Architectural Design and Function of Human Back Muscles I C H A3 P T E R Anita Vasavada, Phd Samuel R
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SECTION Architectural Design and Function of Human Back Muscles I C H A3 P T E R Anita Vasavada, PhD Samuel R. Ward, PT, PhD Scott Delp, PhD Richard L. Lieber, PhD Spinal muscles generate movements of the spine and provide Muscle Architecture the stability needed to protect vital anatomic structures. Muscles must work in coordination with the rest of the neu- Skeletal muscle is highly organized at the microscopic level, as romusculoskeletal system (i.e., vertebrae, tendons, ligaments, evidenced by classic studies that have elucidated the properties and the nervous system) to provide these functions. Large of skeletal muscle fibers. With few exceptions, the arrange- movements of the head require appropriate muscle strength, ment of muscle fibers within and between muscles has received vertebral geometry (e.g., facet joint orientation), ligament much less attention. The microscopic arrangement of muscle compliance, and neural control. The spinal muscles have been fibers relative to the axis of force generation is known as the described as one of three subsystems (the others are the architecture of a muscle.2 Although muscle fiber size (which passive spinal column and neural control) that must work is directly proportional to force generation) is relatively con- together to stabilize the spine.1 sistent among muscles of different sizes, architectural differ- Dysfunction of the spinal musculature is hypothesized ences between muscles show much more variability and more to cause various pathologic conditions, such as segmental strongly affect function. Muscle architecture is a primary instability, low back or neck pain, and degenerative disc determinant of muscle function, and understanding this syndromes. The mechanisms that relate muscle function (or structure-function relationship has great practical impor- dysfunction) to pathologic processes are unclear, however. tance. This understanding not only clarifies the physiologic Some of the factors that lead to pathologic processes may basis for production of force and movement but also provides be elucidated by biomechanical analyses of spine kinematics a scientific rationale for surgery. Muscle architectural studies along with the associated tissue strains and loads. These also provide guidelines for electrode placement during analyses rely on accurate knowledge of muscle forces, moment electromyographic measures of muscle activity, explain the arms, and activation patterns to calculate loads and displace- mechanical basis of muscle injury during movement, and aid ments, but such values are frequently unavailable for spinal in the interpretation of histologic specimens obtained from muscles. Often, spinal muscles are ignored or overly simplified muscle biopsies. (e.g., modeled as one “lumped” muscle) because the anatomy of these muscles is considered too complex to represent Basic Architectural Definitions realistically. The complex anatomy and architecture of spinal muscles profoundly influence their function, however, The various types of architectural arrangement are as numer- and analyses that incorporate these details are required ous as the muscles themselves. For discussion purposes, we to provide the information necessary to predict more describe three general classes of muscle fiber architecture. accurately the role of the muscles in spinal function and Muscles composed of fibers that extend parallel to the force- dysfunction. generating axis of the muscle are described as having a parallel This chapter begins with a description of the important and or longitudinal architecture (Fig. 3–1A). Muscles with fibers often neglected principles of skeletal muscle architecture and that are oriented at a single angle relative to the force- the way in which architecture determines muscle function. generating axis are described as having unipennate architec- Specific information about the anatomy and architecture of ture (Fig. 3–1B). The angle between the fiber and the the spinal musculature is provided when such information is force-generating axis has been measured at resting length in available. The chapter concludes with a presentation of the mammalian muscles over different designs and varies from implications of spinal muscle anatomy and architecture for about 0 to 30 degrees. Most muscles fall into the third motor control and injury. and most general category, multipennate muscles—muscles En 57 Herkowitz_Chapter 3_main.indd 57 6/4/2010 2:39:08 PM 58 BASIC SCIENCE Gluteus medius Vastus lateralis ML FL Biceps muscle FL ML ML = FL A B C FIGURE 3–1 Artist’s conception of three general types of skeletal muscle architecture. A, Longitudinal architecture, in which muscle fibers run parallel to the force-generating axis of the muscle. In this case, the natural example is the biceps brachii. B, Unipennate architecture, in which muscle fibers run at a fixed angle relative to the force-generating axis of the muscle. Here the example is the vastus lateralis muscle. C, Multipennate architecture, in which muscle fibers run at several angles relative to the force-generating axis of the muscle. The example here is the gluteus medius muscle. FL, fiber length; ML, muscle length. constructed of fibers that are oriented at several angles relative Pennation angle (θ) is measured by determining the average to the axis of force generation (Fig. 3–1C). angle of the fibers relative to the axis of force generation of the These three designations are oversimplified, but they muscle. Usually only the pennation angle of fibers on the provide a vocabulary with which to describe muscle designs. superficial muscle surface is measured; however, this is only Because fibers may not be oriented along any of the classic an estimate because pennation angles may vary from superfi- anatomic axes, determination of muscle architecture is impos- cial to deep and from proximal to distal. This superficial to sible from a single biopsy specimen or images obtained by deep variation in pennation has been documented in several magnetic resonance imaging (MRI), computed tomography spinal muscles (see later). Although more sophisticated (CT), or ultrasonography because these methods cannot methods could be developed for measurement of pennation account for variations in fiber length and orientation changes angle, it is doubtful they would provide a great deal more that occur along the muscle length. Other methods have been insight into muscle function because variations in pennation developed to characterize the architectural properties of skel- angle may not strongly affect function.2 etal muscle. Muscle length is defined as “the distance from the origin of the most proximal muscle fibers to the insertion of the most 4 Experimental Determination of Skeletal distal fibers.” Fiber length represents the number of sarco- Muscle Architecture meres in series, and experimental evidence suggests that muscle fiber length is proportional to fiber contraction veloc- Quantitative studies of muscle architecture were pioneered by ity.3,5 Muscle length and fiber length are not the same because Gans and colleagues,2,3 who developed precise methodology there is a variable degree of “stagger” seen in muscle fibers as for defining muscle architecture based on microdissection of they arise from and insert onto tendon plates (see Fig. 3–1B). whole muscles. The parameters usually included in an archi- Muscle fiber length can be determined only by microdissec- tecture analysis are muscle length, fiber or fascicle length, tion of individual fibers from fixed tissues or by laborious pennation angle (i.e., the fiber angle relative to the force- identification of fibers by glycogen depletion on serial sections generating axis), and physiologic cross-sectional area (PCSA). along the length of the muscle.6 Unless investigators are Typically, muscles are chemically fixed in formalin to maintain explicit when they refer to muscle fiber length, they are prob- fiber integrity during dissection. The muscles should be chem- ably referring to muscle fiber bundle length (also known as ically fixed while attached to the skeleton to preserve their fascicle length) because it is extremely difficult to isolate intact physiologic length, or physiologic length in the skeleton fibers, which run from origin to insertion, especially in mam- should be noted. After fixation, muscles are dissected from the malian tissue.6,7 skeleton, their mass is determined, and their pennation angle Experimental studies of mammalian muscle suggest that En and muscle length are measured. individual muscle fibers do not extend the entire muscle Herkowitz_Chapter 3_main.indd 58 6/4/2010 2:39:10 PM 3 Architectural Design and Function of Human Back Muscles 59 length and may not even extend the entire length of a fasci- force relative to a muscle with the same mass and fiber length SECTION cle.6,7 Detailed studies of individual muscle fiber length have but with a 0-degree pennation angle. not been conducted in human spinal muscles, but studies in feline neck muscles illustrate that muscle fibers are often Mechanical Properties of Muscles with arranged in series, ending in tendinous inscriptions within the Different Architectures muscle or terminating intrafascicularly.8,9 Although the terms fiber length and fascicle length are often used interchangeably, As stated earlier, muscle force is proportional to PCSA, and technically they are identical only if muscle fibers span the muscle velocity is proportional to fiber length. By stating that I entire length of a fascicle. In muscle architecture