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Andry Vleeming - One of the best experts on this subject based on the ideXlab platform.
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the thoracolumbar fascia anatomy function and clinical considerations
Journal of Anatomy, 2012Co-Authors: F H Willard, Andry Vleeming, Mark D Schuenke, Lieven Danneels, Robert SchleipAbstract:In this overview, new and existent material on the organization and composition of the thoracolumbar fascia (TLF) will be evaluated in respect to its anatomy, innervation biomechanics and clinical relevance. The integration of the passive connective tissues of the TLF and active muscular structures surrounding this structure are discussed, and the relevance of their mutual interactions in relation to low back and pelvic pain reviewed. The TLF is a girdling structure consisting of several aponeurotic and fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a ‘hydraulic amplifier’, assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interfascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myofascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. At the base of the lumbar spine all of the layers of the TLF fuse together into a thick composite that attaches firmly to the posterior superior iliac spine and the Sacrotuberous Ligament. This thoracolumbar composite (TLC) is in a position to assist in maintaining the integrity of the lower lumbar spine and the sacroiliac joint. The three-dimensional structure of the TLF and its caudally positioned composite will be analyzed in light of recent studies concerning the cellular organization of fascia, as well as its innervation. Finally, the concept of a TLC will be used to reassess biomechanical models of lumbopelvic stability, static posture and movement.
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The function of the long dorsal sacroiliac Ligament ; Its implication for understanding low back pain
Spine, 1996Co-Authors: Andry Vleeming, Chris J Snijders, Rob Stoeckart, Annelies Pool-goudzwaard, Dilara Hammudoghlu, Jan MensAbstract:STUDY DESIGN: In embalmed human bodies the tension of the long dorsal sacroiliac Ligament was measured during incremental loading of anatomical structures that are biomechanically relevant. OBJECTIVES: To assess the function of the long dorsal sacroiliac Ligament. SUMMARY OF BACKGROUND DATA: In many patients with aspecific low back pain or peripartum pelvic pain, pain is experienced in the region in which the long dorsal sacroiliac Ligament is located. It is not well known that the Ligament can be easily palpated in the area directly caudal to the posterior superior iliac spine. Data on the functional and clinical importance of this Ligament are lacking. METHODS: A dissection study was performed on the sacral and lumbar regions. The tension of the long dorsal sacroiliac Ligament (n = 12) was tested under loading. Tension was measured with a buckle transducer. Several structures, including the erector spinae muscle, the posterior layer of the thoracolumbar fascia, the sarcotuberous Ligament, and the sacrum, were incrementally loaded (with forces of 0-50 newtons). The sacrum was loaded in two directions, causing nutation (ventral rotation of the sacrum relative to the iliac bones) and counternutation (the reverse). RESULTS: Forced nutation in the sacroiliac joints diminished the tension and forced counternutation increased the tension. Tension in the long dorsal sacroiliac Ligament increased during loading of the ipsilateral Sacrotuberous Ligament and erector spinae muscle. The tension decreased during traction to the gluteus maximus muscle. Tension also decreased during traction to the ipsilateral and contralateral posterior layer of the thoracolumbar fascia in a direction simulating contraction of the latissimus dorsi muscle. CONCLUSIONS: The long dorsal sacroiliac Ligament has close anatomical relations with the erector spinae muscle, the posterior layer of the thoracolumbar fascia, and a specific part of the Sacrotuberous Ligament (tuberoiliac Ligament). Functionally, it is an important link between legs, spine, and arms. The Ligament is tensed when the sacroiliac joints are counternutated and slackened when nutated. The reverse holds for the Sacrotuberous Ligament. Slackening of the long dorsal sacroiliac Ligament can be counterbalanced by both the Sacrotuberous Ligament and the erector muscle. Pain localized within the boundaries of the long Ligament could indicate among other things a spinal condition with sustained counternutation of the sacroiliac joints. In diagnosing patients with aspecific low back pain or peripartum pelvic pain, the long dorsal sacroiliac Ligament should not be neglected. Even in cases of arthrodesis of the sacroiliac joints, tension in the long Ligament can still be altered by different structures.
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a functional anatomical approach to the spine pelvis mechanism interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
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A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:On pense rarement au dysfonctionnement de l'articulation sacro-iliaque comme cause possible de “lombalgie”. Cela est dû au fait que l'on a recours bien souvent à des modèles anatomiques incomplets. D'un point de vue cinématique, les modèles habituels d'anatomie topographique sont généralement insuffisants car ils individualisent le pelvis, la colonne lombaire inférieure et les membres inférieurs comme des entités distinctes. Cette étude anatomo-fonctionnelle centre son intérêt sur la question de savoir si les relations anatomiques entre le muscle biceps fémoral et le Ligament sacro-tubéral sont cinématiquement utiles. Les forces appliquées au tendon du muscle biceps fémoral, semblent influencer la tension du Ligament sacro-tubéral. Comme la tension du Ligament sacro-tubéral influence la cinématique de l'articulation sacro-iliaque, l'entraînement des ischio-jambiers pourrait influencer l'articulation sacro-iliaque et ainsi la cinématique du rachis lombaire. Les applications cliniques concernant la rétraction des ischio-jambiers, l'instabilité pelvienne et la marche sont discutées. Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
Rob Stoeckart - One of the best experts on this subject based on the ideXlab platform.
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The function of the long dorsal sacroiliac Ligament ; Its implication for understanding low back pain
Spine, 1996Co-Authors: Andry Vleeming, Chris J Snijders, Rob Stoeckart, Annelies Pool-goudzwaard, Dilara Hammudoghlu, Jan MensAbstract:STUDY DESIGN: In embalmed human bodies the tension of the long dorsal sacroiliac Ligament was measured during incremental loading of anatomical structures that are biomechanically relevant. OBJECTIVES: To assess the function of the long dorsal sacroiliac Ligament. SUMMARY OF BACKGROUND DATA: In many patients with aspecific low back pain or peripartum pelvic pain, pain is experienced in the region in which the long dorsal sacroiliac Ligament is located. It is not well known that the Ligament can be easily palpated in the area directly caudal to the posterior superior iliac spine. Data on the functional and clinical importance of this Ligament are lacking. METHODS: A dissection study was performed on the sacral and lumbar regions. The tension of the long dorsal sacroiliac Ligament (n = 12) was tested under loading. Tension was measured with a buckle transducer. Several structures, including the erector spinae muscle, the posterior layer of the thoracolumbar fascia, the sarcotuberous Ligament, and the sacrum, were incrementally loaded (with forces of 0-50 newtons). The sacrum was loaded in two directions, causing nutation (ventral rotation of the sacrum relative to the iliac bones) and counternutation (the reverse). RESULTS: Forced nutation in the sacroiliac joints diminished the tension and forced counternutation increased the tension. Tension in the long dorsal sacroiliac Ligament increased during loading of the ipsilateral Sacrotuberous Ligament and erector spinae muscle. The tension decreased during traction to the gluteus maximus muscle. Tension also decreased during traction to the ipsilateral and contralateral posterior layer of the thoracolumbar fascia in a direction simulating contraction of the latissimus dorsi muscle. CONCLUSIONS: The long dorsal sacroiliac Ligament has close anatomical relations with the erector spinae muscle, the posterior layer of the thoracolumbar fascia, and a specific part of the Sacrotuberous Ligament (tuberoiliac Ligament). Functionally, it is an important link between legs, spine, and arms. The Ligament is tensed when the sacroiliac joints are counternutated and slackened when nutated. The reverse holds for the Sacrotuberous Ligament. Slackening of the long dorsal sacroiliac Ligament can be counterbalanced by both the Sacrotuberous Ligament and the erector muscle. Pain localized within the boundaries of the long Ligament could indicate among other things a spinal condition with sustained counternutation of the sacroiliac joints. In diagnosing patients with aspecific low back pain or peripartum pelvic pain, the long dorsal sacroiliac Ligament should not be neglected. Even in cases of arthrodesis of the sacroiliac joints, tension in the long Ligament can still be altered by different structures.
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a functional anatomical approach to the spine pelvis mechanism interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
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A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:On pense rarement au dysfonctionnement de l'articulation sacro-iliaque comme cause possible de “lombalgie”. Cela est dû au fait que l'on a recours bien souvent à des modèles anatomiques incomplets. D'un point de vue cinématique, les modèles habituels d'anatomie topographique sont généralement insuffisants car ils individualisent le pelvis, la colonne lombaire inférieure et les membres inférieurs comme des entités distinctes. Cette étude anatomo-fonctionnelle centre son intérêt sur la question de savoir si les relations anatomiques entre le muscle biceps fémoral et le Ligament sacro-tubéral sont cinématiquement utiles. Les forces appliquées au tendon du muscle biceps fémoral, semblent influencer la tension du Ligament sacro-tubéral. Comme la tension du Ligament sacro-tubéral influence la cinématique de l'articulation sacro-iliaque, l'entraînement des ischio-jambiers pourrait influencer l'articulation sacro-iliaque et ainsi la cinématique du rachis lombaire. Les applications cliniques concernant la rétraction des ischio-jambiers, l'instabilité pelvienne et la marche sont discutées. Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
Lee A Dellon - One of the best experts on this subject based on the ideXlab platform.
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Sacrotuberous Ligament healing following surgical division during transgluteal pudendal nerve decompression a 3 tesla mr neurography study
PLOS ONE, 2016Co-Authors: Jan Fritz, Benjamin Fritz, Lee A DellonAbstract:Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the Sacrotuberous Ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal spontaneously and will be significantly thicker after healing.
J. P. Van Wingerden - One of the best experts on this subject based on the ideXlab platform.
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a functional anatomical approach to the spine pelvis mechanism interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
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A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the Sacrotuberous Ligament
European Spine Journal, 1993Co-Authors: J. P. Van Wingerden, Chris J Snijders, Andry Vleeming, Rob StoeckartAbstract:On pense rarement au dysfonctionnement de l'articulation sacro-iliaque comme cause possible de “lombalgie”. Cela est dû au fait que l'on a recours bien souvent à des modèles anatomiques incomplets. D'un point de vue cinématique, les modèles habituels d'anatomie topographique sont généralement insuffisants car ils individualisent le pelvis, la colonne lombaire inférieure et les membres inférieurs comme des entités distinctes. Cette étude anatomo-fonctionnelle centre son intérêt sur la question de savoir si les relations anatomiques entre le muscle biceps fémoral et le Ligament sacro-tubéral sont cinématiquement utiles. Les forces appliquées au tendon du muscle biceps fémoral, semblent influencer la tension du Ligament sacro-tubéral. Comme la tension du Ligament sacro-tubéral influence la cinématique de l'articulation sacro-iliaque, l'entraînement des ischio-jambiers pourrait influencer l'articulation sacro-iliaque et ainsi la cinématique du rachis lombaire. Les applications cliniques concernant la rétraction des ischio-jambiers, l'instabilité pelvienne et la marche sont discutées. Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate, since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the Sacrotuberous Ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence Sacrotuberous Ligament tension. Since Sacrotuberous Ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to ‘short’ hamstrings, pelvic instability and walking are discussed.
Jan Fritz - One of the best experts on this subject based on the ideXlab platform.
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Sacrotuberous Ligament Healing following Surgical Division during Transgluteal Pudendal Nerve Decompression: A 3-Tesla MR Neurography Study.
PLOS ONE, 2016Co-Authors: Jan Fritz, Benjamin Fritz, A. Lee DellonAbstract:Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the Sacrotuberous Ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p
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Sacrotuberous Ligament healing following surgical division during transgluteal pudendal nerve decompression a 3 tesla mr neurography study
PLOS ONE, 2016Co-Authors: Jan Fritz, Benjamin Fritz, Lee A DellonAbstract:Pelvic pain due to chronic pudendal nerve (PN) compression, when treated surgically, is approached with a transgluteal division of the Sacrotuberous Ligament (STL). Controversy exists as to whether the STL heals spontaneously or requires grafting. Therefore, the aim of this study was to determine how surgically divided and unrepaired STL heal. A retrospective evaluation of 10 patients who had high spatial resolution 3-Tesla magnetic resonance imaging (3T MRI) exams of the pelvis was done using an IRB-approved protocol. Each patient was referred for residual pelvic pain after a transgluteal STL division for chronic pudendal nerve pain. Of the 10 patients, 8 had the STL divided and not repaired, while 2 had the STL divided and reconstructed with an allograft tendon. Of the 8 that were left unrepaired, 6 had bilateral surgery. Outcome variables included STL integrity and thickness. Normative data for the STL were obtained through a control group of 20 subjects. STL integrity and thickness were measured directly on 3 T MR Neurography images, by two independent Radiologists. The integrity and thickness of the post-surgical STL was evaluated 39 months (range, 9–55) after surgery. Comparison was made with the native contra-lateral STL in those who had unilateral STL division, and with normal, non-divided STL of subjects of the control group. The normal STL measured 3 mm (minimum and maximum of absolute STL thickness, 2–3 mm). All post-operative STL were found to be continuous regardless of the surgical technique used. Measured at level of Alcock’s canal in the same plane as the obturator internus tendon posterior to the ischium, the mean anteroposterior STL diameter was 5 mm (range, 4–5 mm) in the group of prior STL division without repair and 8 mm (range, 8–9 mm) in the group with the STL reconstructed with grafts (p<0.05). The group of healed STLs were significantly thicker than the normal STL (p<0.05). We conclude that a surgically divided STL will heal spontaneously and will be significantly thicker after healing.
