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Thoracolumbar Junction – Back Pain that Doesn’t Resolve with Traditional Treatment

The thoracolumbar junction – or TLJ for short – is a unique area in the human body that can produce back, hip, gynecologic, urologic, testicular, and lower GI pain. While the dysfunction often occurs at the thoracolumbar junction, the pain rarely appears at the source. Because of this, it’s one of the most commonly underdiagnosed – or missed – causes of symptoms in the clinic.

If you’ve been struggling with any of those types of pain and are not experiencing relief, your symptoms could be coming from the TLJ. We’re going to dive into what the thoracolumbar junction is, why it causes the pain it does, the types of TLJ dysfunction, and some exercises to help relieve pain.

What is the Thoracolumbar Junction?

The thoracolumbar junction is where the thoracic spine (mid back) switches to the lumbar spine (low back). In the mid back and low back, the direction of how the joints match up between the spinal segments is different. The thoracic spine is meant to move in a rotational direction and the lumbar spine is meant to move in a forward and backward direction. Whenever the direction of the spinal segment joints changes, it is easier for too much or not enough motion to occur, which causes pain.

This area is also an attachment site for many muscles. The diaphragm (main breathing muscle), iliopsoas (helps lift your leg upwards), erector spinae (big back muscles), quadratus lumborum (helps you ‘hike’ your hip), latissimus dorsi (pull-up muscle), and the thoracolumbar fascia (tight connective tissue) all attach here. The more muscles that attach in an area, the easier it is for something to go wrong.

If you take a dive into the research, very little is known about TLJ discomfort. It’s often studied as another name – Maigne’s Syndrome. The available research is mostly case studies, which isn’t the highest quality evidence. However, we have integrated information from these studies, conversations with colleagues, and clinical patterns we have seen to help us get results for our clients. This is where most of our knowledge and information on Maigne’s Syndrome comes from.

What Thoracolumbar Junction Pain Looks Like

As we discussed at the beginning, TLJ discomfort can occur in a variety of areas. That is because the nerves at the thoracolumbar junction innervate all of those areas. The discomfort typically shows up in one of the areas depicted in the image below. Going forward, we’ll discuss Maigne’s Syndrome as TLJ dysfunction. By this, we are implying that pain due to dysfunction at the TLJ can be in any of the following areas (back, hip, gynecologic, urologic, testicular, and lower GI pain).

thoracolumbar junction pain locations

The Two Types of Thoracolumbar Junction Pain

There’s typically two types of individuals who have TLJ dysfunction – those who utilize the TLJ for stability and those who don’t have enough mobility at the TLJ. The most frequent type we see is those who lack mobility, so we’ll discuss that first.

TLJ Dysfunction from Lacking Mobility

This subset of individuals typically has an onset of pain after performing a repetitive rotational activity (pickleball, hockey, golf, etc.). The individual in question usually lacks motion at the TLJ. Essentially, the discomfort comes from trying to move an area that doesn’t move or moving it more than it wants to move.

Exercises to help this individual involve mobilizing the area. This gets blood flow to the area to help the discomfort resolve. It also helps improve mobility long-term so the discomfort doesn’t become a recurring problem. Here’s a couple exercises we’ve seen be successful for individuals struggling with pain associated with lacking mobility at the TLJ.

TLJ Dysfunction from Lacking Motor Control

On the flip side, a good chunk of individuals who have TLJ dysfunction often use the TLJ for stability when they shouldn’t. This doesn’t mean they aren’t strong enough to execute the proper movement. It does mean that what they think their body is doing and what their body is actually doing are two different things.

It’s much easier to use a joint for stability than it is to use your muscles. The body will take the path of least resistance to accomplish a task. So, if you are unaware you are overarching your back (specifically the TLJ area), you’ll keep doing it because it’s easier than using your muscles to support you.

We most frequently see this type of TLJ dysfunction in active individuals who do some sort of group fitness class or bootcamp. Some ‘tells’ that we use to identify this are overarching the back while pressing weight overhead, weakness in the lower abdominals and hip flexors, and difficulties isolating hip motion from back motion. Because of this, we use exercises aimed at identifying the technical deficits of movements and practicing those movements with correct technique. Here’s a couple examples.

Wrapping up Thoracolumbar Junction Pain

TLJ dysfunction can be tricky to diagnose because the symptoms – while coming from the TLJ – most frequently don’t occur at the TLJ. Instead, they pop up in the back, hip, gynecologic, urologic, testicular, and lower GI areas. While TLJ dysfunction can be tricky to find, it often gets good results with treatment. Eliminating TLJ dysfunction involves a combination of exercises and hands-on therapy (typically cupping for improved mobility around the nerve). If you’ve been struggling with a weird hip or back pain that won’t go away with the traditional exercises, it could be time to consider the TLJ.

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