Erector Spinae: Difference between revisions
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== Description == | == Description == | ||
[[File:Muscles of the back erector spinae group Primal.png|thumb| | [[File:Muscles of the back erector spinae group Primal.png|thumb|400x400px|alt=|Erector spinae group]][[File:Muscles of the cervical region intermediate muscles Primal.png|thumb|Spinalis capitis, longissimus capitis, spinalis cervicis]] | ||
The erector spinae (ES) is a large and superficial muscle that lies just deep to the [[Thoracolumbar Fascia|thoracolumbar fascia]] and arises from | The erector spinae (ES) is one of the [[Core Muscles|core]] and [[Paraspinal Muscles|paraspinal]] muscles, is a large and superficial muscle that lies just deep to the [[Thoracolumbar Fascia|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. | 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. | ||
The ES relationships: | |||
# Covered by thoracolumbar fascia, [[serratus posterior]] inferior, [[rhomboids]], and [[Splenius Capitis|splenii]] muscle groups | |||
# Between the posterior and middle layers of the thoracolumbar fascia in the lumbar regions <ref>Radiopedia Erector Spinae Available: https://radiopaedia.org/articles/erector-spinae-group?lang=us<nowiki/>(accessed 5.3.2022)</ref> | |||
The ES is formed of 3 muscles with its fibres run more or less vertically throughout the [[lumbar]], [[Thoracic Anatomy|thoracic]] and [[Cervical Anatomy|cervical]] regions. It lies in the groove to the side of the vertebral column. <ref name=":0">Whitmore I. [https://onlinelibrary.wiley.com/doi/full/10.1002/%28SICI%291097-0185%2819990415%29257%3A2%3C50%3A%3AAID-AR4%3E3.0.CO%3B2-W Terminologia anatomica: new terminology for the new anatomist]. The Anatomical Record: An Official Publication of the American Association of Anatomists. 1999 Apr 15;257(2):50-3.</ref> | The ES is formed of 3 muscles with its fibres run more or less vertically throughout the [[lumbar]], [[Thoracic Anatomy|thoracic]] and [[Cervical Anatomy|cervical]] regions. It lies in the groove to the side of the vertebral column. <ref name=":0">Whitmore I. [https://onlinelibrary.wiley.com/doi/full/10.1002/%28SICI%291097-0185%2819990415%29257%3A2%3C50%3A%3AAID-AR4%3E3.0.CO%3B2-W Terminologia anatomica: new terminology for the new anatomist]. The Anatomical Record: An Official Publication of the American Association of Anatomists. 1999 Apr 15;257(2):50-3.</ref> | ||
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# [[Longissimus]], the intermediate column | # [[Longissimus]], the intermediate column | ||
# [[Spinalis]], most medial <ref>Musculoskeletal Key Lumbar Musculature Available: https://musculoskeletalkey.com/lumbar-musculature-anatomy-and-function/ (accessed 5.3.2022)</ref> | # [[Spinalis]], most medial <ref>Musculoskeletal Key Lumbar Musculature Available: https://musculoskeletalkey.com/lumbar-musculature-anatomy-and-function/ (accessed 5.3.2022)</ref> | ||
== Anatomy == | == Anatomy == | ||
=== Origin / Insertion === | === Origin / Insertion === | ||
[[File:Spinalis.png|thumb|383x383px|Spinalis thoracis]] | |||
* [[Spinalis Capitis|Spinalis capitis]]: Medial aspect between the superior and inferior nuchal lines of the occiput / | * [[Spinalis Capitis|Spinalis capitis]]: Medial aspect between the superior and inferior nuchal lines of the occiput<ref name=":12">Radiopedia Erector spinae group Available: https://radiopaedia.org/articles/erector-spinae-group?lang=us<nowiki/>(accessed 4.2.2022)</ref> / C7, T1 | ||
* [[Spinalis Cervicis|Spinalis cervicis]]: | * [[Spinalis Cervicis|Spinalis cervicis]]: | ||
* [[Spinalis Thoracis|Spinalis thoracis]]: | * [[Spinalis Thoracis|Spinalis thoracis]]:Spinous processes of T11-[[Lumbar Vertebrae|L2]] <ref name=":02">Spinalis muscle [Internet]. Kenhub. 2021 [cited 30 November 2021]. Available from: https://www.kenhub.com/en/library/anatomy/spinalis-muscle</ref> <ref name=":13">Palastanga, N., & Soames, R. (2012). Anatomy and human movement (6th ed.). Edinburgh: Churchill Livingstone.</ref>/ Spinous processes of [[Thoracic Vertebrae|T2-T8]].<ref name=":15">Palastanga, N., & Soames, R. (2012). Anatomy and human movement (6th ed.). Edinburgh: Churchill Livingstone.</ref> | ||
* [[Longissimus Capitis|Longissimus capitis]]: | |||
* [[Longissimus Capitis|Longissimus capitis]]: Posterior surface of transverse processes of T1 to T5 and the articular tubercle of C4 to C7<ref name="wh">http://www.wheelessonline.com/ortho/longissimus_capitis_1</ref>/ Posterior margin of mastoid process and the temporal bone.<ref name="wh2">http://www.wheelessonline.com/ortho/longissimus_capitis_1</ref><ref name="PP">http://www.primalonlinelearning.com/cedaandp/muscular_system/muscles_of_the_back.aspx#longissimuscapitis</ref> | |||
* Longissimus cervicis: | * Longissimus cervicis: | ||
* [[Longissimus Thoracis|Longissimus thoracis]]: | * [[Longissimus Thoracis|Longissimus thoracis]]: | ||
* [[Iliocostalis Cervicis|Iliocostalis cervicis]]: Angle of ribs 3-6 / Transverse process of C4-C6 | * [[Iliocostalis Cervicis|Iliocostalis cervicis]]: Angle of ribs 3-6 / Transverse process of C4-C6 | ||
* [[Iliocostalis Thoracis|Iliocostalis thoracis]]: Angle of lower six ribs / Angles of upper six ribs and transverse process of C7 | * [[Iliocostalis Thoracis|Iliocostalis thoracis]]: Angle of lower six ribs / Angles of upper six ribs and transverse process of C7 | ||
* [[Iliocostalis Lumborum|Iliocostalis lumborum]]: Iliac crest / L1-L4 lumbar transverse processes, angle of 4-12 ribs and thoracolumbar fascia | * [[Iliocostalis Lumborum|Iliocostalis lumborum]]: Iliac crest / L1-L4 lumbar transverse processes, angle of 4-12 ribs and thoracolumbar fascia | ||
=== Nerve === | === Nerve === | ||
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Description[edit | edit source]
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.
The ES relationships:
- Covered by thoracolumbar fascia, serratus posterior inferior, rhomboids, and splenii muscle groups
- 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 run 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:
- Iliocostalis, most lateral
- Longissimus, the intermediate column
- Spinalis, most medial [3]
Anatomy[edit | edit source]
Origin / Insertion[edit | edit source]
- Spinalis capitis: Medial aspect between the superior and inferior nuchal lines of the occiput[4] / C7, T1
- Spinalis cervicis:
- Spinalis thoracis:Spinous processes of T11-L2 [5] [6]/ Spinous processes of T2-T8.[7]
- Longissimus capitis: Posterior surface of transverse processes of T1 to T5 and the articular tubercle of C4 to C7[8]/ Posterior margin of mastoid process and the temporal bone.[9][10]
- Longissimus cervicis:
- Longissimus thoracis:
- Iliocostalis cervicis: Angle of ribs 3-6 / Transverse process of C4-C6
- Iliocostalis thoracis: Angle of lower six ribs / Angles of upper six ribs and transverse process of C7
- Iliocostalis lumborum: Iliac crest / L1-L4 lumbar transverse processes, angle of 4-12 ribs and thoracolumbar fascia
Nerve[edit | edit source]
Dorsal rami of spinal nerves.[11]
Artery[edit | edit source]
Branches of the vertebral, deep cervical, occipital, transverse cervical, posterior intercostal, subcostal, lumbar and lateral sacral arteries. [12]
Function[edit | edit source]
- Bilateral contraction of the erector spinae muscles cause back and head extension.[13]
- It controls the forward flexion of the thorax, which can occur secondary to gravity. [14]
- 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.
- Unilateral contraction causes ipsilateral side flexion and rotation of the vertebral column and head towards. [12][13]
- Spinalis connects the spinous process of the adjacent vertebrae to each other. [12]
- 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. [12]
- Iliocostalis is the most lateral part of the erector spinae muscles. It attaches to the ribs. [12] 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[edit | edit source]
Assessment[edit | edit source]
Manual Muscle Testing: Trunk Extension
Watch this brief video.
Treatment[edit | edit source]
Physiotherapy Implications[edit | edit source]
The chief 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. 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. [14]
The erector spinae muscles play an important role in the spinal stability and Low Back Pain .
- In patients with low back pain there is decreased activity and atrophy of the multifidus muscle which compromises the spinal stability. [16] The spinal control is compensated for by the increased activity of the erector spinae muscle to stabilize the lumbar spine. [17] 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 increases the risk of injury. [17]
Erector Spinae Flexion-Relaxation Phenomenon: The flexion-relaxation phenomenon is defined as 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 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. [18]
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. [19]
Back Exercises play an important role.
See also Lumbar Instability.
Function and Training[edit | edit source]
This is a 5 minute video on Function and Training of the Erector Spinae Muscles:
References[edit | edit source]
- ↑ Radiopedia Erector Spinae Available: https://radiopaedia.org/articles/erector-spinae-group?lang=us(accessed 5.3.2022)
- ↑ Whitmore I. Terminologia anatomica: new terminology for the new anatomist. The Anatomical Record: An Official Publication of the American Association of Anatomists. 1999 Apr 15;257(2):50-3.
- ↑ Musculoskeletal Key Lumbar Musculature Available: https://musculoskeletalkey.com/lumbar-musculature-anatomy-and-function/ (accessed 5.3.2022)
- ↑ Radiopedia Erector spinae group Available: https://radiopaedia.org/articles/erector-spinae-group?lang=us(accessed 4.2.2022)
- ↑ Spinalis muscle [Internet]. Kenhub. 2021 [cited 30 November 2021]. Available from: https://www.kenhub.com/en/library/anatomy/spinalis-muscle
- ↑ Palastanga, N., & Soames, R. (2012). Anatomy and human movement (6th ed.). Edinburgh: Churchill Livingstone.
- ↑ Palastanga, N., & Soames, R. (2012). Anatomy and human movement (6th ed.). Edinburgh: Churchill Livingstone.
- ↑ http://www.wheelessonline.com/ortho/longissimus_capitis_1
- ↑ http://www.wheelessonline.com/ortho/longissimus_capitis_1
- ↑ http://www.primalonlinelearning.com/cedaandp/muscular_system/muscles_of_the_back.aspx#longissimuscapitis
- ↑ Henson B, Edens MA. Anatomy, Back, Muscles. InStatPearls [Internet] 2018 Dec 23. StatPearls Publishing.
- ↑ 12.0 12.1 12.2 12.3 12.4 Drake R, Vogl AW, Mitchell AW. Gray's Anatomy for Students E-Book. Elsevier Health Sciences; 2009 Apr 4.
- ↑ 13.0 13.1 Palastanga, N., & Soames, R. (2012). Anatomy and human movement (6th ed.). Edinburgh: Churchill Livingstone.
- ↑ 14.0 14.1 Henson B, Kadiyala B, Edens MA. Anatomy, Back, Muscles.[Updated 2020 Aug 10]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021. Available:https://www.ncbi.nlm.nih.gov/books/NBK537074/ (accessed 5.3.2022)
- ↑ Sheena Livingstone. Erector Spinae Muscle Test. Available from: http://www.youtube.com/watch?v=pfbm_-fgylo [last accessed 26/03/14]
- ↑ Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J, Urquhart DM. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. The spine journal. 2017 Nov 1;17(11):1729-48.
- ↑ 17.0 17.1 Mazis N. Does a history of non specific low back pain influence electromyographic activity of the erector spinae muscle group during functional movements. J. Nov. Physiother. 2014;4:226.
- ↑ Park SS, Choi BR. Effects of lumbar stabilization exercises on the flexion-relaxation phenomenon of the erector spinae. Journal of physical therapy science. 2016;28(6):1709-11.
- ↑ Arguisuelas MD, Lison JF, Domenech-Fernandez J, Martinez-Hurtado I, Coloma PS, Sanchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: randomized controlled trial. Clinical Biomechanics. 2019 Mar 1;63:27-33.
- ↑ 3StrongVideos. Function and Training of the Erector Spinae Muscles - Coach. Available from: http://www.youtube.com/watch?v=l9XwHX3ma5A [last accessed 26/03/14]
