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Erector spinae groupSpinalis capitis, spinalis cervicis, longissimus capitis
The erector spinae (ES) is one of the core and paraspinal muscles, is a large and superficial muscle that lies just deep to the thoracolumbar fascia and arises from the erector spinae aponeurosis (ESA).
The ESA is a common aponeurosis that blends with the thoracolumbar fascia, with a proximal attachment on the sacrum and the spinous processes of the lumbar vertebrae.
Between the posterior and middle layers of the thoracolumbar fascia in the lumbar regions [1]
The ES is formed of 3 muscles with its fibres running more or less vertically throughout the lumbar, thoracic and cervical regions. It lies in the groove to the side of the vertebral column. [2] Its muscle mass is poorly differentiated but divides into three sections in the upper lumbar area named:
Branches of the vertebral, deep cervical, occipital, transverse cervical, posterior intercostal, subcostal, lumbar and lateral sacral arteries. [17]
Function
Back ExtensionBilateral contraction of the erector spinae muscles causes back and head extension.[18]
It controls the forward flexion of the thorax, which can occur secondary to gravity. [19]
The actions of the cervical and capitis groups are disputed. These muscles are small when compared to the larger cervical muscle groups and have little force capacity.
The unilateral contraction causes ipsilateral side flexion and rotation of the vertebral column and head. [17][18]
Spinalis connects the spinous process of the adjacent vertebrae. [17]
Longissimus forms the middle part of the erector spinae muscles, lateral to the spinalis. The longissimus muscle forms the main meat of the erector group. It attaches along the transverse process of the vertebrae. [17]
Iliocostalis is the most lateral part of the erector spinae muscles. It attaches to the ribs. [17] Due to the lateral position, tightness in iliocostalis muscles can force the ipsilateral hip into a superior position, or bring the ribcage inferior toward the hip.
Clinical Relevance
Back Pain
The main pathology associated with the back muscles is pain.
These muscles can develop spasms that can be debilitating.
The lower back muscles are a common cause of low back pain (LBP). This entity is often misdiagnosed and involves millions of people of all ages and gender. Patients often undergo exhaustive workups, including an MRI, often unwarranted. [19]
The erector spinae muscles play an important role in the spinal stability and LBP.
In patients with LBP, there is decreased activity and atrophy of the multifidus muscle which compromises the spinal stability. [20] The spinal control is compensated for by the increased activity of the erector spinae muscle to stabilize the lumbar spine. [21] eg erector spinae contract to compensate for the delay in increasing the stiffness of the lumbar spine.
This increased activity of erector spinae increases the compression load on the vertebral column, stimulating the nociceptors of the spinal structures continuously which may increase the risk of injury. [21]
Stretching erector spine
Erector Spinae Flexion-Relaxation Phenomenon: The flexion-relaxation phenomenon is defined as the silencing of the erector spinae myoelectric activity during full trunk flexion.
In healthy individuals with no low back pain, the erector spinae muscles relax in a range from an upright position to full-lumbar flexion, due to the deep back muscles (multifidus) acting to stabilize the lumbar spine.
In individuals with low back pain, the erector spinae flexion-relaxation phenomenon is absent. As the erector spinae functions to stabilize the lumbar spine due to laxity of the passive structures and changes in the neuromuscular activation pattern.
Lumbar stabilization exercises can restore the erector spinae flexion-relaxation phenomenon by strengthening the multifidus muscle. [23]
Myofascial release of the erector spinae muscles in patients with non-specific chronic low back pain normalized the flexion-relaxation response and decreased low back pain. [24]
