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Erector Spinae Audio

Integrated functional anatomy of the iliocostalis, longissimus, and spinalis. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, and stretches for the lower back/erector spinae.

Erector Spinae

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

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I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

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Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes the anatomy and integrated function of the erector spinae muscles (a.k.a. low back, erectors, paraspinal muscles, or paraspinous muscles). The erector spinae is actually a skeletal muscle group, including the longissimus, spinalis, and iliocostalis, and each may have lumborum, thoracis, and cervicis regions. This muscle group is located on either side of the vertebral (spinal) column, with attachment points on the sacrum, spine, ribcage, and skull, although these muscles are relatively superficial, sections do lie deep to other muscle groups like the scapular retractors, or lower back structures like the thoracolumbar fascia. The erector spinae are composed primarily of type I muscle fibers. The erector spinae muscle crosses the joints of the spine (facet joints), are the primary extensors of the spine, may contribute to lateral flexion and rotation, as well as anterior tilting of the pelvis, and nutation of the sacroiliac joint. This course also describes the role of the erector spinae in facet joint arthrokinematics, fascial integration (with the thoracolumbar fascia), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the erector spinae muscle for detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. loss of extensibility (tight back/stiff back), lower back pain, chronic pain, lumbar muscle fatigue, and acute spinal column injuries including herniated nucleus pulposus and nerve root impingement), the synergistic function of the erector spinae (e.g. extension of the spine with the latissimus dorsi and lateral flexion of the spine with the external obliques, internal obliques, and QL), and erector spinae exercises and techniques for enhancing sports performance (e.g. ensuring ideal erector length for optimal low back and core stability, strength, and power).

Brookbush Institute’s most recommended techniques for the Erector Spinae (see videos below):

Thoracic Spine Release (Using a Foam Roller)

A cross-sectional view of the erector spinae complex

 Course Description: Erector Spinae

 late 14c., "upright, not bending," from Latin erectus "upright, elevated, lofty; eager, alert, aroused; resolute; arrogant," past participle of erigere "raise or set up," from e- "up, out of" + regere "to direct, keep straight, guide"

 c.1400, "backbone," later "thornlike part" (early 15c.), from Old French espine "thorn, prickle; backbone, spine" (12c., Modern French épine), from Latin spina "backbone," originally "thorn, prickle" (figuratively, in plural, "difficulties, perplexities"), from PIE*spe-ina-, from root *spei- "sharp point" (see 

 (n.1)). Meaning "the back of a book" is first attested 1922. (

 pelvic bone, 1706, Modern Latin, from Latin ilia (plural) "groin, flank, side of the body from the hips to the groin" (see 

). In Middle English it meant "lower part of the small intestine." Vesalius gave the name os ilium to the "bone of the flank." (

 "pertaining to the ribs," 1630s, from French costal (16c.), from Medieval Latin costalis, from costa "a rib" (see 

 "that extends considerably from end to end," Old English lang "long," from Proto-Germanic *langgaz (cognates: Old Frisian and Old Saxon lang, Old High German and German lang, Old Norse langr, Middle Dutch lanc, Dutch lang, Gothic laggs "long"). (

 Various sound changes and contractions led to various forms, including 

, as evidenced by irregular superlatives. (

 suffix forming adjectives from nouns or other adjectives, "of, like, related to, pertaining to," Middle English -al, -el, from French or directly from Latin -alis (

 "pertaining to or situated near the loins," 1650s, from Modern Latin lumbaris, from Latin lumbus "loin". (

 "chest of the body," late 14c., from Latin thorax "the breast, chest; breastplate," from Greek thorax (genitive thorakos) "breastplate, chest," of unknown origin. (

 early 15c., "ligament in the neck," from Latin cervix "the neck, nape of the neck," from PIE *kerw-o-, from root *ker- (1) "horn, head" (see 

 (n.)). Applied to various neck-like structures of the body, especially that of the uterus (by 1702), where it is shortened from medical Latin cervix uteri (17c.). Sometimes in medical writing 18c.-19c. cervix of the uterus to distinguish it from the neck sense. (

 early 13c., "of or pertaining to the head," from Old French capital, from Latin capitalis "of the head," hence "capital, chief, first," from caput (genitive capitis) "head" (see 

A posterior view of the erector spinae muscles, obliques, and quadratus lumborum

https://upload.wikimedia.org/wikipedia/commons/7/7a/LumbarTriangle.jpg

Attachments & Innervation: Erector Spinae

The origin and insertions locations on the inferior side of the skull

Where is the Erector Spinae Located

Palpating the Erector Spinae

Introduction to the Erector Spinae

Spine: Primary extensor, and may assist in ipsilateral flexion & ipsilateral rotation.

The longissimus capitis and spinalis capitis may also extend, ipsilaterally rotate, and cause ipsilateral flexion of the atlantooccipital joint.

The iliocostalis lumborum may also depress the ribs; increasing the volume of the intrathoracic cavity (8). The combined effect of the iliocostalis thoracis and iliocostalis cervicis is a little less clear and may actually serve to elevate the upper six ribs; this would be beneficial for increasing the total volume of the intrathoracic cavity and also help to explain why we extend our spine when taking a forceful deep breath.

Pelvis: Anterior pelvic tilt and ipsilateral elevation (3).

Sacrum: Nutation in conjunction with anterior rotation of the pelvis via the thoracolumbar fascia.

Cadaver dissection of the Iliocostalis

Cadaver dissection of Iliocostalis Image location - RVU Anatomy - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/db4round2_animated.gif

 Spine (from occiput to sacroiliac joint), ribs, and pelvis.

The erector spinae may act to stabilize the spine (often included in analysis of the muscles active during "bracing"), especially in the presence of considerable external load (15); however, segmental alignment and stabilization must be maintained by the deeper intrinsic stabilizers of the spine. That is to say that the erector spinae cannot maintain optimal alignment of the vertebral column without the transversospinalis muscles (multifidi, rotatores, semispinalis, intertransversarii, and interspinalis).

Spine: flexion, contralateral flexion & contralateral rotation

Pelvis: contralateral elevation and posterior tilting

Atlantooccipital joint: flexion, contralateral flexion & contralateral rotation

Note: The erector spinae may play their largest role in eccentrically decelerating forward flexion or "slumping". EMG studies show a linear increase in activity of the erector spinae from standing to 45º of forward bending, beyond that point EMG activity decreases as increased ligamentous tension unloads the erector spinae (8, 20).

Cervical Spine: Longissimus capitis and spinalis capitis contribute to extension of the upper cervical spine along with the semispinalis capitis, splenius capitis, suboccipitals, 

 (8). The synergists of ipsilateral flexion would be the same muscles; however, recruitment would be unilateral with the muscles on the same side. Rotation would also include the same muscles firing on the ipsilateral side, with the excepstion of the

, which performs rotation in the opposite direction, so the contralateral 

Extension of the Lumbar Spine and Anterior Tilting of the Pelvis: The 

 and psoas work synergistically with the erector spinae to increase the lumbar lordosis. In conjunction with the iliacus, and all hip flexors, these muscles may also act to anteriorly rotate the pelvis and nutate (flex) the sacrum.

Lateral Flexion of the Lumbar and Thoracic Spine: When the erector spinae fire unilaterally they may contribute to lateral flexion along with the 

, internal obliques, and quadratus lumborum (and potentially the 

Ipsilateral Rotation of the Lumbar Spine: When the erector spinae fire unilaterally they may contribute to ipsilateral rotation along with the contralateral 

, ipsilateral internal obliques and potentially the ipsilateral 

The erector spinae, as a "global muscle" of the core, may become synergistically dominant along with the 

. This is the common presentation when an individual adopts an anterior pelvic tilt or 

The facet joints and attachments of the spine

Arthrokinematics

Erector Muscle Actions

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 embedded 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 nature's “motherboard.” 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.

Image of the fascial system of the body connecting muscles

 This fascial structure may be one of the most complex structures of the human movement system. Studies have verified a rich presence of Pacini corpuscles (quick adapting receptors that respond to pressure and vibration), Paciniform corpuscles (like Pacini corpuscles but smaller), Golgi Tendon Organ (slower adapting receptors that respond to muscular contraction), and Interstitial Receptors (free nerve ending they may respond to tension, pressure, or pain). The thoracolumbar is invested by the erector spinae, quadratus lumborum, internal obliques, 

 and semitendinosus via the sacrotuberous ligament (3). The potential for synergies via facially mediated recruitment strategies, as well as the influence of these synergies on thoracolumbar stiffness and lumbar support has been a subject of continued study and debate (13 - 15, 17).

Layers of the thoracolumbar fascia

Layers of the Thoracolumbar Fascia - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 388, Public Domain, https://commons.wikimedia.org/w/index.php?curid=564147

The investment of the erector spinae in the deep layer of the thoracolumbar fascia that runs continuously with sacrotuberous ligament gives rise to the idea of a communicating synergy between the erector spinae and 

 under the heading "Subsystems above." It is interesting to note that this deep layer is also the only layer to extend to the thoracic spine (17).

The idea that the multifidus and erector spinae may have a "hydraulic effect"; increasing spine stiffness and resisting flexion moments by filling their respective fascial compartments during active contraction has been researched and no significant effect was observed (13).

 The spinalis capitis starts to blend and become less distinguishable from the deeper transversospinal muscles, and the longissimus becomes a deeper muscle inserting on the mastoid process beneath the sternocleidomastoid and splenius capitis. These muscles are enveloped by the prevertebral layer of the deep cervical fascia, along with all other extensors of the cervical spine except the upper 

. It is likely that movement of the head and neck result in changes in muscle activity of the spinalis and longissimus capitis and cervicis and affect the activity of the erector spinae several levels below the cervical spine, if not the entire length. A common compensation noted during lifting (for example a deadlift) is full extension of the cervical spine with a concurrent increase in lumbar extension. These may be evidence of reliance on a facially mediated synergy via the cervical extensors and deep layer of the thoracolumbar fascia (the 

), becoming dominant for an inhibited or weak gluteus maximus and reliance on larger movers associated with the superficial layer of the thoracolumbar fascia (the 

Dissection of the deep erectors in the cervical spine

Dissection of deep erectors in the cervical spine via RVU Anatomy - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/sot3_animated.gif

A picture of the deep longitudinal subsystem which includes the erector spinae complex

Subsystems

Fascial Integration

 by many clinicians, texts, and studies (2, 7, 8, 13-18). It should be mentioned that this may happen unilaterally, especially as a result of sacroiliac joint dysfunction or lumbar pathology. Among 283 patients with a diagnosis of chronic intractable benign lumbar pain, 96% had tender/trigger points in the lumbar erectors (18). We find altered length and activity of the erector spinae in 

The erector spinae is most often short and over-active in 

 which also has a propensity to become short/over-active, resulting in synergistic dominance of the global trunk musculature (

) and inhibition of intrinsic stabilizers (

). Further, changes in erector spinae activity may be due to an increased thoracic kyphosis in those with 

 (19, 21) and alterations in length tension.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, the erector spinae contribute to an increased lordosis and anterior pelvic tilt. Further, the erector spinae may contribute to dysfunction unilaterally resulting in a relatively anteriorly rotated pelvis and sacral nutation. These changes in lumbar spine, pelvic and sacral position are commonly associated with dysfunction of the lumbar spine, pelvis, and hips, and potentially pathology. Several studies have noted an increase in lumbar erector activity in those with low back pain (despite no change in cross-sectional area), in conjunction with multifidus atrophy (17, 22, 23).

 the erector spinae may become over-active as a result of 

 and/or over-activity of the erector spinae may contribute to 

 by altering sacroiliac joint arthrokinematics resulting in dyskinesis and initiating a compensation pattern that reduces 

 and medius activity, increased knee valgus and an increase 

The longissimus and spinalis capitis and cervicis may play a significant role in cervical dysfunction, contributing to an increase in the upper cervical spine extension, closure of the facet joints, a reduction in both passive and active rotation (often in both directions), a reduction in flexion, and a reduction in passive contralateral flexion. Resolution and normalization of erector spinae activity at the cervical spine may be dependent on not only release of the levator scapulae, but release of all associated structures, mobilization of stiff facets, optimization of cervical arthrokinematics, and postural re-education.

The Bridge: The erector spinae may serve as a "bridge" between the cervical spine and lumbopelvic-hip complex dysfunction. For example, if an individual adopts forward head posture, this may increase activity throughout the length of the erector spinae and lead to adaptive shortening over time. This increase in activity transmitted to proximal attachment may result in an increased lumbar lordosis and an anterior pelvic tilt. A biomechanical model of this relationship may also contribute to dysfunction as forward head translation is often compensated by an increase in lumbar extension to maintain an equilibrium of the spine and torso over the hips and pelvis. If the anterior pelvic tilt adopted in this compensation pattern persists, other muscles may be affected and dysfunction will continue to spread. This scenario may be reversed - altered pelvic position leading to a change in erector spinae activity and length and cervical spine dysfunction.

, the erector spinae has a propensity toward 

 for the erector spinae should be part of a human movement professional's repertoire. Further, mobilization for the lumbar, thoracic and cervical spine may aid in optimizing the length and activity of the erector spinae, and when applicable self-administered mobilizations should be included in a patient/clients program. Manual mobilizations should be part of the repertoire of any licensed professional (PT, ATC, DC, DO) treating pathologies relating to the spine.

Sternal costal joint dysfunction (the thoracic spine "drives" the ribs)

Signs of Altered Length/Tension and Tone:

: Short/Over-active on side of dysfunction

Note: Flexion tests would be ideal for testing the length of these muscles, but I find that goniometry with a traditional goniometer is so unreliable for the measurement of range of motion of the spine, it is essentially useless. Further, taping distance between the spinous processes does not accommodate different sized individuals. Bubble inclinometers offer far more reliability, but lack research validated norms.

"In the superficial (erector spinae) group, the iliocostalis thoracis and iliocostalis lumborum are most likely to develop active trigger points" (8).

Palpation results in tenderness (trigger points or tender points) and may result in radiating symptoms; however, erector spinae trigger points tend to be more focal with common sites being just lateral to the cervical-thoracic junction, mid-thoracic vertebrae, and lower lumbar/sacroiliac region.

Postural Dysfunction and the Erector Spinae

Thoracic Spine (Self-Administered) Release and Mobilization

Self-administered Thoracic Spine Mobilization: Rotation

Self-administered Thoracic Spine Mobilization: Posterior to Anterior with Extension

Latissimus Dorsi, Erector Spinae Static Stretch (Child's Pose)

Latissimus Dorsi Active Stretch (Child’s Pose)

Exercises and Techniques for the Erector Spinae 

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

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

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

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

Rosomoff, HL, Fishbain, DA, Goldberg, M, Santana, R, and Rosomoff, RS. Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain. 1989; 37: 279–287

Otoshi, K., Takegami, M., Sekiguchi, M., Onishi, Y., Yamazaki, S., Otani, K., Shishido, H., Shinichi, K., Shinichi, K. (2014). Association between kyphosis and subacromial impingement syndrome: LOHAS study. 

Harriss AB, Brown SHM. (2015). Effects of changes in muscle activation level and spine and hip posture on erector spinae fiber orientation. 

Park K, Oh J, An D, et al. (2015). Difference in selective muscle activity of thoracic erector spinae during prone trunk extension exercise in subjects with slouched thoracic posture. 

Gildea JE, Hides JA, Hodges PW. (2013). Size and symmetry of trunk muscles in ballet dancers with and without low back pain. 

Beneck GJ, Kulig K. Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. 

Bibliography

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Erector Spinae

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