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Reflex Control of Human Trunk Muscles

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Reflex Control of Human Trunk Muscles REFLEX CONTROL OF HUMAN TRUNK MUSCLES Iain David Beith A thesis submitted to the University of London for the degree of Doctor of Philosophy Department of Physiology University College London ProQuest Number: 10014995 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10014995 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT Muscles of the human trunk are arranged in layers and attach either to the vertebral column or to the pelvis and thorax. Present understanding suggests the deeper muscles, attached to the vertebral column, stabilise the spine, whereas the more superficial muscles, attached to the thorax and pelvis, produce and control trunk movement. If so, the control of these two groups may differ, with deeper muscles working synergistically and those more superficially located acting antagonistically to one another. To this end the role that reflex connections between the different muscles may play in mediating either synergistic or antagonistic roles was investigated. Muscle afferent activity was evoked via a series of mechanical taps applied to individual muscle/tendon complexes of three abdominal and two paraspinal muscles by means of a mechanical tapping device. The resultant reflex responses were recorded by surface electromyography in the same five muscles, both ipsilateral and contralateral to the applied tap. This allowed analysis of the effect of muscle afferents from any one muscle to all the others. Short latency, (less than 25ms) heteronymous muscle afferent connections are excitatory and widespread between the abdominal muscles. They are also excitatory between ipsilateral paraspinal muscles, but inhibitory between these muscles contralaterally. Reflexes are mostly absent between abdominal and paraspinal muscles. Specifically, connections both to and from the internal oblique muscle (10), the deepest abdominal muscle studied, were the most widespread and potent, with the connection from one 10 to the other being of similar amplitude and minimal difference in latency. It is suggested that at least the earliest part of the short latency excitatory crossed reflexes observed here, are monosynaptically mediated. In addition, there is evidence of asymmetry in the presence and strength of these reflexes between the left and right sides. Longer latency reflexes with latencies of between 40 and 50ms were also observed between all muscle groups studied. These were excitatory within the abdominal and paraspinal groups, but inhibitory between them. However, whether these originate from muscle or cutaneous afferents is unclear. ACKNOWLEDGEMENTS I wish to thank Dr Philip Harrison for supervising me throughout this process and for initially highlighting the need to study the reflex control of trunk muscles. It has been good to observe at such close hand and learn the process of scientific investigation, from one so able. I also thank Professor John Stephens for being there when I needed him as my second supervisor. These acknowledgements would not be complete without reference to Caroline Alexander my fellow PhD student. Working together in the same research group has inevitably provided peer support, and that has been invaluable and good fun. Many others have also supported me through this process. At King College London my enduring thanks to go to Professor Di Newham for being there and believing I could do this, to Peter Milligan for patience and to Bob Roberts, for patience and technical support. Numerous colleagues have also been there. This has been most obvious in the coffee room with Claire White, Duncan Critchley, Heather Holder Powell, and Joan McMeeken. In addition Phil, Caroline and Matt Morrisey read and commented on full version of the thesis, God Bless you all. Other colleagues who have listened patiently include Mike Hurley, Olga Rutherford, and Sheila Kitchen among many. I would also like to acknowledge the help and support of Mr John O’Dowd in gaining the financial support of the Arthritis Research Campaign. Many people outside the academic environment including my family and my in-laws have also listened with great patience especially in the last six months when I really have had nothing to else to talk about but trunk muscle reflexes. Maybe those who I have not been able to keep up with regularly haven’t missed much. However, there is one person who has endured more than any other, probably more than I will ever know, and that is my wife Avril. Words cannot express my appreciation. Thank you. Postscript The viva voce to examine this thesis was held on 20* June 2002. On that day my father was admitted to hospital, and when I saw him there that evening he was very proud to be told I had passed (pending minor corrections). He died five weeks later. I learned on 6* August 2002 that the minor corrections to the thesis had been accepted. Ironically, that was the day of his funeral. I would like to dedicate this thesis to the memory of my dad who was always interested in how it was going. STATEMENT REGARDING THE AUTHORS INVOLVEMENT IN THIS WORK All the work in this thesis has been undertaken solely by Iain Beith, except the investigation into the reflex control of the of the ipsilateral and contralateral rectus abdominis muscles, including the use of vibration. This work was initially undertaken with Stelios Myriknas who then submitted this as project work, in partial fulfilment of the MSc in Neuroscience at University College London. The investigation of the reflex control between the RA muscles has subsequently been extended by me, Iain Beith. GLOSSARY OF TERMS RA - rectus abdominis EO - external oblique 10 - internal oblique TrA - transversus abdominis IC - iliocostalis lumborum LM - lumbar multifidus ES - erector spinae EMG - electromyography ASIS - anterior superior iliac spine PSIS - posterior superior iliac spine NZ - neutral zone EZ - elastic zone Homologous - left and right pairs of trunk muscles i.e. left and right EO i* - ipsilateral cr* - contralateral TABLE OF CONTENTS ABSTRACT....................................................................................................................2 ACKNOWLEDGEMENTS...........................................................................................3 STATEMENT OF AUTHORSHIP...............................................................................4 GLOSSARY OF TERMS..............................................................................................5 1 INTRODUCTION.................................................................................... 25 1.1 Introduction to the study. ....................................................................................25 1.2 Stability o f the lumbar spine ............................................................................... 26 1.3 Classifying trunk muscles by position .................................................................21 1.4 Abdominal muscle anatomy andfunction ........................................................... 31 1.4.1 Rectus abdominis ........................................................................................31 1.4.2 External oblique ..........................................................................................32 1.4.3 Internal oblique ...........................................................................................32 1.4.4 Transversus abdominis ...............................................................................34 1.4.5 Attachment of the abdominal muscles posteriorly .....................................35 1.4.6 Attachments of the anterolateral abdominal wall muscles anteriorly 36 1.4.7 Innervation of the abdominal muscles ....................................................... 38 1.4.8 Location of the motoneurone pools of the abdominal muscles ................. 38 1.4.9 Muscle fibre type of the abdominal muscles .............................................. 39 1.5 The functions of the abdominal muscles. ............................................................40 1.5.1 Co-activation of the left and right abdominal muscles ...............................40 1.5.2 Abdominal muscle activity in response to a perturbation .......................... 41 1.6 Paraspinal muscle anatomy and function ........................................................... 43 1.6.1 Iliocostalis lumborum .................................................................................43 1.6.2 Lumbar multifidus ......................................................................................43 1.6.3 Innervation of the IC and LM muscles .......................................................45 1.6.4 Location of the motoneurone pools of the paraspinal muscles .................. 46 1.6.5 Fibre typing of the paraspinal muscles .......................................................46 1.6.6 Functions of the paraspinal muscles ...........................................................47 1.6.7 Responses of the paraspinal muscles to perturbations ................................49
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