Myofascial Slings

Written by Dr Steven Hewitt — Chiropractor · AHPRA: CHI0001115420 · Last reviewed: May 2026

The concept of myofascial slings describes integrated chains of muscle and connective tissue that work together to transmit force across the body during movement. Rather than viewing muscles as isolated actuators — each contracting to produce a single movement at a single joint — the sling model recognises that force is transmitted longitudinally and obliquely through fascial connections between muscles, and that these connections are anatomically confirmed and biomechanically significant.

The clinical implication is direct: when a structure at one point in a sling is dysfunctional, the load it can no longer manage is redistributed to adjacent structures — including structures at a considerable distance from the pain site. Lower back pain is not simply a lumbar spine problem. Proximal hamstring pain is not simply a hamstring problem. Lateral knee pain is not simply an iliotibial band problem. Each of these presentations involves a sling, and addressing only the symptomatic structure, while the rest of the chain is unassessed, is a common reason why the same pain recurs after treatment.

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What the Oblique Slings Are Actually For

Sport is where the oblique slings are most visible, but it is not their main job. They exist for walking.

Human gait is built on dissociation between the shoulder girdle and the pelvis: as the right leg swings forward the trunk counter-rotates and the left arm swings with it. That counter-rotation is the anterior and posterior oblique slings loading and releasing. It is why we walk the way we do — and why a penguin, which does not dissociate the two girdles, waddles instead.

The pay-off is efficiency, and it has been measured from an unexpected direction. When walkers were asked to flatten their gait — to minimise the normal up-and-down movement of the body's centre of mass — the metabolic cost of walking rose by 17 to 27 per cent [1]. Taking the bounce out did not make walking easier, it made it harder, because less of the movement was being stored and returned by elastic tissue and more of it had to be produced by muscle. Across a day's walking that return is the difference between a gait you can sustain for hours and one you cannot — which, for a species that historically had to walk to eat, was not a small matter.

A fair question at this point: if the slings matter to walking, why can you walk perfectly well with your hands in your pockets? Because the arms are not what drives the system. When arm swing was restricted experimentally there was no change in the energy cost of walking, and the deltoid was found to contract eccentrically, decelerating the arm rather than swinging it — the arms behave as passive dampers of rotation the legs have already created [2]. The counter-rotation between pelvis and ribcage is the part that loads the diagonal, and that continues whatever the arms are doing. In our clinical experience the arms still take part — a mass being decelerated is a mass putting tension through the tissue that decelerates it — but they are passengers in the system, not its engine.

In our clinical experience the same principle shows up at very slow speeds, though that is an observation rather than the thing those experiments measured. Walking very slowly is tiring. At a shuffle the diagonal never loads quickly enough for much elastic return to happen, so more of the work falls to muscle. The shopping-centre shuffle is exhausting for a reason.

In our clinical experience this is the more useful way to explain the slings to someone who does not play sport: we exploit the system for sport, but it exists for gait.

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Fascia as the Medium

The force transmission that makes slings functionally coherent is mediated by fascia — the continuous connective tissue network that surrounds, invests, and connects every muscle in the body. The thoracolumbar fascia is the central hub of the posterior sling system: anatomically, it connects the gluteus maximus and contralateral latissimus dorsi across the midline, and connects the erector spinae and multifidus to the sacrotuberous ligament below. [3] The biceps femoris long head has been shown to be histologically continuous with the sacrotuberous ligament — tissue-level evidence that at least one junction of the deep longitudinal sling is a genuine anatomical connection rather than a functional analogy. [4]

Fascial force transmission has also been measured in living people rather than cadavers: tensioning the latissimus dorsi shifts the resting position of the opposite hip and increases its passive stiffness — force arriving somewhere the muscle does not attach. [5] This means that fascial stiffness or restriction at any point in a chain alters the mechanical behaviour of every other structure connected to it — creating the pattern of widespread tension and recurrent injury that many people with persistent musculoskeletal pain will recognise.

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How We Use the Sling Model

In clinical practice, the sling model informs both assessment and treatment. When a patient presents with recurrent lower back pain, we assess not just the lumbar spine but every sling that transmits load into it — because any of the four can contribute, and which one is doing so is a question for assessment rather than an assumption. The deep longitudinal sling carries load up through the calf, hamstrings and sacrotuberous ligament. The posterior oblique sling brings in the gluteus maximus, the thoracolumbar fascia and the contralateral latissimus dorsi. The lateral stability sling tends to show itself when the pain is worse in single-leg loading. And the anterior oblique sling reaches the lumbar spine less obviously, through the lateral raphe and the posterior anchor of the abdominal wall — which is why a restriction at the front of the trunk or hip can present as pain at the back of it. When a patient has persistent lateral knee pain, we assess the posterior oblique and lateral stability systems that govern pelvis and hip mechanics in walking and running.

Treatment is directed at the densifications and load deficits across the relevant sling, not just at the pain site. This approach — identifying and treating the sites that compromise normal load sharing, rather than the site where the altered load is felt — is the distinguishing feature of the fascial model in practice. Each sling article below explains the anatomy, the clinical logic, and the conditions most commonly associated with that sling's dysfunction.

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The Slings and the Conditions They Connect

The four slings each connect to specific clinical presentations across the musculoskeletal system:

The deep longitudinal sling is most relevant to plantar fasciopathy, Achilles tendinopathy, proximal hamstring tendinopathy, sacroiliac joint dysfunction, and recurrent lower back pain in people who also have restricted ankle dorsiflexion or poor posterior chain strength.

The posterior oblique sling is central to sacroiliac joint loading, gluteal tendinopathy, rotator cuff presentations with a thoracolumbar component, and the persistent lower back tension that comes with poor gluteus maximus activation during hip extension.

The anterior oblique sling is most relevant to groin pain, adductor tendinopathy, recurrent lateral ankle sprain (where trunk rotation mechanics contribute), and anterior pelvic pain presentations where the hip flexor-trunk rotation interface is involved. Because the chain continues past the trunk onto the shoulder blade through serratus anterior, it is also relevant to shoulder impingement and rotator cuff presentations where scapular upward rotation is limited.

The lateral stability sling — a neuromuscular co-activation system rather than an anatomical fascial chain — governs pelvic stability in single-leg stance. It is relevant to lateral hip pain, ITB syndrome, patellofemoral pain, recurrent ankle sprain and chronic ankle instability — where the pelvis failing to hold level leaves the foot landing under a shifting centre of mass — and lower back pain that is worse in single-leg loading activities such as walking, stair climbing, and running.

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