Anatomy and Biomechanics of the Back Muscles in the Lumbar Spine With Reference to Biomechanical Modeling

Hansen, Lars; Zee, Mark de; Rasmussen, John; Andersen, Thomas Bull; Wong, Christian; Simonsen, Erik B.

doi:10.1097/01.brs.0000229232.66090.58

Cited by 184 publications

(154 citation statements)

References 99 publications

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“…Lieber (13) considers that the best information currently available on this issue derives from a study that showed that fast fibers generate just slightly more tension than slow fibers do (80) . As recently reviewed (79) , values for specific tension vary over a large range, between 22.5 N/cm 2 and 100 N/cm 2 . Unfortunately, comparison data for the specific tension of postural HRMT are not available.…”

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 92%

“…The lumbar multifidus is the largest and strongest of the low back paravertebral muscles that cross the lumbosacral level, but its exact morphology and role are complex and not fully determined (71)(72)(73)(74)(75) . Nevertheless, rather than its being a prime mover, the specialized multifidus, and especially its deep fibers, are largely credited with postural stabilization of the lumbar spine (40,61,(72)(73)(74)(75)(76)(77)(78)(79) .…”

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

“…Optimal function requires a balanced coordination of all core and peripheral muscle groups. The core muscles provide mainly segmental stability; the more peripheral muscles control mainly global movements and general stabilization of the trunk (61,79) . An insufficiency of one group, such as the core multifidus, places excessive demand on the peripheral muscles to provide chronic stabilization.…”

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

“…Posterior muscles that are more superficial, such as the iliocostalis, are more adapted to controlling mobility and large perturbations in posture. They are mainly phasic, type 2 ("fast-twitch") muscles designed for rapid motion rather than for chronic postural stabilization (79) . Their architecture and orientation are also biomechanically leveraged for global movements and dynamic positioning (67)(68)(69)(70) .…”

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

“…Early observational understandings lead to theories or models of processes, which then generate initial predictions and guide experimentation (114) . Quantitative simulations of theoretical models also contribute to more refined understandings of natural processes (79) .…”

Section: Scientific Understanding Of Natural Processesmentioning

confidence: 99%

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Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Masi

Nair²,

Evans³

et al. 2010

IJTMB

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Methods: Biomechanical, clinical, and physiological studies were reviewed to interpret the passive stiffness properties of HRMT that help to stabilize various relaxed functions such as quiet balanced standing. Biomechanical analyses and experimental studies of the lumbar multifidus were reviewed to interpret its passive stiffness properties. The lumbar multifidus was illustrated as the major core stabilizing muscle of the spine, serving an important passive biomechanical role in the body.Results: Research into muscle physiology suggests that passive resting tension (CNS-independent) is generated in sarcomeres by the molecular elasticity of low-level cycling cross-bridges between the actomyosin filaments. In turn, tension is complexly transmitted to intimately enveloping fascial matrix fibrils and other molecular elements in connective tissue, which, collectively, constitute the myofascial unit. Postural myofascial tonus varies with age and sex. Also, individuals in the population are proposed to vary in a polymorphism of postural HRMT. A few people are expected to have outlier degrees of innate postural hypotonicity or hypertonicity. Such biomechanical variations likely predispose to greater risk of related musculoskeletal disorders, a situation that deserves greater attention in clinical practice and research. Axial myofascial hypertonicity was hypothesized to predispose to ankylosing spondylitis. This often-progressive deforming condition of vertebrae and sacroiliac joints is characterized by stiffness features and particular localization of bony lesions at entheseal sites. Such unique features imply concentrations and transmissions of excessive force, leading to tissue micro-injury and maladaptive repair reactions.Conclusions: The HRMT model is now expanded and translated for clinical relevance to therapists. Its passive role in helping to maintain balanced postures is supported by biomechanical principles of myofascial elasticity, tension, stress, stiffness, and tensegrity. Further research is needed to determine the molecular basis of HRMT in sarcomeres, the transmission of tension by the enveloping fascial elements, and the means by which the myofascia helps to maintain efficient passive postural balance in the body. Significant deficiencies or excesses of postural HRMT may predispose to symptomatic or pathologic musculoskeletal disorders whose mechanisms are currently unexplained.

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Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 92%

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

Section: Scientific Understanding Of Natural Processesmentioning

confidence: 99%

See 3 more Smart Citations

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Masi

Nair²,

Evans³

et al. 2010

IJTMB

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Three‐dimensional study of the musculotendinous architecture of lumbar multifidus and its functional implications

2008

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Lumbar multifidus (LMT) is a key muscle, which provides stability to the lumbar spine, and has been shown to have altered neuromuscular recruitment following acute episodes of low back pain. Architectural parameters are important determinants of function, but have not been well documented for LMT. Therefore, the purpose of this study is to model and quantify the architecture of LMT throughout its volume. Nine male and one female formalin-embalmed cadaveric specimens (average age 80 +/- 11 years) without any evidence of spinal deformity/pathology were used. The musculotendinous components of LMT were serially dissected and digitized. Next, the data were imported into MAYA to create a three-dimensional model of each segment of LMT from which architectural parameters including fiber bundle length (FBL), fiber bundle angle (FBA), and tendon length were quantified. Water displacement was used to determine volume. The data were analyzed using paired t-tests and ANOVA followed by Tukey's post-hoc test (P

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Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

Lee,

Tseng,

Chang

et al. 2024

Cancer Medicine

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BackgroundPredictive analytics is gaining popularity as an aid to treatment planning for patients with bone metastases, whose expected survival should be considered. Decreased psoas muscle area (PMA), a morphometric indicator of suboptimal nutritional status, has been associated with mortality in various cancers, but never been integrated into current survival prediction algorithms (SPA) for patients with skeletal metastases. This study investigates whether decreased PMA predicts worse survival in patients with extremity metastases and whether incorporating PMA into three modern SPAs (PATHFx, SORG‐NG, and SORG‐MLA) improves their performance.MethodsOne hundred eighty‐five patients surgically treated for long‐bone metastases between 2014 and 2019 were divided into three PMA tertiles (small, medium, and large) based on their psoas size on CT. Kaplan–Meier, multivariable regression, and Cox proportional hazards analyses were employed to compare survival between tertiles and examine factors associated with mortality. Logistic regression analysis was used to assess whether incorporating adjusted PMA values enhanced the three SPAs' discriminatory abilities. The clinical utility of incorporating PMA into these SPAs was evaluated by decision curve analysis (DCA).ResultsPatients with small PMA had worse 90‐day and 1‐year survival after surgery (log‐rank test p < 0.001). Patients in the large PMA group had a higher chance of surviving 90 days (odds ratio, OR, 3.72, p = 0.02) and 1 year than those in the small PMA group (OR 3.28, p = 0.004). All three SPAs had increased AUC after incorporation of adjusted PMA. DCA indicated increased net benefits at threshold probabilities >0.5 after the addition of adjusted PMA to these SPAs.ConclusionsDecreased PMA on CT is associated with worse survival in surgically treated patients with extremity metastases, even after controlling for three contemporary SPAs. Physicians should consider the additional prognostic value of PMA on survival in patients undergoing consideration for operative management due to extremity metastases.

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Anatomy and Biomechanics of the Back Muscles in the Lumbar Spine With Reference to Biomechanical Modeling

Cited by 184 publications

References 99 publications

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Three‐dimensional study of the musculotendinous architecture of lumbar multifidus and its functional implications

Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

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