Rotatores, Interspinales and Intertransversarii

Human Movement Science & Functional Anatomy of the:

Rotatores, Interspinales and Intertransversarii

by Brent Brookbush MS, PES, CES, CSCS, ACSM H/FS

Rotatores, Interspinales and Intertransversarii – http://o.quizlet.com/online-courses/online-courses/i/NDaCQd2yIly10Kw7L3aOHQ.jpg

Rotatores

• Origin: Transverse processes of vertebrae at all levels (3)
• Insertion: Base of the spinous process and adjacent lamenae. The fibers spanning one segment may be referred to as short rotatores or rotatores brevis. The fibers spanning 2 segments may be referred to as long rotatores or rotatores longus (3).
  • The rotatores are deep to the multifidus ; lying between and adjacent (lateral) to vertebral facets. (The multifidus fill the vertebral arch between spinous and transverse process, lying on top (posterior) the facet joints.) The rotatores muscles are enveloped by the deepest and most medial layer of spinal fascia that extends from spinous process to transverse process in cross section. The multifidus and interspinales are also enclosed within this compartment.
    • It is unlikely that the rotatores can be deferentially palpated. However, when a "nodule" is palpated in the trough between spinous and transverse process, adjacent to a dysfunctional spinal segment, it may be over-activity and increased tissue density (trigger or tender points) within fascicles of the rotatores and multifidus.
• Nerve: Segmentally innervated by dorsal rami of adjacent spinal nerves (3).
• Action:
  • Extension, ipsilateral flexion, and contralateral rotation (although the cross-sectional area, small moment arm, and length imply little if any contribution to motion.)
  • Segmental (vertebrae on vertebrae) stabilization.
  • Based on a study by Nitz and Peck (15), these muscles exhibit 4.5 to 7.3 times the muscle spindle density of the multifidus, implying greater contribution to position sense, proprioception, and a role in reflexive facilitation, and/or inhibition of larger and more superficial spinal and trunk musculature (13, 15).

Interspinales

• Origin: These muscles extend between adjacent spinous processes in the cervical spine (below C2), often the extreme upper and lower regions of the thoracic spine, and the lumbar spine. Note these muscles are not present between mid-thoracic segments.
  • The interspinales are embedded in a complex fascial network that includes the supraspinous ligament, interspinous ligament, the ligamentum nuchae in the cervical spine, and encased within the same fascial envelope that surrounds the multifidus and rotatores. It is not possible to palpate this musculature, and their position and surrounding fascial network has posed a challenge to safe, effective and consistent EMG analysis.
• Nerve: Segmentally innervated by dorsal rami of adjacent spinal nerves
• Action:
  • Extension (although the cross-sectional area, small moment arm, and length imply little if any contribution to motion.)
  • Segmental (vertebrae on vertebrae) stabilization.
  • It has been proposed by McGill that these muscles may serve a similar role to the rotatores in position sense, proprioception and reflexive facilitation.

Cross section of cervical spine - http://d3j7fudf8o8iuo.cloudfront.net/var/ezwebin_site/storage/images/media/images/e-anatomy/rachis-anatomy-illustrations/cross-section-anatomy-neck-cervical-vertebra/2334804-1-fre-FR/cross-section-anatomy-neck-cervical-vertebra_medical512.jpg

Intertransversarii (Intertransversarius)

• Origin and Insertion: These muscles extend between adjacent transverse processes in the cervical spine, lower thoracic spine, and all lumbar vertebrae. The cervical region is subdivided between anterior and posterior muscles; indicating their position relative to the anterior and posterior tubercles of the transverse process. In the lumbar spine the muscles are divided into small lateral and medial muscles relative to their position on the transverse process.
  • The intertransversarii are deep musculature. In the lumbar spine the are enveloped by the deepest layers of the thoracolumbar fascia and adjacent the intertransverse ligaments, bordered by the psoas anteriorly and longissimus posteriorly. (See cross section of lumbar spine depicted below) In the cervical spine these muscles are enveloped by deep cervical fascia (pretracheal layer anteriorly), adjacent the intertransverse ligament and bordered by the longissimus capitis posteriorly and scalenes anteriorly. It is not possible to palpate this musculature, and their position and surrounding fascial network has posed a challenge to safe, effective and consistent EMG analysis.
• Nerve: The anterior and posterior segments in the cervical spine, and lateral segments in the lumbar spine are segmentally innervated by ventral rami of adjacent spinal nerves. The medial intertransversarii from L1 - L5 are segmentally innervated by dorsal rami of the adjacent spinal nerve (3).
• Action:
  • Lateral flexion (although the cross-sectional area, small moment arm, and length imply little if any contribution to motion.)
  • Segmental (vertebrae on vertebrae) stabilization.
  • Based on the study mentioned above, the deep position of this muscle, innervation by dorsal and ventral rami, and the relative size of this muscle - it would seem that these muscles function much like the rotatores and interspinales as force and length transducers.

Note the anterior and posterior tubercles of the transverse process; the attachments of the intertransversarii muscles. Grey's Anatomy - 20th Edition: http://intranet.tdmu.edu.ua/data/kafedra/internal/anatomy/classes_stud/en/stomat/ptn/1/02%20General%20structure%20of%20vertebra..files/image005.gif

Integrated Function:

• Stabilization:
  • The rotatores, interspinales and intertransversarii may contribute to intersegmental stabilization, although the force they are capable of producing is relatively small when compared to the multifidus and larger paraspinal musculature (for example, the erector spinae ).
  • It is more likely that their role in spinal stabilization is related to a high density of muscle spindles paired with receptor activation within the facet joint capsules (ruffini endings and pancini corpuscles) resulting in reflex arcs that facilitate or inhibit paraspinal and global core musculature, specifically the multifidus , transverse abdominis , internal obliques , and potentially the diaphragm and pelvic floor. In essence, these muscles play a role in signaling optimal recruitment of larger core muscles more capable of producing the force necessary to stabilize the spine (13, 14, 15). It would not surprise me if these muscles also played a similar role in the cervical spine by affecting deep cervical flexor and splenius muscle activity.
• Eccentrically Decelerates:
  • Rotatores eccentrically decelerates flexion, ipsilateral rotation and contralateral flexion
  • The interspinales eccentrically decelerate flexion
  • The intertransversarii eccentrically decelerate contralateral flexion
  • All of these muscles likely play a larger role in eccentrically decelerating spinal accessory motions, namely anterior translation, superior glide, and distraction (note: this means that contralateral musculature may eccentrically decelerate compression, posterior translation, and inferior glide of facets joints on the opposite side).
• Synergists:
  • As these muscles are extensors it is tempting to consider them synergists of the multifidus , erector spinae and latissimus dorsi.  We could even consider the intertransversarii as a synergist of the quadratus lumborum  in lateral flexion; however, this does not seem congruent with the function of this musculature proposed above. It may be helpful to note these relationships in terms of length/tension and relative length change in the assessment of posture, but it has been proposed by McGill that this musculature is actually more active eccentrically (15). For example, an excessive lordosis would result in adaptive shortening of the larger extensors of the lumbar spine, namely the erector spinae, latissimus dorsi, and multifidus, as well as, these deep muscles; the rotatores, intertansversarii and interspinales. However, the deeper muscles are more active during spinal flexion.
  • The transversospinalis, intertransversarii, and interspinalis muscles act synergistically with the multifidus as segmental stabilizers.
  • It is my assertion that the most pertinent synergistic relationship between the rotatores, intertransversarii, interspinales and other musculature, is acting synergistically as a sensory organ of the Intrinsic Stabilization Subsystem (ISS) . That is to say that these muscles function as force transducers and joint position receptors to signal optimal motor unit recruitment of the transverse abdominis , multifidus , internal obliques , pelvic floor and diaphragm.

Cadaver Dissection - Multifidus - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/db8_animated.gif

Subsystems

• Studies show synergistic recruitment of the lumbar multifidus with activation of the transverse abdominis  ("drawing in"). Further, similar recruitment strategies relative to load have been noted in the pelvic floor and diaphragm (13). The synergistic recruitment of these muscles increases intra-abdominal pressure, tension in the thoracolumbar fascia, segmental rigidity between vertebrae, sacroiliac joint stiffness, and improves segmental alignment (13). It is believed that the optimal function of these muscles is part of a feed forward mechanism that enhances the stability of the spine, including - increased efficiency of force generated by global stabilizers to resist external loads. This muscular synergy is often referred to as the "intrinsic" or "local" stabilizers, and is discussed further in the "Core Subsystem " articles under "Intrinsic Stabilization Subsystem ". In my analysis, the rotatores, interspinalis and intertransversarii (deep muscles of the spine) should also be included in this subsystem. As mentioned above, research has shown greater receptor density in the rotatores (muscle spindles), implying that they may act as "proprioceptive organs" to monitor intervertebral alignment (the intertransversarii and interspinales playing a similar role)(15). As the multifidus are ideal for altering intervertebral alignment due to their larger size and segmental innervation, it seems likely that the intertransversarii, interspinales and rotatores, acting as "proprioceptive organs" may be intimately tied via reflex arc these larger segmental stabilizers, playing a role in multifidus muscle activity and resting tone (13). If this is true, then any length change in the interspinales, intertransversarii and rotatores, would result in synergistic recruitment of the multifidus, and further the transverse abdominis, pelvic floor and diaphragm. In essence, these muscles may be the trigger that fires the feed forward mechanism that is the intrinsic stabilization subsystem.

Note the location of the intertransversarii and interspinalis in the lumbar spine and the relatively small cross-sectional area - http://classconnection.s3.amazonaws.com/694/flashcards/597694/png/multifidus_cross-section1310444956368.png

Arthrokinematics:

• The deep position of these muscles, spanning a signal segment, imply that these muscles may play an important role in accessory motion of the spine and zygapophyseal joint. The combined force of this musculature would impart compression and posterior shear. Ipsilaterally these muscles may contribute to posterior glide, compression and contralateral rotation. This position relative to intervertebral dysfunction and stiffness is often given the title "stuck closed". However, this combined motion would also result in the opposing actions on the contralateral side (superior glide, distraction and ipsilateral rotation), a position often termed "stuck open." It may be that the relative length (adaptive shortening) and activity (tonicity) of these muscles are primary contributors to joint position and relative stiffness, and that these muscles are the structures most affected by joint mobilization. It is worth considering this idea relative to what protocols have proven most effective for changes in muscle length - example, if statically stretching (static holds for greater than 30 seconds) muscles has proven most effective for increasing muscle length, should we use sustained holds to improve accessory motion? - Or, is the effectiveness of oscillation similar to the adaptation we see in active stretching? The eccentric function of these muscle may be essential to optimal alignment of facets, vertebral bodies and disks. Their position close to the axis of rotation of each vertebrae and between processes may imply a role essential to preventing excessive anterior translation and superior glide that would result in damage to the facet joint capsules and the annulus of intervertebral discs. As each segmentally innervated group of fascicles may function independently to adjust the position of individual vertebrae moment to moment and maintain the axis of rotation about the intervertebral disks these muscles may play a role in fine-tuning vertebral motion, for example, the normal top down anterior glide of each segment, one vertebrae at a time, during spinal flexion. At the risk of sounding redundant, this may be accomplished via their role as force and length transducers affecting multifidus muscle activity to impart the forces that alter arthrokinematics.

Note the combined action of extension, ipsilateral flexion and contralateral rotation caused by the multifidus and rotatores. Consider how this would close facet joints and maximally reduce vertebral foramen (although ipsilateral rotation would maximally close facets) - http://www.massagetoday.com/content/images/dalton032_2145_1_2_8144.jpg

Fascial Integration:

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force, but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors imbedded in the connective tissue and the attached musculature. In this way my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as natures "mother board." A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Fascial Integration of the Multifidus:

• I could find no evidence of a fascial link between the intertransversarii, interspinales, and rotatores, a fascial link between anyone of these muscles and other paraspinal muscles, or a link between these muscles and fascial sheaths. It would seem likely that the intertransversarii and interspinales blend with the interspinous ligaments and intertransverse ligament, but again I could not find a specific reference. If this "blending" occurs it may make for an interesting study regarding receptor activity, as muscle and ligament generally are embedded by different receptor types, that may result in opposing activity of surrounding musculature.
• The idea has been proposed that the erector spinae may have a "hydraulic effect" (note that the multifidus, rotatores and interspinales exist in the same facial compartment); increasing spine stiffness and resisting flexion moments. In essence, filling their respective fascial compartments during active contraction like an air splint. However, the idea has been researched and no significant affect was observed (13).

Ligaments of the Spine – http://www.spineuniverse.com/online-courses/online-courses/sites/default/files/legacy-images/ligaments300x302-BB.jpg

Behavior in Postural Dysfunction:

Like the multifidus these muscle may be prone to adaptive shortening and over-activity, or asymmetrical under-activity and atrophy.

Like the multifidus, the intertransversarii, interspinales, and rotatores are prone to over-activity and adaptive shortening, although chronic and/or traumatic pathology of the low back may result in under-activity, adaptive lengthening, and atrophy. This atrophy is most often seen as a chronic maladaptation to low back pathology and is generally asymmetrical (although it is hard to determine from research whether the contralateral side is hypertrophied, overactive, and relatively short) (13, 15). From the perspective of exercise intervention these muscles are not specifically addressed, but are affected by "intrinsic stabilization subsystem " integration.

These muscles may play a significant role in manual therapy of the spine and may be addressed specifically, or at least in conjunction with the multifidus. As mentioned above the increased tissue density that is often felt as a "nodule" adjacent to the spinous process in a dysfunctional spinal segment may be hypercontractility (trigger points or tender points) of the multifidus and rotatores. Manual release of these "nodules" is a common practice that may be recommended before mobilization. Further, it may be that mobilization of the spine is effective because it affects the relative length and activity of this musculature.

In Upper Body Dysfunction (UBD) these muscles may be short and over-active in the cervical spine, and may be over-active with little or no change in length in the lumbar spine, becoming synergistically dominant with the extensors and global stabilizers of the lumbar spine in the presence of an under-active/inhibited Intrinsic Stabilization Subsystem (ISS) . However, the lumbar segments of these muscles would rarely play any significant role in upper body dysfunction.

In Lower Leg Dysfunction (LLD)  the rotatores, intertransversarii and interspinales rarely play a key role. However, adaptive shortening, may occur when paired with synergistic dominance of the erector spinae and the Deep Longitudinal Subsystem (DLS) .

In Lumbo Pelvic Hip Complex Dysfunction (LPHCD) the lumbar segments are most often short/over-active along with the extensors of the lumbar spine. In Sacroiliac Joint Dysfunction (SIJD)  it is common to see the asymmetrical changes in activity discussed above, resulting in an over-active and hypertrophied side and a presumably atrophied side. In this case, manual release of over-active fascicles and joint mobilization for restricted motions should be paired with exercise that challenges the Intrinsic Stabilization Subsystem to stabilize the lumbar spine and resist rotation to the ipsilateral side (rotation of the superior vertebrae).

In short, these muscles are not often addressed unless a licensed professional is specifically treating spinal segments with manual techniques. Rather they are integrated with Intrinsic Stabilization Subsystem exercises (See Below), and core work.

Although trigger point release and stretching may be indicated (for short/over-active muscles), the rotatores and multifidus can only be released manually and the most appropriate lengthening techniques for affecting changes in length would be joint mobilizations directed at increasing accessory motion.

Clinical Implications:

• Cervical dysfunction and neck pain
• Cervical thoracic junction pain
• Scapulothoracic pain
• Lumbar spine pain
• Sacroiliac joint pain and dysfunction
• Hip hike
• Lateral shift of lumbar spine

Signs of Altered Length/Tension and Tone:

• Overhead Squat:
  • Forward Head: Short/Over-active
  • Anterior Pelvic Tilt: Short/Over-active
  • Asymmetrical Weight Shift: Short/Over-active on side of dysfunction
• Goniometric Assessment
• Decreased Spine Contralateral flexion
• Decreased Spine Flexion
• Decreased Spine Rotation
• Palpation of the Rotatores (and Multifidus):
• See image below for common trigger point locations and referral pain pattern for active trigger points.

Multifidus Trigger Points - http://www.triggerpoints.net/sites/default/files/Multifidi,%20Rotatores.png

Exercises involving the Rotatores, Interspinales and Intertransversarii:

Active Stretch and Spine Mobilization:

Intrinsic Stabilization Subsystem Activation:

TVA Isolated Activation

Intrinsic Stabilization and Gluteus Maximus Activation Progression:

Hardest Quadruped Progression Ever:

Bibliography:

1. Phillip Page, Clare Frank , Robert Lardner , Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
2. Dr. Mike Clark & Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams & Wilkins
3. Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc.
4. Michael A. Clark, Scott C. Lucett, NASM Essentials of Personal Training: 4th Edition, © 2011 Lippincott Williams and Wilkins
5. Leon Chaitow, Muscle Energy Techniques: Third Edition, © Elsevier 2007
6. Tom Myers, Anatomy Trains: Second Edition. © Elsevier Limited 2009
7. Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, © 2002 Mosby Inc.
8. David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens
9. Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company
10. Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition © 2011 F.A. Davis Company
11. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani_, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins_
12. Andrew Biel, Trail Guide to the Human Body: 4th Edition, © 2010
13. Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization - A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004
14. Craig Liebenson, Rehabilitation of the Spine: A Practitioner's Manual, (c) 2007 Lippincott Williams & Wilkins
15. Stuart McGill, Low Back Disorders: Second Ediction © 2007 Stuart M. McGill

© 2013 Brent Brookbush

Questions, comments, and criticisms are welcome and encouraged.