Case Study: Lateral Raphe Tear in a Competitive Athlete

Our Patient

Our patient is a 27 year-old male soccer player complaining of persistent low back pain, with difficulty maintaining engagement of the core muscles during high-intensity drills. The patient could not recall an acute injury, but he mentioned a sudden twisting maneuver during a game six weeks prior that “felt off,” although it caused no immediate pain.

The Challenge

Over the following weeks, the athlete noticed that activating his core was becoming progressively more difficult, especially during spriting and rotational actions. He also reported soreness in the lumbar spine and contralateral hip that worsened after training sessions, and posterior chain discomfort during running and cutting maneuvers.

Our Diagnostic Process

Clinical Examination

During the clinical exam, we noted poor co-contraction between the anterior abdominal wall and the paraspinal muscles. We also discovered altered breathing mechanics, with reduced lateral expansion.

Physical palpation revealed subtle densification along the lateral raphe region – a complex of dense connective tissue formed by the fusion of layers of the thoracolumbar fascia (TLF). The TLF is often described as a “fascial zipper” along both sides of the lower back whose dysfunction gives a sensation of “disconnect” rather than pain.

Our Treatment Protocol

Our treatment approach for this athlete was personalized and multimodal:

• Prolotherapy injections targeting the lateral raphe to restore tensile integrity and improve fascial load-sharing.
• DNS (Dynamic Neuromuscular Stabilization), a holistic method to retrain muscle activation in the abdominal canister, to restore reflexive co-contraction and normalize intra-abdominal pressure regulation.
• Stecco Fascial Manipulation, an evidence-based method of releasing densifications in adjacent fascial planes to optimize force transmission and enhance frictionless gliding.

Results

After six weeks of multimodal treatment, the athlete reported improved abdominal wall activation, decreased compensatory lumbar pain, and restored efficiency of rotational action and sprint mechanics.

Discussion

Lateral raphe tears are common in athletes, often formed by repetitive microtraumas that worsen over time. In this case, we suspect that the raphe failed due to a sudden rotational load during soccer that may have created the initial tear, aggravated by TLF densifications that disrupted load transmission.

Raphe tears rarely present as localized pain at the site of injury. Instead, tensegrity of the abdominal canister is destabilized, and the athlete loses a reflexive co-contraction between the anterior and posterior stabilizers.

This results in:

• Loss of connectivity during sport-specific movements
• Difficulty activating the core muscles under load
• Pain that manifest elsewhere due to compensatory strategies

The takeaway:

• The presence or absence of pain can be misleading.
• Lateral raphe dysfunction can masquerade as lumbar, hip, or pelvic pain.
• For athletes struggling with “loss of abdominal connection” or unexplained weakness, the lateral raphe should be considered as a potential missing link.