them: adjacent to the L3 spinous process in the poste-
rior layer and to the L3 transverse process in the MLF. The
buckle remained in this location throughout, with the fascia
being gently repositioned at the base of the buckle before test-
ing each muscle. LD or (alternately) GM, then EO, IO, and TrA
were each gripped close to (2 cm) their fascial attachment
using two 23-cm Doyen intestinal clamps oriented perpendic-
ular to muscle fascicle direction and fixed together by cable ties.
Tension was applied to this gripping system by three hooked
chains linked centrally on a metal ring. Two hooks were at-
tached to the grips, one around each cable tie, and the third
connected to the hand-held spring balance. Tension was ap-
plied in the direction of the attaching muscle fascicles while
fascial tensile force measures were taken at 1 N intervals and
photographs at 10 N intervals. Tensile force measures were
taken three times on each side up to 10 N, since the thinnest
attachments tended to tear at 10 to 15 N. On the final measure,
tension was slowly increased from 10 N and recorded in 5 N
increments to failure. The maximum load required to tear the
muscle and, if possible, the maximum fascial tensile force val-
ues were recorded. TrA, IO, and EO attachments were gener-
ally not tested to capacity at the PLF but preserved for testing at
the MLF. During the latter and where feasible, they were re-
gripped at the same location.
Tension and Muscular Attachments Barker et al 131
Figure 3. Displacement and area mapping of latissimus dorsi. a:
Experimental setup with 10 N applied tension moving fascial mark-
ers. Note the strain gauge inserted at L3. b: An arc is drawn
around the most distant markers visibly moving toward the grips
with applied tension. The white line measures the distance at
which the farthest fascial displacement occurs. The total area of
fascia affected is bordered by the arc, reference scale bars, and
musculofascial junctions.
Fascial Widths. Photographs were taken on the first test at
both 0 N and 10 N using a digital camera (Nikon D1, Nikon
Corp., Tokyo, Japan) from a fixed height with a 50-mm refer-
ence scale bar positioned parallel to the fascia. Photographs for
each muscle were then aligned on computer using Adobe Pho-
toshop 5.0 (Adobe Systems Inc., San Jose, CA). The widths of
the PLF and MLF were each measured from photographs taken
during testing of TrA with 10 N tension applied, using long
reference scale bars (calibrated with the 50-mm scale bar; i.e.,
0.5 mm). Measurement was taken between the edge of the
(spinous or transverse) process of L3 and the lateral raphe. The
width from vertebral processes to the musculotendinous junc-
tion of TrA was also taken at this level, and repeat width mea-
sures were performed on three cadavers.
Fascial Displacement. Fascial movement was determined by
magnifying the aligned (0 N and 10 N) images to life size and
alternating between them. An arc was drawn around the most
distant markers, visibly moving toward the grips (and away
from their adjacent, more distal markers), so that dots to either
side of the arc separated with the 10 N applied traction. Fur-
thest fascial displacement measures were taken of the distance
(in centimeters) between the grips and the most distant detect-
able point of fascial displacement on the arc, using a long ref-
erence scale bar aligned between the midpoint of the grips and
the midpoint of the arc (Figure 3). Mean contralateral displace-
ment was similarly measured along this line, between the mid-
line and the arc.
Fascial Areas. To determine the total area of fascia affected
(e.g., from arc to musculotendinous junction), lines were
drawn from each end of the arc to the edges of the grips and the
intervening musculofascial junctions traced (Figure 3). This
fascial area was then imported into an image analysis program
(NIH Image; U.S. National Institutes of Health; http://
rsb.info.nih.gov/nih-image/) and the scales were again cali-
brated to calculate the fascial area affected. The vertebral levels
and side(s) on which fascial movement occurred were also
noted, as was any fascial movement across the vertebral pro-
cesses. The latter values, for muscles that consistently displaced
132 Spine Volume 29 Number 2 2004

Table 1. Fascial Displacement Table 2. Fascial Areas and Tensile Forces (L and R) at
10N Tension
Fascial Displacement Mean (n 16 sides) at
10N applied tension Tensile Force in Fascia
Muscle Area (cm2) at L3 (N)
Attachment* Furthest (cm) Contralateral (cm)
n Mean Range n Mean Range
TrA 16 3 4 2.5
LD 14 2 42 Posterior layer
EO 10.5 2.5 1 1.5 LD* 8 61 4876 7 4.9 1.214.2
GM 10 3.5 2.5 1.5 TrA 8 59 2288 7 2.2 0.45.0
IO 9 4.5 12 GM 8 31 171 7 0.8 0.11.8
TrA 2 9 1.5 IO 7 25 449 7 1.5 0.24.4
IO 2 6 1.5 EO 8 15 636 7 0.7 0.12.8
EO 2 64 Middle layer
* Abbreviations for muscles as given in Figure 2. TrA2 8 14 821 7 3.9 1.58.1
IO2 7 7 521 5 1.4 0.62.6
EO2 7 7 020 6 0.9 0.13.1
* LD area is likely greater than indicated as its gripped area was restricted.
fascia bilaterally, were pooled and averaged. On two cadavers,
displacement and area measures were repeated three times.
between 0 and 10 N at the level of L4, was 0 to 3 mm,
Statistical Analysis. For each muscle tested on each side, the with mean value (pooled for LD, GM, and TrA) 1.4
resultant fascial tensile forces and movement were analyzed. 0.7 mm.
Where fascial tensile force readings did not demonstrate a se-
quential increased output with applied tension, they were ex- Fascial Areas
cluded from analysis. This occurred in the eighth cadaver, fol- Displacement of fascial markers in the posterior layer
lowing replacement of a strain gauge, limiting the tensile force indicated that traction on the attachments of TrA and
data to results from seven cadavers. These values were con- LD affected the greatest areas of fascia (Table 2). Tension
verted to approximate Newtons of tensile force by multiplying on these two muscles always resulted in fascial move-
each by the constant (2.76) obtained from the average calibra- ment bilaterally between T12 and S1. Traction on the
tion value at 10 N. attachments of IO and GM caused fascial movement be-
Paired samples t tests were used to detect differences be- low L3 (to S1 and S3, respectively), although the bilateral
tween left and right sides for tensile force and area measures effect varied; traction on GM moving the attached fascia
and results from both sides pooled. Paired sample correlations
bilaterally in 14 of 16 sides and traction on IO moving it
were then used to detect any correlation between tensile force
and area measures. The average (pooled) fascial area measures
bilaterally in 8 of 16 slides. Traction on EO affected a
affected by each muscle were compared using a one-way anal- smaller area of fascial markers between L1 and L3 and
ysis of variance. Following a significant result, fascial area was typically unilateral (9 of 16 sides) in its effect.
means affected by tension on each muscle were compared using In the MLF, traction to the attachment of TrA dis-
a Tukeys multiple comparison test at P 0.05.22 This process placed markers across the entire fascial region (from
was similarly applied to fascial tensile force measures. T12L1 to L5S1), while traction to IO moved markers
below L3 and traction to EO moved markers above L3.
Results
In all cases, a smaller area of fascia was affected than in
There were no apparent trends between area or tensile the posterior layer, and all effects were unilateral, mov-
force measures and sex, age, weight, or time since death. ing ipsilateral markers as far as the tips of lumbar trans-
The cadaver with the left lumbar surgical scar had intact verse processes. The fibrous thickenings of the MLF that
spinous processes and equal widths of fasciae on both attach to the transverse processes were particularly
sides. It demonstrated minimal differences between sides prominent during tensile transmission.
on all measures.
Tensile Force Measures
Fascial Widths Applying 10 N tension to the LD attachment resulted in
Mean widths of the MLF and PLF at L3 (from vertebral the highest tensile force in the PLF at L3 (4.9 N), fol-
processes to lateral raphe) were 2.6 cm and 7.1 cm ( 0.5 lowed by TrA (2.2 N), IO, GM, and then EO (Table 2).
cm), respectively. The mean distances from transverse Tensile force values from traction on TrA, IO, and EO
and spinous processes to the musculotendinous junction were generally higher in the middle layer but followed a
of TrA were 7 cm and 11 cm ( 0.9 cm), respectively. similar trend in both MLF and PLF, with TrA transmit-
ting most tension to fascia at L3, followed by IO, and
Fascial Displacement
then EO (3.9, 1.4, and 0.9 N, respectively).
In all cases, fascial markers were displaced toward the
grips. The mean farthest distances at which fascial dis- Statistical Analysis
placements took place (from the grips) are presented in Paired samples t tests indicated no significant difference
Table 1. Errors between repeat displacement measure- between left and right sides for tensile force or area mea-
ments (on two cadavers) were 1.5 cm. The actual sures, so results for the two sides were pooled before
movement of PLF markers across the midline, observed further analysis.
 Tension and Muscular Attachments Barker et al 133

Table 3. Tukeys Multiple Comparisons of Fascial Areas Comparison of Fascial Areas and Tensile Forces
and Fascial Tensile Forces Area and tensile force measures are compared in Figure
4. Both measures varied considerably between cadavers
Comparisons between mean areas (cm2)*
LD TrA GM IO EO TrA IO EO (by up to 1.74 N and 24 cm2), but errors between repeat
2 2 2 measurements were comparatively small, up to 0.77 N
61.2 58.5 31.8 25.4 15.1 14.7 8.1 7.7 for tensile forces and 7 cm2 for areas. Although fascial
tensile forces (at L3) showed similar trends to fascial area
measures, they did not correlate significantly. Differences
Comparisons between mean fascial tensile forces (N)* between them were greatest in the MLF, where tensile
LD TrA TrA IO IO 2 EO GM EO
2 2 forces tended to be larger and affected relatively small
4.9 3.9 2.2 1.5 1.4 0.9 0.8 0.7 areas.
Maximum Fascial Tensile Forces
* Means arranged in order from greatest to least, nonsignificant differences There were fewer results for maximum tension values
(P 0.05) linked via lines.22
before failure; however, these indicated that highest ten-
sions could be applied to GM, then LD, TrA, EO, and
then IO (Table 4). By contrast, the tensile forces gener-
One-way analysis of variance indicated differences ex- ated in the fasciae during application of maximum ten-
isted between mean areas affected by different muscles. sion were, in descending order: LD, TrA, IO, GM, and
Tukeys multiple comparison indicated that mean areas EO in the posterior layer and TrA2, IO2, and EO2 in the
for LD and TrA were significantly greater than all other MLF. Tensile force values generated by maximum ten-
means but not significantly different from each other (Ta- sion on TrA, IO, and EO in the posterior layer are not
ble 3). The mean fascial area affected by GM was not true maxima, as their attachments were only tractioned
significantly greater than areas affected by IO or EO in to failure in the middle layer.
the posterior layer, or TrA in the middle layer (TrA2),
Discussion
but it was greater than areas affected by the obliques in
the MLF (IO2 and EO2). Other areas were not statisti- Fascial Widths
cally different. Width measures between the L3 transverse process and
One-way analysis of variance for tensile forces indi- lateral raphe indicate that the MLF is relatively narrow
cated difference(s) existed between the fascial tensile (mean 2.6 cm) but is continuous beyond the lateral raphe
forces produced at L3 by tension on different muscles. for approximately 4.5 cm as the TrA aponeurosis. This
Tukeys multiple comparison indicated mean tensile distance contrasts with earlier descriptions of 9 cm,11,12
force produced by LD at L3 was significantly greater indicating that these studies may have reported the fas-
than mean tensile forces for GM and EO but that there cial width as the distance between transverse processes
were no other significant differences between means and the musculotendinous junction of TrA. Width values
(Table 3). for both MLF and PLF in the current study are relatively

Figure 4. Fascial area and tensile force measures at 10 N. The areas of lumbar fasciae displaced and tensile forces developed in fasciae
with 10 N applied tension to attached muscles. Tensile force indicates the transverse component of tensile force at L3. Abbreviations
for muscles as given in Figure 2.
134 Spine Volume 29 Number 2 2004
Table 4. Maximum Applied Tension and Resultant Maximum Fascial Tensile Forces
Posterior Layer of Lumbar Fascia
LD TrA
n sides/14 10 11
Maximum applied 33.1 (2040) 25.0* (2040) 45.0 (3070)
tensile force
(N) (range)
Maximum fascial 6.4 (0.518.8) 4.6* (0.18.1) 1.0 (0.12.1)
tensile force
(N) (range)
* Value not true maximum.
low because of the use of aged specimens with smaller
body build but may also be slightly reduced by not ac-
counting for fascial curvature. This factor was mini-
mized by taking measures during application of 10 N
tension. The conditions had the advantage of more
closely replicating an isolated, submaximal contraction
of TrA, which is how tension on the fasciae has been
proposed to influence the neutral zone.23
Results indicate that, under these conditions, the MLF
provides a more direct route from the lateral raphe for
contraction of TrA to potentially influence vertebral
movement. This proposal is supported by the limited
data from Tesh et al in lumbar intra-abdominal balloon
studies,7,11 in which tension generated by the MLF (from
increased pressure in the balloon) was proposed to pro-
vide a substantial (14.5 Nm) resistance to lateral flexion
torque, even if the PLF was cut.
Fascial Displacement
The greatest fascial displacement was through the at-
tachments of TrA and LD, followed by EO, GM, and IO.
Displacements were found to be equal or greater in mag-
nitude than those of Vleeming et al8 despite the current
study applying only one fifth of the tension (Table 5).
Specimens in both studies were elderly, and although
Vleeming et al8 tested a smaller (n 3) sample, the main
difference was in the embalmed status of cadavers. The
substantially lower tension required to displace fascia in
this study is consistent with reports that embalmed tissue
is up to 5 times stiffer than unembalmed.13
The order of displacement results differed from the
order of area results with regard to EO. Fascial displace-
ment from tension on EO was larger than that from
tension on IO and GM, yet the area of fascia affected by
it was smaller. Displacement values of Vleeming et al8
Table 5. Comparative Fascial Displacement
Fascial Displacement (cm)
Muscle Current Study (n 8) Vleeming et al8 (n 3)
Attachment (10N applied tension) (50N applied tension)
LD 14 2 810
EO 10.5 2.5 04
GM 10 3.5 47
Middle Layer
GM IO EO TrA 2 IO 2 EO 2
6 3 6 10 3 3
13.1* (1020) 21.2* (2030) 33.8 (2050) 16.5 (1030) 23.3 (2050)
4.2* (0.15.7) 0.8* (0.12.1) 5.2 (0.410.5) 4.4 (0.35.0) 2.8 (0.44.9)
were consistent with the order of area measures in the
current study (EO GM; Table 5). Displacement mea-
sures may have been overestimated for EO in this study
because of difficulties gripping the muscle attachment in
isolation from its costal attachment and aligning grips
perpendicular to their tensile force on the PLF. Fascial
area measurements corrected this limitation by exclud-
ing all other tissue (than fascia) and provided relatively
different results for EO ( IO and GM). Area results are
thus considered by the authors to be more accurate and
in keeping with those of Vleeming et al.8
The actual displacement of PLF markers across the
spinous processes was consistent with observations of
Tesh11 that up to 3 mm fascial movement occurred away
from the L4 spinous process when increasing intra-
abdominal pressure to 60 mm Hg. Although the MLF
attachments were not similarly mobile across the trans-
verse processes, in some cases (for both PLF and MLF),
application of tension slightly moved the entire vertebral
column. This was corrected as much as possible by image
alignment.
Every muscle tested in this study produced fascial dis-
placement. Contralateral effects were observed (collec-
tively) between T12 and S3, up to 4 cm from the midline.
Vleeming et al8 reported that, in embalmed cadavers,
traction to muscles resulted in contralateral fascial move-
ment only below the level of L4, with traction to GM
causing the greatest contralateral movement (up to 4 cm
from the midline) followed by LD (up to 2 cm). The
authors attributed the ease of tensile transmission across
the midline at these lower levels to the fascia having loose
or absent attachments to spinous processes and supraspi-
nous ligaments below L4.8 This is supported by indepen-
dent studies.2,24
Since embalming increases collagen cross-linkage,25 it
may have resulted in greater fixative effects above L4,
where more dense fibrous tissue exists. This may explain
why bilateral effects were less apparent above this level in
the Vleeming et al8 study. Unembalmed data in the cur-
rent study more closely reflect the in vivo mobility of the
PLFs midline attachments. Data indicate that, in a lum-
bar extension position, with absence of tone in enclosed
or attached muscles, these tissues demonstrate some de-
gree of mobility across the midline at all lumbar and

Figure 5. The lumbar fasciae in cross section. a: At the level of L4. b: At the level of L2. Note IOs attachment to the lateral raphe. Note
EOs attachment to the lateral raphe. Ps psoas; QL quadratus lumborum; Mf multifidus. Abbreviations for muscles as given in Figure
2).
upper sacral levels. If muscles with contralateral effects
contracted bilaterally in vivo, one might cumulative fas-
cial tension to be generated on both sides.
Fascial Areas and Attachments
Application of just 10 N tension to the attachments of
LD and TrA caused bilateral displacement of approxi-
mately 60 cm2 of the PLF throughout the lumbar region
(T12S1). These areas were significantly greater than all
others (P 0.05). The total fascial area affected by LD is
likely to be even greater (and more extensive into tho-
racic and sacral regions) than indicated, as the gripped
part of its attachment was restricted in the present study.
Tension to GM caused bilateral effects in the lower lum-
bar region (L3S3) in 7 of 8 cadavers. These results sup-
port the Vleeming et al8 proposal that LD and GM may
act across the midline, lumbar spine, and sacroiliac joint
via the PLF.8 Results also indicate that TrA is the only
lateral abdominal muscle capable of influencing all lum-
bar vertebral segments via both the PLF and MLF. Its
fascicles26 also align well with inferolateral fibers that
have been described below T12 in both layers.1,10
Both oblique muscles attach to vertebrae via the PLF
and MLF: IO below L3 and EO above it. The attach-
ments of EO are in agreement with studies on the poste-
rior8 and middle1,10 layers, although are in contrast with
findings of Bogduk and MacIntosh.2 The attachment of
EO to lumbar fasciae is often not reported in current
texts2729 while some older texts differ regarding the at-
tachments of IO.12,30 In the current study, IO and EO
attached to both fascial layers on all 16 sides and all
attachments demonstrated tensile transmission.
TrA, IO, and EO acted on similar segmental levels via
both layers of lumbar fasciae, indicating a common at-
tachment to the two layers via the lateral raphe. This
supports typical depictions of the lateral raphe29,30 and
contradicts descriptions of IO attaching behind the lat-
Tension and Muscular Attachments Barker et al 135
eral raphe to the PLF,12 or of TrA and IO having more
limited attachments to the PLF.7 Traction on TrA af-
fected the PLF to the level of T12 and may explain the
occurrence of inferolateral fibers in the PLF below this
level,1,10 which have previously been attributed to GM8
(the latter being effective on the PLF only to the level of
L3). This study also highlights that diagrams of the lum-
bar fasciae in cross section typically represent them be-
low the level of L3, since EOs attachment is usually not
shown (Figure 1). Figure 5 depicts the lateral raphe and
its attachments above versus below L3. The observation
that TrA and IO affected fasciae to the level of S1 indi-
cates that these muscles may act via fasciae across the
lumbosacral junction and are consistent with observa-
tions that aponeurotic fibers from IO may be traced,
via the PLF, to the spinous process of S1.12
Fascial tension in the posterior layer was often trans-
mitted across and between its attachments to spinous
processes, with markers moving up to 3 mm. By contrast,
the vertebral attachments of the MLF appear more fixed,
transmitting tension directly to the transverse processes.
This is in keeping with descriptions from other
studies.7,10
Tensile Force Measures
Tensile force values (N) should be treated with caution
due to differences between the calibrated material and
fascia; rubber having been used for consistency and ease
of gripping. In addition, tensile force measures are lim-
ited to the horizontal component of tension generated in
a small in situ sample of the fascia at L3. In vivo, a
vertical or gain component would also be generated
due to the oblique fibers, so forces may differ to those
indicated, but measures are intended primarily to pro-
vide a comparison between muscles. Study parameters
were chosen to best enable the detection and comparison
of tensile forces from various attachments with minimal
136 Spine Volume 29 Number 2 2004
disruption to the fasciae. When compared at 10 N applied
tension, the highest fascial tensile forces resulted from ten-
sion to LD and TrA in the PLF and to TrA in the MLF, with
smaller tensile forces being generated by tension on the ob-
liques and GM (Figure 4). Approximately 50% of the ap-
plied force to LD was transmitted to the fascia at L3, and
this was the only tensile force that differed significantly
from other values (GM and EO; Table 3).
Tensile force measures are largely related to each mus-
cle attachment and the position and orientation of the
strain gauge. For example, LD had the closest attach-
ment (and grip site) to L3, whereas GMs attachment
was comparatively distant from it, so the tensile force
able to be detected from tension on GM was low. The L3
level was chosen for its central location in the fascia and
a horizontal orientation for the buckle since both MLF
and PLF fiber directions are more horizontal than verti-
cal and all attaching muscles tested had a horizontal
component to their fiber direction.
In the MLF, tensile forces from tension on TrA, IO,
and EO were relatively high. They most likely reflect the
closer location of the gauge to the lateral raphe (and
shorter width of the MLF) and may be partly attributable
to the more fixed attachments of the MLF to transverse
processes, or to its more transverse fiber orientation.10
Regardless of the mechanism, the MLF is clearly better
structured to transmit (submaximal) transverse tensile
forces from TrA at this level.
Comparison of Areas and Tensile Forces
Tensile forces at 10 N tension showed similar trends to
area results, indicating that the buckle position and ori-
entation were appropriate and represent the effect of
most muscles (with the exception of GM) on the fasciae.
However, tensile force and area measures did not corre-
late significantly. This was most likely because of the
limitations of using a fixed position and orientation of
the gauge and because of differences in widths of the two
layers since these factors affected tensile force measures
and/or area measures differently. Tensile force measures
may also have varied at different spinal levels; in some
cases, tension was visibly unevenly distributed through-
out fascia above or below the gauge.
Maximum Tensile Forces
Where possible, attachments were stressed to produce
maximum fascial tensile forces. Many muscles tore as
the final fascial tensile force reading was taken, limiting
the number and accuracy of these results. When applying
40 N tension to LD and TrA, mean transverse tensile
forces of 6.4 N and 4.6 N, respectively, were generated in
the PLF at L3, while applying 50 N tension to TrA gen-
erated a mean tensile force of 5.2 N in the MLF. The
range of maximum values was considerable, with LD
and TrA generating up to 19 N and 8 N in the posterior
layer, respectively, and TrA up to 9.5 N in the middle
layer. In all cases, the attaching muscle fascicles tore (just
proximal to the grip site) at maximum tension, rather
than the fascia itself. In no cases did the grips slip.
Maximum tensile forces did not increase proportion-
ally with applied tension and were generally smaller than
expected from the increased applied load. This may be
explained by failure of individual muscle fascicles. Al-
though high maximum tensile forces could be applied to
the attachments of GM and EO, these sites were located
relatively far from the strain gauge site, with tension not
being transferred to the fascia (Table 5). In addition,
some adjacent muscle fascicles (with strong bony attach-
ments) may have been gripped. Future studies should
take particular care to isolate the fascial attachment
only.
Sample Characteristics and Fascial Tension
The lack of apparent association between weight, age, or
time since death and tensile force or area measures was
unexpected. Wide interindividual variation has been ob-
served for fascial thickness,10 fibrosity,1 muscular at-
tachments,2 and tensile effect of muscle attachments on
the PLF.8 The MLF has been observed to vary in thick-
ness and fibrosity between sides.10 In previous work,1 it
was proposed that fascial changes may be associated
with increased weight and force transmission; however,
that was not supported by this study. Of interest, the
freshest cadavers demonstrated comparatively low
fascial tensile forces and tolerated small maximum ap-
plied traction loads before tearing. Unembalmed cadav-
ers appear, on a biomechanical basis, to be appropriate
for testing musculofascial attachments at low loads for
some weeks after death.
Methodologic Considerations
Findings of fascial area and tensile force from the current
study may differ from those expected in a younger pop-
ulation because of changes associated with ageing, in-
cluding disc space narrowing, reduced lumbar lordosis,
muscle atrophy, changes in collagen composition, and
cross-linking. Duration of storage of the specimens fol-
lowing death and limitations of force calibration may
have also affected absolute values. However, since mus-
cle attachments remain constant with age, storage and
different positions of the spine, their effects via fasciae at
segmental levels, as documented in this sample, are still
representative. A moderate decrease in the failure
strength of connective tissue is generally noted with age-
ing,3133 but this would be expected to have minimal
effect at the submaximal loads used in the current study.
In addition, any variations in tissue stiffness associated
with ageing would be expected to affect all muscle at-
tachments similarly and not to influence their relative
tensile force values.
Despite variability in the location of grips, the limita-
tions of visual mapping of fascial marker movement
and variation in area and tensile force results between
cadavers, all specimens showed similar trends. Further-
more, errors between repeat measurements were small.
This observation supported measurement techniques
and indicated that repetitive application of force was
unlikely to have caused tissue damage. Since a submaxi-

mal force was applied, no tissue damage was expected;
however, as a precaution, repetitions were used consis-
tently for all muscles tested.
The functional implications of this study are limited to
passive tensile capacity of individual attachments under
specific test conditions, so should be considered together
with reported electromyographic behavior of these mus-
cles acting in concert in vivo. Although muscle bellies
function to shorten and transmit tension to their attach-
ing tendons and aponeuroses, transmission is neither
passive nor uniformly distributed. Factors such as muscle
cross-sectional area, physiologic cross-sectional area
(fascicle length), variations in fascicle direction, timing of
onset, type and rate of contraction, and whether actions
are unilateral or bilateral must also be considered when
estimating the forces that muscles may generate.
Despite its limitations, this study is useful in indicating
the relative tensile capacity of various attachments on the
lumbar fasciae in unembalmed specimens. It also defines
the segments of the spine likely to be influenced by each
muscle via its fascial attachments.
Implications for Sacroiliac Stability
Despite proposals that the PLF, with its attached (LD
and GM) muscles may contribute to compression of the
sacroiliac joint,8 this study found the effects of tension on
LD (and TrA) only extended via the PLF to fascial mark-
ers at S1, limiting their potential to affect this joint. By
contrast, tension on GM was found to displace PLF
markers to as low a level as S3. Both GM and LD, how-
ever, tend to be recruited in a phasic fashion for partic-
ular activities34 while the EMG features of TrA may in-
dicate a role in control of neutral zone movement both in
the lumbar spine and at the sacroiliac joint. Increasing
importance is being attributed to TrA in control of move-
ment at the sacroiliac joints, but via its anterior iliac
attachments.35 These, however, are direct rather than via
the lumbar fasciae.
Implications for Lumbar Segmental Stability
The magnitudes of forces (10 N) used in the current
study are approximately 20% of those estimated by
mathematical analysis to be generated in the MLF at
each segment (48 N) during maximal intra-abdominal
pressure (Figure 6). They are similar to those potentially
generated in the MLF and PLF by tonic contraction of
TrA that occurs in healthy subjects before trunk petur-
bations6,14,15,23,36,37 and are proposed to influence the
segmental neutral zone.6,14,15,36 Limitation of neutral
zone movement is recognized to be important in injury
prevention,17,38 with biomechanical models predicting
that very small amounts (3%) of maximum muscle con-
traction may be sufficient to restore segmental stability.38
This study was designed to simulate the effects of iso-
lated muscle tension. When TrA contracts before limb
movements,6,14,15,36 it may act briefly on the vertebrae in
relative isolation (along with the deep fascicles of multi-
fidus).36 Even the small amounts of tension applied in
this study through TrA were transmitted via fascial at-
Tension and Muscular Attachments Barker et al 137
Figure 6. Estimated maximum MLF hoop stress per segment at-
tributable to intra-abdominal pressure (IAP). Adapted from Tesh.11
Assuming the abdomen acts as a pressurized thin walled vessel,
then the maximum hoop stress per spinal level attributable to it will
be as follows:
Hoop stress (p r)/t
Where:
P maximum IAP
200 mm Hg (Morris et al40)
26.6 103 N/m2 (after converting: 0.2 mm Hg (13.6 103)
kg/m3 Hg 9.8 m/s2)
r radius of abdominal cavity
0.12 m (Tesh11)
t thickness of abdominal wall
Force area hoop stress
(p r l t)/t
Where:
l length of MLF over one spinal level 0.015 m (Tesh11)
Fprl
26.6 103 N/m2 0.12 m 0.015 m
48.0 N/segment
total force in MLF
tachments to all lumbar vertebral processes. By contrast,
EO and IO are only capable of affecting the upper or
lower lumbar segments (via lumbar fasciae), respec-
tively. TrA also generated greater tensile forces in fasciae
than the obliques. In addition, the results suggest that
fasciae may be particularly well structured to tolerate
small tensile loads, since fascial tensile forces increased
with applied tension on most muscles up to 10 N, but not
proportionally above this.
The lumbar fasciae form a likely mechanism for TrA
to influence the segmental neutral zone, and it appears
the MLF, with its short width and firm attachments to
transverse processes, may provide the most efficient
route. Motion segment studies performed during appli-
cation of tension indicate that the PLF has the capacity to
influence early range intersegmental movement in the
sagittal plane.11 The MLF might be predicted to have a
similar effect on segmental neutral zone movement, with
a particular advantage in the transverse plane. Overall,
the results of this study also provide anatomic and bio-
mechanical support for the basis of exercises incorporat-
ing submaximal contraction of TrA.37,39 Such exercises
are frequently recommended for management and pre-
vention of low back pain.
138 Spine Volume 29 Number 2 2004
Conclusion
Low levels of tension are effectively transmitted between
transversus abdominis and the middle or posterior layers
of lumbar fascia. Via them, transversus abdominis may
influence intersegmental movement.
Key Points
Lumbar fasciae in unembalmed cadavers was
dissected.
Low level tension on attached muscles produces
fascial tensile force and movement.
Results indicate how muscles and fasciae may
affect the lumbar spine.
Transversus abdominis can influence all lumbar
segments via the lumbar fasciae.
Acknowledgments
The authors thank John Behrsin (Wickham Road Phys-
iotherapy) for loan of equipment, Colin Anderson, Ian
Story, and Roger Hughes for academic advice, Stuart
Thyer for photography, Matt Jackson, Trevor Allen,
Ivica Grkovic, and Scott Robbins (University of Mel-
bourne) for technical assistance, and Donna Urquhart,
Marius Fahrer, and Rita Bruns (University of Mel-
bourne) and Michael Adams (University of Bristol) for
their constructive comments.
References
1. Barker PJ, Briggs CA. Attachments of the posterior layer of lumbar fascia.
Spine. 1999;24:17571764.
2. Bogduk N, MacIntosh JE. The applied anatomy of the thoracolumbar fascia.
Spine. 1984;9:164 170.
3. Farfan HF. Mechanical Disorders of the Low Back. Philadelphia: Lea &
Febiger, 1973.
4. Gracovetsky S, Farfan HF, Lamy C. The mechanism of the lumbar spine.
Spine. 1981;6:249 262.
5. Gracovetsky S, Farfan H, Helleur C. The abdominal mechanism. Spine.
1985;10:317324.
6. Hodges PW, Richardson CA. Feedforward contraction of transversus abdo-
minis is not influenced by the direction of arm movement. Exp Brain Res.
1997;114:362370.
7. Tesh KM, Dunn JS, Evans JH. The abdominal muscles and vertebral stabil-
ity. Spine. 1987;12:501508.
8. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, et al. The posterior layer of
the thoracolumbar fascia: its function in load transfer from spine to legs.
Spine. 1995;20:753758.
9. Bogduk N, Johnson G, Spalding D. The morphology and biomechanics of
latissimus dorsi. Clin Biomech. 1998;13:377385.
10. Barker PJ, Urquhart DM, Briggs CA, et al. The middle layer of lumbar fascia
and muscle attachments to lumbar transverse processes: implications for
fracture and segmental stability. 2003: In press.
11. Tesh KM. The Abdominal Muscles and Vertebral Stability, PhD Thesis.
Glasgow, Scotland: University of Strathclyde, Bioengineering Unit, 1986;
166 349.
12. Testut L, Latarjet A. Traite dAnatomie Humaine, 9th ed. Paris: G. Doin &
Compagnie, 1948:944 952.
13. Wilke HJ, Krischak S, Claes LE. Formalin fixation strongly influences bio-
mechanical properties of the spine. J Biomech. 1996;29:1629 1631.
14. Cresswell AG, Grundstrom H, Thorstensson A. Observations on intra-
abdominal pressure and patterns of abdominal intra-muscular activity in
man. Acta Physiol Scand. 1992;144:409 418.
15. Hodges PW, Richardson CA. Delayed postural contraction of transversus
abdominis in low back pain associated with movement of the lower limb.
J Spinal Disord. 1998;11:46 56.
16. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar
spine associated with low back pain: a motor control evaluation of transver-
sus abdominis. Spine. 1996;21:2640 2650.
17. Panjabi MM. The stabilizing system of the spine: II. Neutral zone and insta-
bility hypothesis. J Spinal Disord. 1992;5:390 396.
18. Barker PJ, Briggs CA. The lumbar fasciae and spinal stability. In: Boyling JD,
Jull GJ, eds. Grieves Modern Manual Therapy of the Vertebral Column, 3rd
ed. Edinburgh: Harcourt Health Sciences, 2003, in press.
19. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing
exercises for first-episode low back pain. Spine. 2001;26:E243E248.
20. OSullivan PB, Twomey LT, Allison GT. Evaluation of specific stabilizing
exercise in the treatment of chronic low back pain with radiologic diagnosis
of spondylolysis or spondylolisthesis. Spine. 1997;22:2959 2967.
21. Behrsin JF. The Morphology of the Lumbar Spinal Ligaments and Their
Stress Response During Physiological Movements, Masters Thesis. Mel-
bourne: University of Melbourne, Anatomy & Cell Biology, 1988:9398.
22. Zar JH. Biostatistical Analysis, 4th ed. Upper Saddle River, NJ: Prentice
Hall, 1999.
23. Hodges PW, Cresswell A, Thorstensson A. Preparatory trunk motion accom-
panies rapid upper limb movement. Exp Brain Res. 1999;124:69 79.
24. Rissanen PM. The surgical anatomy and pathology of the supraspinous and
interspinous ligaments of the lumbar spine with special reference to ligament
ruptures. Acta Orthop Scand Suppl. 1960;46:199.
25. Chapman JA, Tzaphlidou M, Meek KM, et al. The collagen fibril: a model
system for studying the staining and fixation of a protein. Electron Microsc
Rev. 1990;3:143182.
26. Urquhart DM, Barker PJ, Hodges PW, et al. Regional morphology of tran-
versus abdominis, obliquus internus and obliquus externus abdominis.
2003: In press.
27. Bergmark A. Stability of the lumbar spine: a study in mechanical engineering.
Acta Orthop Scand Suppl. 1989;230:154.
28. Sinnatamby CS. Lasts Anatomy: Regional and Applied, 10th ed. Edinburgh:
Churchill Livingstone, 1999.
29. Williams PW, Bannister LH, Berry MM, et al. eds. Grays Anatomy, 38th ed.
New York: Churchill Livingstone, 1995.
30. Poirier P. Myologie. In: Poirer P, Charpy A, eds. Traite dAnatomie Hu-
maine. Paris: Masson et Compagnie, 1901:497.
31. Blevins FT, Hecker AT, Bigler GT, et al. The effects of donor age and strain
rate on the biomechanical properties of bone-patellar tendon-bone allo-
grafts. Am J Sports Med. 1994;22:328 333.
32. Simonsen EB, Klitgaard H, Bojsen-Moller F. The influence of strength train-
ing, swim training and ageing on the Achilles tendon and m. soleus of the rat.
J Sports Sci. 1995;13:291295.
33. Woo SL, Ohland KJ, Weiss JA. Aging and sex-related changes in the biome-
chanical properties of the rabbit medial collateral ligament. Mech Ageing
Dev. 1990;56:129 142.
34. Mooney V, Pozos R, Vleeming A, et al. Exercise treatment for sacroiliac
pain. Orthopedics. 2001;24:29 32.
35. Richardson CA, Snijders CJ, Hides JA, et al. The relation between the trans-
versus abdominis muscles, sacroiliac joint mechanics, and low back pain.
Spine. 2002;27:399 405.
36. Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the
lumbar multifidus muscle are differentially active during voluntary arm
movements. Spine. 2002;27:E29 E36.
37. Richardson CA, Jull GA, Hodges PW, et al. Therapeutic Exercise for Spinal
Segmental Stabilization in Low Back Pain. London: Harcourt Brace, 1999:
42 49, 66 68.
38. Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine:
implications for injury and chronic low back pain. Clin Biomech. 1996;11:
115.
39. Richardson CA, Jull GA. Muscle control-pain control: what exercises would
you prescribe? Man Ther. 1995;1:210.
40. Morris JM, Lucas DB, Bresler B. Role of the trunk in stability of the spine.
J Bone Joint Surg Am. 1961;43:327351.