Lumbar dorsal fascia. How to pump up the lumbar-thoracic fascia. Diagnosis of the causes of lower back pain

Back muscles

Superficial muscles (first layer)

Superficial muscles (second layer)

Deep back muscles

Suboccipital muscles

Fascia of the back

.Superficial fascia of the back (fascia dorsi superficialis) being part of the superficial fascia of the body, it is poorly developed in the back area. It separates the subcutaneous fat from the trapezius and latissimus dorsi muscles.

nuchal fascia ( fascia nuchae) located in the back of the neck, between the superficial and deep layers of muscles. Medially it fuses with the nuchal ligament, laterally it passes into the superficial layer of the fascia of the neck, and above it is attached to the superior nuchal line.

Lumbothoracic fascia (fascia thoracolumbalis) has two plates: superficial and deep.

starts from the spinous processes of the thoracic and lumbar vertebrae, the median sacral crest and covers the posterior surface of the erector spinae muscle.

starts from the transverse processes of the lumbar vertebrae, above - from the XII rib, below - from the iliac crest and covers the anterior surface of the erector spinae muscle.

In the lumbar region, both plates are connected along the outer edge of the erector spinae muscle, thereby forming an osteofibrous sheath for this muscle

Back topography

Topographic formations of the back include: lumbar triangle, Lesgaft-Greenfelt triangle and auscultation triangle

Lumbar triangle (trigonum lumbale) It is bounded below by the iliac crest, medially by the latissimus dorsi muscle, and laterally by the external oblique abdominal muscle. The bottom of the triangle is the internal oblique abdominal muscle.

Triangle (rhombus) Lesgaft-Grinfelt (spatium tendineum lumbale) located above the lumbar triangle and bounded above by the inferior serratus posterior muscle, medially by the erector spinae muscle, and laterally by the internal oblique abdominal muscle. Sometimes this triangle can be shaped like a diamond. In this case, it will be limited from above medially by the inferior posterior serratus muscle, from above laterally by the XII rib, the lower medial and lateral walls of the rhombus correspond to the medial and lateral walls of the triangle.

The bottom of the triangle or diamond is the deep plate of the thoracodorsal fascia.

Both triangles are weak points of the posterior abdominal wall, within which lumbar hernias can form.

Auscultation triangle (trigonum auscultationis) located in the upper back. From above it is limited by the lateral edge of the trapezius muscle and the lower edge of the rhomboid major muscle, and from below by the upper edge of the latissimus dorsi muscle. In this triangle, auscultation of the lower lobe of the lung is performed.

Muscles and fascia of the chest. Topography of the chest.

Chest muscles

Superficial muscles

Deep muscles

Fascia of the chest

Superficial fascia of the chest (fascia pectoralis superficialis) is part of the superficial fascia of the body. It forms a capsule for the mammary gland, extending deep into it dense connective tissue strands - ligaments that support the mammary gland.

Pectoral fascia ( fascia pectoralis) consists of 2 plates: superficial and deep.

Superficial plate (lamina superficialis) covers the pectoralis major muscle on both sides. Medially it attaches to the edge of the sternum, above – to the clavicle, laterally – it passes into the axillary and deltoid fascia.

Deep plate (lamina profunda) covers the pectoralis minor muscle on both sides.

Proprietary pectoral fascia (fascia thoracica) covers the outer surface of the chest wall

Intrathoracic fascia (fascia endothoracica) lines the inner surface of the chest walls. The parietal pleura is adjacent to it.

Breast topography

Topographically, in the chest area, 3 triangles are considered, located one above the other and which are topographic formations on the anterior wall of the axillary fossa.

Clavipectoral triangle (trigonum clavipectorale) Bounded above by the clavicle, below by the upper edge of the pectoralis minor muscle

Thoracic triangle (trigonum pectorale) corresponds to the contours of the pectoralis minor muscle.

Submammary triangle (trigonum subpectorale) bounded above by the lower edge of the pectoralis minor muscle, below by the lower edge of the pectoralis major muscle.

The lumbar region has the following weak points:

• Petit triangle is formed in the place where the edges of the external oblique abdominal muscle and the latissimus dorsi muscle diverge. The base of this triangle is the ilium. In turn, the bottom of the triangle is formed by the internal oblique abdominal muscle. Petit's triangle is a weak point in the lumbar region, since the muscle layer here is relatively unexpressed.
• Lesgaft–Grunfeld rhombus formed by the edges of the internal oblique abdominal muscle and the inferior posterior serratus abdominal muscle. The upper border of the rhombus is the lower edge of the inferior posterior serratus abdominal muscle, and below and outside the rhombus is limited by the posterior edge of the internal oblique abdominal muscle. The inner border of this formation is the edge of the erector spinae muscle. The bottom of the rhombus is represented by the aponeurosis ( wide tendon plate) transverse abdominis muscle.

The arteries that are located in the lumbar region are branches of the abdominal aorta, as well as the median sacral artery. At the top, the arteries of the lumbar region communicate ( anastomose) with branches of the intercostal arteries, and below - with branches of the iliac arteries. The outflow of venous blood is carried out by veins that belong to the system of the inferior as well as the superior vena cava. The nerves in the lumbar region are branches of the lumbosacral plexus.

What structures can become inflamed in the lower back?

The following tissues and organs can become inflamed in the lumbar region:

• Leather the lumbar region can be affected by pyogenic microbes ( staphylococci and streptococci). These pathogens can affect hair, sweat and sebaceous glands. With a boil in the pathological process ( purulent-necrotic inflammation) the hair shaft is involved, as well as the surrounding tissue. With this pathology, the most pronounced pain is observed on the third or fourth day, when the core of the boil undergoes purulent melting ( Nerve endings are also damaged). With furunculosis ( ) high temperature occurs ( up to 39 – 40ºС), chills, severe headaches. Another pathology that can affect the skin of the lower back is carbuncle. A carbuncle is characterized by damage to several hair follicles at once ( hair shaft), which are located close to each other. As a result, a general infiltrate is formed ( accumulation of lymph, blood and some cells), which can reach a diameter of up to 6–10 centimeters. Unlike a boil, a carbuncle is a more painful formation and occurs with severe symptoms of general intoxication of the body ( weakness, decreased performance, decreased appetite, headache, dizziness, etc.). Also, the skin of the lumbar region can be affected by ecthyma ( penetration of streptococci into the skin). During this pyoderma ( skin lesions from pyogenic bacteria) a small blister of pus forms on the skin, which later transforms into an ulcer. This particular ulcer is a rather painful formation.
• Fat fiber may be involved in the inflammatory process during pancreatic necrosis ( death of pancreatic tissue) or with purulent damage to the kidneys, adrenal glands or other structures located in the retroperitoneal space. Retroperitoneal phlegmon ( purulent melting of fiber) proceeds in a non-specific manner. At the initial stage, body temperature rises to 37 - 38ºС, chills and malaise may occur. Subsequently, a pulling or throbbing pain occurs in the lumbar region, which gradually becomes diffuse ( pain may radiate to the buttock or stomach). It is worth noting that pain intensifies during movement and forces a person to take a forced lying position.
• Spinal column. Non-infectious inflammation of the spine with damage to the lumbar and sacral region, as well as paravertebral tissues ( ankylosing spondylitis) also leads to pain. The pain is localized not only along the spinal column, but also in the muscles. In addition to pain in the spine, there is a feeling of stiffness that occurs at rest and gradually decreases during movement. As ankylosing spondylitis progresses, pain and stiffness appear in the hip joints, and all active movements in the spine are practically blocked due to fusion of the articular surfaces of the vertebrae. Also, the spine can be affected by tuberculosis, brucellosis ( an infection transmitted from sick animals to people that affects various internal organs) or osteomyelitis ( purulent inflammation of bone tissue).
• Muscles and ligaments The lumbar region may also be involved in the inflammatory process. Most often, these tissues become inflamed due to traumatic injuries, hypothermia, or prolonged exposure to a forced position.
• Kidneys. Inflammation of the renal pelvis ( ) and intercellular substance of the kidney ( glomerulonephritis) is also characterized by pain in the lumbar region. Pathological changes most strongly affect the renal tubules through which blood is filtered.
• Appendix ( appendix). If the appendix is ​​located in an atypical position ( behind the cecum), then when it is inflamed ( appendicitis) severe pain occurs in the lumbar region. It is worth noting that acute appendicitis is an indication for emergency hospitalization and surgery.

Causes of lower back pain

Causes of lower back pain

• Sprained muscles and ligaments of the lumbar region most often occurs in athletes during excessive physical exertion or when using incorrect technique. In addition to pain, which is a consequence of severe spasm of muscle tissue, there is a feeling of stiffness in the spine and tissue swelling. When soft tissue is bruised, a hematoma may occur ( local accumulation of blood), which can increase pain due to compression of the surrounding tissues in which the nerve receptors are located.
• Fractures of the spine in the lumbar region. Most often we are talking about a compression fracture of the spine, which occurs when the spine is excessively flexed or about fractures of the transverse and spinous processes. A compression fracture is indicated by constant pain in a standing or sitting position, which almost completely disappears if the person lies down. In addition to pain, loss of sensation and weakness in the perineum and lower extremities may occur.
• Spinal tumors as benign ( osteoblastoma, osteoid osteoma, hemangioma, etc.), and malignant ( myeloma, osteosarcoma, penetration of metastases into the spine) lead to pain, which can have varying intensity. Pain quite often radiates to the lower extremities, and sometimes to the upper extremities. A characteristic feature of such pain is the lack of therapeutic effect from the use of painkillers. Weakness and numbness in the lower extremities also occurs ( in some cases - paralysis), violation of the act of urination and defecation, violation of posture.

Diagnosis of the causes of lower back pain

To diagnose these types of pyoderma ( skin lesions caused by penetration of pyogenic bacteria) as a boil, carbuncle or ecthyma, consultation with a surgeon or dermatologist is necessary. An accurate diagnosis is made based on the clinical picture of the pathology, as well as on the basis of a visual examination of the affected area of ​​the skin. To determine the type of pathogen ( staphylococcus and/or streptococcus) resort to bacterial culture, and also do an antibiogram ( determine the sensitivity of the pathogen to various antibiotics).

Myositis is diagnosed by a neurologist. Characteristic complaints, the clinical picture of the disease, as well as electromyography data are taken into account ( method of recording electrical potentials emanating from muscles). Sometimes they resort to ultrasound examination ( Ultrasound) to study muscle tissue to assess its structure and degree of damage. In a general blood test, an increase in erythrocyte sedimentation rate, an increase in the number of white blood cells, and an increase in C-reactive protein ( one of the acute phase proteins of inflammation).

Ankylosing spondylitis ( ankylosing spondylitis) is diagnosed by a rheumatologist. In order to confirm the diagnosis, specific symptoms are taken into account, such as pain and stiffness in the spine, which worsens at rest, as well as pain in the chest. It is also necessary to conduct a magnetic resonance imaging of the spine or radiography. It is worth noting that magnetic resonance imaging is a more sensitive method and allows you to detect pathological changes at the very beginning of the disease. In addition, a general blood test is required, which most often reveals an increase in ESR ( erythrocyte sedimentation rate).

Diagnosis of retroperitoneal phlegmon should be carried out by a physician or surgeon. Sluggish phlegmon is extremely difficult to diagnose, since the symptoms are extremely inexpressive ( especially if treatment has already been prescribed for another disease). Acute phlegmon is diagnosed by palpating a painful mass formation ( infiltration). In a general blood test, an increase in the number of white blood cells characteristic of the inflammatory process is noted ( leukocytes), shift of the leukocyte formula to the left ( increase in the number of young forms of neutrophils) and increased erythrocyte sedimentation rate.

Scheuermann-Mau disease should be diagnosed in adolescence by an orthopedic surgeon. One of the leading clinical manifestations of the disease is an increase in the severity of thoracic kyphosis ( physiological curvature of the thoracic spine), which is not eliminated even with maximum extension of the spine. As the disease progresses, x-rays reveal a wedge-shaped deformation of the thoracic and lumbar spine. Magnetic resonance imaging and indirectly on x-rays can reveal degenerative changes in the intervertebral discs. It is worth noting that in the initial stages of this disease the clinical picture is extremely nonspecific and diagnosing Scheuermann-Mau disease is very problematic.

The diagnosis of spinal brucellosis should be made by an infectious disease specialist. Important data to confirm such a diagnosis is confirmation of contact with animals ( cattle, small livestock or pigs) or eating insufficiently thermally processed animal products. The clinical picture of the disease is also taken into account. Confirmation of the diagnosis is carried out by performing specific laboratory tests that detect the pathogen in the blood ( polymerase chain reaction, blood culture, Wright reaction).

In order to identify tuberculous lesions of the spine, radiography or computed tomography is performed ( the photo is taken in two projections). The images reveal foci of vertebral destruction, sequestration ( areas of completely destroyed bone tissue), as well as, in some cases, shadows that indicate local accumulations of pus. In order to confirm the diagnosis, it is necessary to do a bacterial culture of the affected bone tissue or abscess contents. A blood test reveals signs of an inflammatory process - an increase in the erythrocyte sedimentation rate, an increased concentration of C-reactive protein, an increase in the number of white blood cells. A tuberculin test is also performed, which in most cases will be positive. The diagnosis is confirmed by an orthopedist.

A neurologist can confirm the diagnosis of lumbar osteochondrosis. Diagnosis is made based on typical clinical signs of the disease ( pain along the affected nerve, unilateral muscle atrophy, as well as impaired sensitivity of the compressed nerve). Confirmation of the diagnosis is carried out using radiography or magnetic resonance imaging ( "gold standard of diagnosis") lumbar region. The photographs show degenerative changes in the intervertebral discs, as well as the location and degree of compression of the spinal root.

Scoliosis must be diagnosed by an orthopedist. Most often, this pathology is detected in childhood. To determine the degree or severity of scoliosis curvature, a scoliosis meter is used or the angles of curvature are determined on an x-ray of the spine. It is the X-ray method that makes it possible to detect scoliosis at the earliest stages of the disease.

Diagnosis of spinal osteomyelitis is carried out by an orthopedic doctor, therapist or surgeon. Diagnosis takes into account the clinical picture of the disease, as well as radiography or tomography. It is worth noting that the “gold standard” is tomography ( computer or magnetic resonance), which allows you to identify the volume and degree of damage to the bone tissue of the spine. If fistulas are present, fistulography is performed ( filling the fistula canal with a contrast agent followed by radiography).

Acute appendicitis is diagnosed by a surgeon, therapist or emergency physician. With an atypical position of the appendix ( if it is located behind the cecum, and not below it) the clinical picture is somewhat different from the classical one. To confirm retrocecal appendicitis, press on the right Petit triangle with a finger, and then sharply remove it, as a result of which the pain sharply intensifies ( Gabay's symptom). Pain is also characteristic when pressing with a finger on the right Petit triangle ( Yaure-Rozanov symptom).

Diagnosis of intestinal obstruction is carried out by a surgeon. The diagnosis is confirmed by identifying various characteristic symptoms of intestinal obstruction ( listening to the “splashing noise” over intestinal loops, etc.). X-rays reveal horizontal levels of liquid, and gas bubbles above them ( Kloiber's sign) and intestinal striation ( Kerckring's folds symptom). Ultrasound examination reveals an enlarged area of ​​the intestine, thickening of the intestinal wall with mechanical intestinal obstruction ( blockage of the intestines at any level) or excessive accumulation of gases and liquids - with dynamic intestinal obstruction ( impaired intestinal motility).

In women, back pain can occur in the following situations:

• Adnexitis ( salpingo-oophoritis) is a pathology in which inflammation of the uterine appendages occurs ( ovaries and fallopian tubes). With acute adnexitis, severe pain appears in the lower back and lower abdomen. In addition, body temperature rises ( 38 – 38.5ºС), chills appear, sweating increases. Quite often muscle pain and headaches occur. The chronic course of adnexitis is manifested by dull and nightly pain in the lower abdomen, in the groin, and sometimes in the vagina. The pain also radiates ( distributed by) in the lower back and pelvis.
• Pregnancy. During pregnancy, the load on the spine is redistributed. As a result, the load on the lumbar spine and the muscular-ligamentous apparatus increases several times, which leads to pain of varying intensity. It is necessary to mention the fact that most often lower back pain during pregnancy occurs in pregnant women with weak back and abdominal muscles, as well as in those women who are overweight or obese.
• Premenstrual syndrome in quite rare cases it causes pain in the lumbar region. Some scientists explain this phenomenon by the fact that when hormonal levels change, muscle tone increases, leading to overstrain of the back muscles and in particular the lower back muscles.

What are the causes of nagging pain in the lower back?

The following causes of nagging pain in the lower back are identified:

• Sprained ligaments and muscles is one of the most common causes of nagging pain in the lower back, especially in athletes and people leading an active lifestyle. Depending on the degree of damage, the pain can be either acute or nagging. Tissue swelling and stiffness of movement also occur. In some cases, when a muscle is bruised, a hematoma may occur ( local accumulation of blood), which can compress surrounding tissues and increase pain.
• Staying in an awkward position for a long time quite often leads to lower back pain. Most often, pain occurs due to a long sitting position, since it is in the sitting position that the spinal column and muscles experience maximum stress. Sometimes pain occurs in the morning after waking up. This indicates that the person slept on an uncomfortable bed and/or in an awkward position, which led to spasm of the lower back muscles.
• Inflammation of the lower back muscles occurs when tense muscles are bruised or when they are hypothermic. The pain is usually aching, pulling and intensifies with movement. If myositis is not treated in time ( muscle inflammation), then partial or complete loss of functionality of muscle tissue occurs.

Why does the lower back hurt during pregnancy?

Pain may also be referred to the buttock, thigh, lower leg and foot ( observed when the sciatic nerve is compressed). The nature of the pain can vary, but most often it is described as shooting, burning or stabbing. Often there is a feeling of burning and tingling in the leg.

It is worth noting that most often lower back pain occurs in pregnant women who are overweight or obese, as well as in those women who have poorly developed back and abdominal muscles. Also at risk are women who were diagnosed with spinal osteochondrosis before pregnancy ( dystrophic changes in intervertebral discs) or scoliosis ( rachiocampsis). In this case, lower back pain may continue to bother you after childbirth.

Why does the lower back on the left hurt?

Below are the most common causes of left-sided lower back pain:

• Stomach and duodenal ulcers usually manifests itself as pain in the upper abdomen, which can radiate to the thoracic and lumbar segment of the spine, as well as to the left side of the lower back. The appearance of “hunger” pain is characteristic ( stop after eating) and night pain. Also, with a peptic ulcer, heartburn, nausea, and sometimes vomiting occur.
• Left-sided renal colic most often occurs due to occlusion ( blockage) ureter stone. In this case, a sharp and severe pain occurs, which radiates to the groin, left side, and sometimes to the thigh. After the attack, the pain subsides somewhat and becomes nagging.
• Osteochondrosis is a pathology in which the cartilage tissue of the intervertebral discs is affected. As a result, the peripheral part of the intervertebral disc is destroyed, and the central part, protruding, compresses the nerve roots of the spinal cord. If the left spinal root is pinched, this leads to weakness of the muscles located to the left of the spinal column. Pain may also be reflected in the buttock and lower limb ( sciatica).
• Sprained muscles and ligaments of the lower back quite often occurs when performing heavy physical work in combination with bending the body. This type of damage often occurs in untrained people or in athletes with excessive exercise. When the muscle-ligamentous apparatus is sprained, pain of varying intensity occurs. Also characteristic is the appearance of tissue swelling and limitation of movement in the spine.

Why does my lower back hurt and pull after a massage?

If lower back pain persists for three or more days, and also if the pain is localized in the spine, then this is a reason to stop the massage, as it can only worsen the pain. You should also immediately consult a doctor to determine the cause of these pains. It is worth noting that back massage has some contraindications.

Among the contraindications to massage, it is worth noting the following:

• tumors;
• diseases of the hematopoietic system;
• allergic diseases with skin rashes;
• high body temperature;
• atherosclerosis of cerebral vessels ( blockage of blood vessels by atherosclerotic plaques);
• hypertensive and hypotensive crises ( marked increase or decrease in blood pressure);
• some mental illnesses;
• purulent-inflammatory diseases;
• myocardial ischemia ( decreased arterial blood flow to the heart muscle).

Scientists believe that any pathological changes in the functioning of the musculoskeletal system are people’s retribution for walking upright. Throughout life, our body experiences enormous stress, as a result of which ligaments, tendons and cartilage suffer. When joints are healthy, they operate smoothly and quietly. But sometimes during movement there is a crunching sound in the bone joints, especially large ones. In most cases, it is accompanied by discomfort and pain. Why does the hip joint crunch, what to do about it - such questions are of great concern to those suffering.

Prerequisites for functional changes

The hip joint is the junction of the largest bones: the femur and the pelvis. It consists of the head, the acetabulum, along the edge of which the acetabular lip is located, and the articular space. The cavity of the joint is filled with synovial fluid and lined with cartilage tissue, which provides it with high-quality gliding. The acetabular lip covers the head and securely fixes it, preventing it from falling out of the acetabulum. If the integrity of any of these components is violated, the hip joints crack. In medicine, this problem is called snapping hip syndrome.

The reasons for this condition are different. Sometimes the presence of such symptoms occurs without any prerequisites and is not a sign of illness. Factors causing degenerative changes in the structure of cartilage:

• excessive physical activity;
• salt deposition as a consequence of disturbed water-salt and mineral balance;
• mechanical trauma that causes a violation of the integrity of the bone and cartilaginous structures of the joint;
• increased flexibility of bone joints;
• immaturity of the muscular and connective apparatus around the joint.

Other causes of crunching in the hip joint are associated with degenerative changes resulting from the following factors:

• development of arthritis or arthrosis;
• gout or progressive osteochondrosis;
• inflammatory processes in cartilage, tendons and other elements of the ligamentous apparatus;
• increased degree of wear of articular surfaces;
• overweight;
• mismatch of bone joint surfaces.

Sometimes crunching and clicking sounds are associated with metabolic and endocrine disorders, poor nutrition and non-compliance with the daily routine.

Such functional changes cannot be attributed only to the age factor, because sometimes a crunch in the hip joint occurs in a child. Prerequisites: congenital pathologies, underdevelopment of muscle tissue around ligaments and cartilage, trauma.

Symptoms of pathology

During its operation, the bone joint undergoes heavy loads, which entails negative consequences that have a destructive effect on its tissues. The very first sign of functional disorders is a crunch in the hip joint without pain.

A characteristic sound signals wear of bone joints or the beginning of the development of destructive changes in tissues. Depending on the extent of the spread of this process, a clicking hip is accompanied by pain of varying degrees of intensity, discomfort, and limited mobility.

In the problem area, a feeling of springy resistance may appear, reinforced by the subsequent failure of the head. Such clicks are characterized by the onset of the development of arthrosis or polyarthritis. The patient experiences swelling and swelling of the tissues surrounding the joint, and the body temperature rises.

Classification of pathological disorders

Clicking and crunching sounds in the thigh are classified depending on the location of the problem:

• outer. The sound characteristic of pathology occurs in the outer part of the femoral diarthrosis due to the jumping off of the connective fascia when moving from the greater trochanter of the femur. Having undergone systematic blows, the joint capsule becomes inflamed, and the patient develops bursitis;
• intra-articular. This species is characterized by disturbances inside the diarthrosis cavity. As a result of deterioration in the sliding of the head along the acetabulum, it jumps off, making a sound similar to a click. An example of an intra-articular pathology is congenital dysplasia;
• interior. The mechanism of the crunch is caused by the rolling of the iliopsoas muscle through the head of the femoral bone. If left untreated, the risk of bursitis complications increases significantly.

Types of pathologies

A characteristic sign does not always indicate a problem. Clicking sounds can occur due to the accumulation of air bubbles in the synovial fluid, during excessive exercise or due to stress. However, if they worsen the quality of life, continue for a long time and are accompanied by other signs, then the person needs the help of a specialist.

To understand why the hip joint crunches, it is necessary to carefully examine the symptoms of the pathology and determine its type. Even if this is the only visible sign of pathology, examination may reveal accompanying symptoms, allowing a correct diagnosis to be made and treatment to begin.

Iliopsoas syndrome

The iliopsoas muscle is the most common cause of clicking joints. This is explained by the tendon jumping over the acetabular labrum and femoral head during excessive and intense physical activity. At first, sounds characteristic of the problem occur rarely, but as the disorder progresses, their frequency increases and becomes almost constant. Gradually, other signs join the characteristic crunch:

• dull pain in the groin when flexing and straightening the limbs;
• feeling of resistance in the joint;
• joint weakness.

A special test is performed for diagnosis. This muscle is loaded with various sets of exercises. If characteristic sounds occur during their execution, the patient’s diagnosis is confirmed.

Systematic friction of the ligaments can cause iliopectineal bursitis, which significantly complicates the patient’s condition.

Iliotibial band syndrome

If the hip joint is cracking, a possible cause is increased friction in the iliotibial fascia. This type of pathology is most common in athletes whose occupation is associated with intense mobility of the limbs. Characteristic sounds are accompanied by pain on the outside of the joint. Possible complications include trochanteritis, an inflammatory process that develops in the trochanteric bursa. It is characterized by increased pain in the periarticular area, redness of the tissues and their swelling.

More details

Acetabular labral tear

The cartilaginous lip is involved in stabilizing the hip joint. Violation of its integrity occurs due to injury or degenerative changes in the structure of tissues. The rupture is characterized by:

• pain in the groin area or above;
• characteristic sounds when moving;
• impaired mobility;
• feeling of resistance in the joint.

For diagnosis, the patient is subjected to a special test with physical stress on the joints of the bones. Pathology is indicated by the appearance of a painful crunch.

Osteoarthritis

Degenerative changes in the structure of cartilage and ligaments often cause a person to have cracking hip joints. One of the pathologies is osteoarthritis. It is more often diagnosed in the male half of the population, since they are more susceptible to heavy physical activity and sports. The following signs indicate the disease:

• restriction of mobility in the problem area;
• sensation of joint friction;
• “starting” pain syndrome (when the first steps after a long period of rest are difficult);
• visible deformation of the bone connection (in advanced forms).

Pain occurs not only while walking, but when supporting the damaged tendon. If the disease has become advanced, the feeling of discomfort persists even at rest. If left untreated, the patient faces disability.

Osteochondropathy

If a crunch occurs in the hip joint in a child, then it can be assumed that he has Perthes disease or osteochondropathy. Usually occurs in children under 12 years of age. The essence of the pathology is necrotic processes of the femoral head, accompanied by the following symptoms:

• pain syndrome;
• fatigue when walking;
• limited limb mobility;
• limping gait;
• shortening of one leg.

Without treatment, the disease progresses rapidly and leads to deforming osteoarthritis.

Mechanical damage

Joint injuries occupy a wide niche in the development of pathological disorders in humans. A characteristic crunch can accompany sprains and ruptures of ligaments and tendons, dislocations, fractures, and bruises. The patient experiences pain of varying degrees of intensity depending on the type of injury received, swelling and swelling of soft tissues, bruising, and limited mobility.

Hip dysplasia

This type of joint pathology is more typical for newborns and is diagnosed by an orthopedist in the patient’s infancy. If left untreated at a later age, the crunching and clicking sounds are accompanied by lameness, “duck gait,” a feeling of heaviness, fatigue in the hip, and instability of the joint. In the future, dysplasia can develop into coxarthrosis.

For any functional disorders accompanied by a crunch of the hip joint, differential diagnosis is necessary.

Crunching in the femoral joint with pain also occurs in other diseases: intervertebral hernia, cartilage tear, fracture of the pelvic bones or femoral neck, osteoperiostitis of the pubic bone and others.

Diagnosis of pathology

It is naive to believe that cracking joints are harmless manifestations of functional changes in bone structures. Such symptoms can mask serious pathologies that require timely assistance from a specialist.

Despite the possibility of making a preliminary diagnosis using special tests and samples, final conclusions about the patient’s condition can only be obtained by conducting additional types of examination. These include:

• ultrasonography;
• radiography;

The doctor decides which one to choose, based on the results of the preliminary examination and the technical capabilities of the medical institution. When the results of additional tests are ready, a consultation with an orthopedic traumatologist will be required.

Treatment methods

When your hip joints are cracking, you should never let the problem take its course. No, it won’t go away on its own, but complications will definitely appear. The choice of treatment method depends on the nature of the pathology. Therapeutic manipulations with crunchy joints are carried out in two directions: conservative and surgical.

Conservative therapy

From the beginning of treatment, conservative medicine is used. If you are not in a hurry to see a specialist because you are afraid of a scalpel, then you don’t have to worry, no one will operate on you right away.

First of all, the patient will be asked to review the load regime on the limb and, if possible, unload it as much as possible. If the pathology is inflammatory in nature, non-steroidal anti-inflammatory drugs are prescribed. They allow you to level out tissue damage and eliminate pain. These include Nimesulide, Celebrex, Ketanov, Ibuprofen, Piroxicam and others. They are fast-acting, have a symptomatic effect, but can cause adverse reactions. You cannot use such products for a long time, as their effectiveness decreases.

To alleviate the patient's condition, he is prescribed glucocorticosteroid hormonal drugs. The most popular are Hydrocortisone, Diprospan, Kenalog. If the disease is complicated by severe pain, then injections of glucocorticosteroids are administered into the area of ​​the joint capsule. These are hormonal drugs that ensure normal blood flow in tissues, reduce muscle spasms, and eliminate pain.

To reduce pain and muscle spasms, the doctor may recommend taking muscle relaxants (Mydocalm, Sirdalud). Warming ointments are prescribed for the same purpose. They do not have a pronounced therapeutic effect, but relieve pain well. The most common are Espol, Menovazin, Nicoflex-cream, Gevkamen, Finalgon.

For arthrosis, chondroprotectors are used to restore cartilage tissue and synthesize synovial fluid inside the joint. Their action is aimed at preventing destructive changes. The disadvantage is the need for long-term use, since the drug has a cumulative effect. When treating crunching and clicking, Glucosamine, Teraflex and Chondroitin sulfate are used. If synovial fluid is formed in insufficient quantities, injections with hyaluronic acid are injected into the diseased joint to replace it. Examples of such agents are Ostenil, Farmatron, Durolan and others.

At the first manifestations of a pathological disorder of the bone articulation, accompanied by characteristic clicks, you should consult a doctor. The sooner the correct diagnosis is made, the greater the chances of a favorable outcome of therapy. However, the disease is treated not only with medication.

Physiotherapy

Exercise therapy has a good therapeutic effect for any problems with cartilage and ligaments. The set of exercises is aimed at strengthening muscle tissue in the periarticular area, ligaments and mobile joints, restoring motor functions and improving the support functions of the limb.

You need to practice regularly and always in the presence of an instructor who monitors and corrects the correct execution of the complex. When doing exercise therapy, no additional loads should be placed on the affected joint that could aggravate the patient’s condition.

For people suffering from snapping hip syndrome, doctors advise monitoring their physical activity, minimizing any sports training during treatment, or completely abandoning it for a while. If you cannot fully comply with these conditions, then it is better to replace them with swimming.

Physiotherapy

The use of a physiotherapeutic set of procedures allows you to reduce the intensity of discomfort and completely get rid of crunching, clicking and pain. Some types are used even after surgical treatment to reduce soft tissue swelling. Regeneration will be much more efficient.

Depending on the root cause of the pathology and the diagnosis, physiotherapeutic methods for treating clicking in the joints include:

• electrical stimulation;
• cryotherapy;
• acupuncture;
• electrophoresis;
• magnetic therapy;
• laser correction;
• shock wave therapy.

The great advantage of this type of treatment is that they allow you to act on the affected area without affecting nearby tissues and structures. Using these techniques, you can significantly reduce the dosage of medications taken without compromising the effectiveness of therapy. Massage as part of a complex treatment for cracking in the hip joint without pain also gives a good result.

Treatment of joints Read more >>

Proper nutrition

When dealing with clicking and crunching in bone joints, nutrition is important. The patient's diet should be complete, balanced, and help reduce body weight. The diet should include fatty fish, mainly sea fish, dairy products, poultry, legumes, nuts, other protein-rich foods, fruits and fresh vegetables. If you have problems with cartilage and bone joints, it is useful to eat gelatin (aspic, jellied meat, jelly). Sweets such as marshmallows and marshmallows are allowed, but you should not overuse them.

During treatment, you should avoid nightshade vegetables, red meat, preservatives and smoked foods. Alcohol in any form or quantity is strictly prohibited. When planning your diet, you need to reduce your salt intake.

Surgery

If the use of medications does not achieve the desired result, this may be a reason for surgical treatment. With internal and external localization of the problem, we can limit ourselves to partial intersection of the tendon of the iliopsoas muscle at the place of its attachment to the joint. If the localization of the pathology is intra-articular, then a complete replacement of the bone joint will be required.

With timely medical care for hip crunch, you can get rid of the problem only with conservative treatment without surgery.

Crunching in the hip joint cannot be considered a disease. This is one of the signs of any of the known pathologies of the musculoskeletal system. If it appears, it means that there is a malfunction in the body and it needs medical attention. You should not hope for a miracle and quick healing, because the problem can be dealt with with conservative treatment. If you let the situation take its course, the operation cannot be avoided.

The lumbosacral spine: how it works, main diseases

The spine is a very complex skeletal system that serves as the supporting axis of the body and ensures upright posture. It reliably protects the spinal cord and ensures the correct location and functioning of internal organs. It is to this that all parts of the skeleton are attached.

The spine also provides static stability and dynamic mobility of the human body. It consists of several departments. Each of them has its own structural features and functions. One of these sections, which experiences enormous loads every day, is commonly called the lumbosacral spine.

General information about the department

As in other sections, there are vertebrae in the lumbosacral spine. Each vertebra has anterior and posterior sections. The anterior section is the vertebral body, the structure of which is designed for easy folding of the vertebrae into a vertical structure.

The bodies bear the main weight and resist compression. The posterior section is an arch that protects the spinal cord. In addition, it serves to connect the spinal motion segments. Behind the arch there are processes that serve to attach ligaments and muscles.

Each vertebra has 4 facet joints, with the help of which it is connected to neighboring vertebrae. These joints provide mobility to the spinal column.

As a result of the placement of the vertebrae one above the other, the arches form a hollow tube called the spinal canal. This is where the spinal cord coming from the brain is located. Nerve fibers diverge from it in all directions. They form the roots of the spinal nerves. The spinal cord ends at the level of the 2nd lumbar vertebra. The roots extending from it hang further into the spinal canal and exit through the intervertebral foramina.

Between the vertebral bodies there are intervertebral discs, which serve to unite the vertebrae and eliminate friction between them. They look like a ring with a jelly-like substance in the center (core). The disc annulus consists of elastic fibrous fibers that are attached to the vertebral bodies. These discs also perform a shock-absorbing function during human movement, ensuring the sliding of the vertebrae.

With spinal injuries or frequent spinal overstrains, the liquid core may leak through cracks in the annulus fibrosus. In this case, intervertebral hernias are formed, which pinch the nerve roots and cause pain.

Thus, the anterior complex of the spine acts as a support for the entire body, and the posterior complex protects the spinal cord, controls the mobility of the vertebrae and fastens the spinal motion segments.

Spinal motion segment

The spinal motion segment is the part of the spine that is formed by 2 adjacent vertebrae. It also includes the ligamentous apparatus of these vertebrae, their joints, intervertebral disc and paravertebral muscles. Each such segment has 2 intervertebral foramina, through which blood vessels and spinal nerve roots pass.

The lumbar region contains 5 such spinal motion segments. In this case, the last segment is formed by the 5th lumbar and 1st sacral vertebrae.

Lumbar spine

This part of the spine consists of 5 vertebrae. In some cases, during lumbarization, there are 6 vertebrae in it, which is a variant of the norm. The vertebrae of this section are designated by the Latin letter L and a number corresponding to the serial number of the vertebra.

It is the lumbar region that bears the entire weight of the overlying spine. Because of this, the vertebrae have their own characteristics. All of them have a large support part, which increases from L1 to L5. Not only the width, but also the height of the vertebral body increases.

The lumbar vertebrae have the most pronounced and massive processes. The central parts of the transverse processes are rudiments of ribs that merged with the true transverse processes during evolution. At the base of these processes there are also small additional processes.

The spinous processes are located almost horizontally behind, almost at the level of the vertebral bodies. Their ends are thickened and directed backwards. This location and structure of these processes is associated with great mobility of the spine in this part.

The L5 vertebra should be highlighted separately. Its body is higher in front than in the back and has a wedge shape. This structure is necessary for the formation of lumbar lordosis.

Despite the fact that the intervertebral foramina in this part of the spine are quite wide, it is here that pain syndrome is most often observed due to damage to the roots. This is explained by the high mobility of the department and the heavy loads on it. The exception is the 5th vertebra. It is he who has the smallest intervertebral foramen at the junction with the sacrum, despite the fact that the corresponding spinal nerve has the largest diameter among all spinal nerves.

Sacral spine

The sacral spine is represented by 5 fused vertebrae. They are designated S1-S5. The vertebrae of the department do not fuse immediately. Fusion begins at approximately 14 years of age and is completed by 25 years of age. It is not uncommon for the sacrum to fuse with the 5th lumbar vertebra only after 25 years.

The fused vertebrae are called the sacrum. It looks like a pyramid, pointing downwards.

The base of the sacrum with its anterior edge forms an angle protruding forward, together with the L5 vertebra. On the base there are 2 articular processes that are directed backward and slightly to the side.

On the front side of the sacrum there are visible transverse lines - the places of fusion of the vertebrae. Along the edges there are pelvic sacral foramina through which the spinal nerves exit.

The posterior surface of the sacrum is covered with 3 lines of scallops. They are formed by fusion of the rudiments of the articular and spinous processes.

Inside the sacrum there is a continuation of the spinal canal, which ends in the inferior sacral foramen. This hole is important in medicine. This is where the epidural block is performed.

Thanks to this structure of the sacral region, intervertebral hernias practically do not occur in it.

Coccygeal region

This section does not belong to the lumbosacral region, but is the final part of the spine. The coccyx consists of 3-5 vertebrae fused together, which have lost their characteristic features. This department does not perform any important role in the human body. Articular cartilage and adjacent ligaments provide good mobility of the tailbone, so that it can tilt back during childbirth.

Department bends

The lumbar spine has a physiological forward curve called lumbar lordosis. It begins to form in childhood from the moment the child begins to walk upright. Due to the posterior displacement of the load axis in conditions of lumbar bending, circular rotation of the body is ensured.

The sacral section has a curve directed backwards. It is called sacral kyphosis.

These bends are very important for the whole body. Thanks to them, shock-absorbing properties of the spine are ensured, shocks during running and walking are softened, which protects the brain from damage when the body moves.

Ligaments

The department is strengthened by the following ligaments: posterior longitudinal, supraspinous (absent at the level of the 5th lumbar-1st sacral vertebrae), transverse body, transverse sacral, transverse iliac, sacrotuberous, sacrococcygeal, yellow, etc.

All ligaments play a very important role, as they fix the spinal column and regulate movements in it. They limit the tilt of the body to the sides, forward and backward, while compensating for displacement of the vertebrae.

Innervation of the department

The lumbar plexus is formed by the interweaving of the I-IV lumbar spinal nerves. It resembles the shape of a triangle with the apex directed along the vertebral bodies. The lumbar plexus branches into terminal and collateral branches. The latter innervate the quadratus lumborum muscle and the psoas major and minor muscles. The terminal branches are represented by the ilioinguinal, iliohypogastric, femorogenital, femoral, obturator nerves and the cutaneous nerve of the thigh.

The sacral plexus is formed by the lumbosacral trunk and the 1st-3rd sacral nerves. It is located under the pelvic fascia on the front of the body of the piriformis muscle. The sacral plexus has 1 terminal and 6 collateral branches, which in turn are divided into many nerves.

DISEASES AND INJURIES

This part of the spine is most often exposed to various injuries and pathologies. The reason for this is the peculiarities of the functioning of the department. It is here that there is the greatest freedom of movement of the vertebrae, which need to support the entire mass of the overlying sections.

Also, it is this department that bears the greatest load when lifting and moving heavy objects, during prolonged sitting, when working in a bent position or associated with frequent bending and straightening, etc.

Injuries can occur due to an unsuccessful fall from a height, the collapse of heavy objects (for example, the collapse of a building), as well as due to an accident. Lesions of the spine in this section are very dangerous, as they can cause complete immobility or even death.

Pain in the lumbar and sacral spine can occur not only due to injuries. Its cause may be:

In some cases, lower back pain does not indicate problems with the spine. This is the so-called moving pain in diseases of the internal organs. Therefore, if you experience even mild pain or discomfort in the lower back, you should seek help from a doctor. Based on the tests and studies performed, he differentiates the disease and prescribes appropriate treatment.

Risk factors for developing diseases of the lumbosacral region:

• congenital anatomical features of the spine;
• previous spinal column injuries;
• overweight;
• high growth;
• smoking;
• poor physical development;
• psychological factors.

Prevention of lower back diseases

To avoid diseases of the lumbosacral region, you should adhere to the following recommendations:

• monitor posture and correct body position during work and rest;
• play sports: yoga, gymnastics, etc.;
• try not to carry weights;
• avoid drafts and hypothermia;
• distribute weights evenly between your hands;
• sleep on an orthopedic mattress;
• monitor your weight;
• get rid of bad habits;
• change body position as often as possible when working in one position for a long time.

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SUPERFICIAL BACK MUSCLES

The superficial muscles of the back are attached to the skeleton of the shoulder girdle and to the humerus and are located in two layers (Fig. 116, 117). The first layer consists of the trapezius muscles and the latissimus dorsi muscle, the second layer consists of the rhomboid major and minor muscles and the levator scapulae muscle.

trapezius muscle,T.trapezius, flat, triangular in shape, with a wide base facing the posterior midline, occupies the upper back and back of the neck. It begins with short tendon bundles from the external occipital protrusion, the medial third of the superior nuchal line of the occipital bone, from the nuchal ligament, the spinous processes of the VII cervical vertebra and all thoracic vertebrae, and from the supraspinous ligament. From the origin, the muscle bundles are directed, noticeably converging, in the lateral direction and attached to the bones of the shoulder girdle. The upper bundles of muscles pass downward and laterally, ending on the posterior surface of the outer third of the clavicle. The middle bundles are oriented horizontally, pass from the spinous processes of the vertebrae outward and are attached to the acromion and scapular spine. The lower bundles of the muscle follow upward and laterally, passing into the tendon plate, which is attached to the scapular spine. The tendon origin of the trapezius muscle is more pronounced at the level of the lower border of the neck, where the muscle is greatest in width. At the level of the spinous process of the VII cervical vertebra, the muscles of both sides form a well-defined tendon area, which is found in the form of a depression in a living

person.

The trapezius muscle is located superficially throughout its entire length, its upper lateral edge forms the posterior side of the lateral triangle of the neck. The lower lateral border of the trapezius muscle crosses the latissimus dorsi muscle and the medial border of the scapula externally, forming the medial border of the so-called auscultation triangle. The lower border of the latter runs along the upper edge of the latissimus dorsi muscle, and the lateral border along the lower edge of the rhomboid major muscle (the size of the triangle increases when the arm is bent forward at the shoulder joint, when the scapula moves laterally and anteriorly).

Function: simultaneous contraction of all parts of the trapezius muscle with a fixed spine brings the scapula closer to the spine; the upper muscle bundles raise the scapula; upper and lower bundles with simultaneous contraction. forming a pair of forces, they rotate the scapula around the sagittal axis: the lower angle of the scapula moves forward and in the lateral direction, and the lateral angle moves upward and medially. With a strengthened scapula and contraction on both sides, the muscle extends the cervical spine and tilts the head back; with unilateral contraction, it slightly turns the face in the opposite direction.

Innervation: n. accessorius, plexus cervicalis (C m - C, v) -

Blood supply: a. transversa cervicis, a. occipitalis, a. suprascapularis, aa. intercostales posteriores.

Latissimus dorsi muscleT.latissimus dorsi, flat, triangular in shape, occupies the lower half of the back on the corresponding side.

The muscle lies superficially, with the exception of the upper edge, which is hidden under the lower part of the trapezius muscle. Below, the lateral edge of the latissimus dorsi muscle forms the medial side of the lumbar triangle (the lateral side of this triangle is formed by the edge of the external oblique abdominal muscle, the lower - the iliac crest, see Fig. 117). It begins as an aponeurosis from the spinous processes of the lower six thoracic and all lumbar vertebrae (together with the superficial plate of the thoracolumbar fascia), from the iliac crest and the median sacral crest. The muscle bundles follow upward and laterally, converging towards the lower border of the axillary fossa. At the top, muscle bundles are attached to the muscle, which start from the lower three to four ribs (they extend between the teeth of the external oblique abdominal muscle) and the lower angle of the scapula. Covering the lower angle of the scapula with its lower bundles from behind, the latissimus dorsi muscle sharply bends, spirals around the teres major muscle, the posterior edge of the axillary fossa passes into a flat thick layer of veins, which is attached to the crest of the lesser tubercle of the humerus. Near the place of attachment, the muscle covers from behind the vessels and nerves located in the axillary fossa. It is separated from the teres major muscle by a synovial bursa.

Function: brings the arm to the body and turns it inward (pronation), extends the shoulder; lowers the raised hand; if the arms are fixed (on the horizontal bar), the torso is pulled towards them (when climbing, swimming).

Innervation: n. thoracodorsalis (Civ- Soup).

Blood supply: a. thoracodorsalis, a. circumflexa humeri posterior, aa. intercostales posteriores.

The levator scapulae muscleT.levdior scapulae, begins with tendon bundles from the posterior tubercles of the transverse processes of the upper three or four cervical vertebrae (between the places of attachment of the middle scalene muscle - in the front and the splenius muscle of the neck - in the back). Moving downward, the muscle attaches to the medial edge of the scapula, between its upper angle and the spine of the scapula. In its upper third the muscle is covered by the sternocleidomastoid muscle, and in the lower third by the trapezius muscle. Immediately anterior to the levator scapulae muscle are the nerve to the rhomboid muscle and the deep branch of the transverse cervical artery.

Function: raises the scapula, simultaneously bringing it closer to the spine; with a strengthened shoulder blade, it tilts the cervical part of the spine in its direction.

Blood supply: a. transversa cervicis, a. cervicalis ascendens.

Rhomboid minor and major muscles,vol.rhomboidei minor et major, often fuse and form one muscle. The rhomboid minor muscle starts from the lower part of the nuchal ligament, the spinous processes of the VII cervical and I thoracic vertebrae and from the supraspinous ligament. Its bundles pass obliquely - from top to bottom and laterally and are attached to the medial edge of the scapula, above the level of the spine of the scapula.

The rhomboid major muscle originates from the spinous processes of the II-V thoracic vertebrae; attaches to the medial edge of the scapula - from the level of the spine of the scapula to its lower angle.

The rhomboid muscles, located deeper than the trapezius muscle, themselves cover the posterior superior serratus muscle and partially the erector spinae muscle.

Function: brings the scapula closer to the spine, while simultaneously moving it upward.

Innervation: n. dorsalis scapulae (Civ-Cv).

Blood supply: a. transversa cervicis, a. suprasca-pularis, aa. intercostales posteriores.

Two thin flat muscles are attached to the ribs - the superior and inferior serratus posterior (Fig. 118).

Serratus posterior superior muscleT.serratus posterior superior, located in front of the rhomboid muscles, begins in the form of a flat tendon plate from the lower part of the nuchal ligament and the spinous processes of the VI-VII cervical and I-II thoracic vertebrae. Directing obliquely from top to bottom and laterally, it is attached with separate teeth to the posterior surface of the II-V ribs, outward from their corners.

Function: raises the ribs.

Innervation: nn. intercostales (Thi-Thiv).

Blood supply: aa. intercostales posteriores, a. cervicalis profunda.

Serratus posterior inferior muscleT.serratus posterior inferior, lies in front of the latissimus dorsi muscle, begins with a tendon plate from the spinous processes of the XI-XII thoracic and I-II lumbar vertebrae; closely fused with the superficial plate of the thoracolumbar fascia and the beginning of the latissimus dorsi muscle. Attached by separate muscular teeth to the four lower ribs.

Function: lowers the ribs.

Innervation: pp. intercostales (Thix-Thxn).

Blood supply: aa. intercostales posteriores.

DEEPMUSCLESBACKS

The deep back muscles form three layers: superficial, medium and deep. The superficial layer is represented by the splenius capitis muscle, the splenius neck muscle and the erector spinae muscle; the middle layer is the transverse spinalis muscle; the deep layer is formed by the interspinous, intertransverse and suboccipital muscles.

The muscles of the superficial layer, which are the type of strong muscles that perform predominantly static work, achieve the greatest development. They extend throughout the back and back of the neck from the sacrum to the occipital bone. The origins and attachments of these muscles occupy large surfaces and therefore, when contracting, the muscles develop great force, holding the spine in an upright position, which serves as a support for the head, ribs, entrails and upper limbs.

The muscles of the middle layer are oriented obliquely, spreading from the transverse processes to the spinous processes of the vertebrae. They form several layers, and in the deepest layer the muscle bundles are the shortest and are attached to adjacent vertebrae; The more superficial the muscle bundles lie, the longer they are and the greater the number of vertebrae they spread over (from 5 to 6).

In the deepest (third) layer, the short muscles are located between the spinous and transverse processes of the vertebrae. They are not present at all levels of the spine; they are well developed in the most mobile parts of the spinal column: cervical, lumbar and lower thoracic. This deep layer includes the muscles located in the back of the neck and acting on the atlanto-occipital joint. They are called the suboccipital muscles.

The deep muscles of the back become visible after the superficial muscles are prepared layer by layer and transected: the latissimus dorsi muscle and the trapezius muscle - in the middle between the points of their origin and insertion (Fig. 119).

Belt head muscle, T.splenius capitis, located directly anterior to the upper parts of the sternocleidomastoid and trapezius muscles. It starts from the lower half of the nuchal ligament (below the level of the IV cervical vertebra), from the spinous processes of the VII cervical and the upper three to four thoracic vertebrae. 1 The bundles of this muscle pass upward and laterally and are attached to the mastoid process of the temporal bone and the rough area under the lateral segment of the superior nuchal line of the occipital bone.

Function: with bilateral contraction, the muscles extend the cervical spine and head; with unilateral contraction, the muscle turns the head in its direction.

Innervation: posterior branches of the cervical spinal nerves (Csh - Cvin).

splenius neck muscle,T.splenius cervicis, starts from the spinous processes of the III-IV thoracic vertebrae. It is attached to the posterior tubercles of the transverse processes of the two or three upper cervical vertebrae, covering from behind the beginning of the fascicles of the levator scapulae muscle. Located in front of the trapezius muscle.

Function: with simultaneous contraction, the muscles extend the cervical part of the spine; with unilateral contraction, the muscle turns the cervical part of the spine in its direction.

Innervation: posterior branches of the cervical spinal nerves (Ciii-Cviii).

Blood supply: a. occipitalis, a. cervicalis profunda.

Muscle, straightening the spine T.erector spinae. This is the strongest of the autochthonous muscles of the back, extending along the entire length of the spine - from the sacrum to the base of the skull. It lies anterior to the trapezius, rhomboid, serratus posterior, and latissimus dorsi muscles. The back is covered with a superficial layer of the thoracolumbar fascia. It begins with thick and strong tendon bundles from the dorsal surface of the sacrum, spinous processes, supraspinous ligaments, lumbar, XII and XI thoracic vertebrae, posterior segment of the iliac crest and thoracolumbar fascia. Part of the tendon bundles, starting in the sacrum, merges with the bundles of the sacrotuberous and dorsal sacroiliac ligaments.

At the level of the upper lumbar vertebrae, the muscle is divided into three paths: lateral, intermediate and medial. Each tract gets its own name: the lateral one becomes the iliocostal muscle, the intermediate one becomes the spinalis muscle. Each of these muscles is in turn divided into parts.

The structural features of the erector spinae muscle developed during anthropogenesis in connection with upright posture. The fact that the muscle is highly developed and has a common origin on the bones of the pelvis, and above is divided into separate tracts that attach widely on the vertebrae, ribs and at the base of the skull, can be explained by the fact that it performs the most important function - it holds the body in an upright position. At the same time, dividing the muscle into separate tracts, subdividing the latter at different levels of the dorsal side of the body into shorter muscles that have a shorter length between the points of origin and insertion, allows the muscle to act selectively. So, for example, when the iliocostal lumbar muscle contracts, the corresponding ribs are pulled downwards and thereby create a support for the manifestation of the force of the diaphragm during its contraction, etc.

Iliocostalis muscle,T.iliocostalis (see Fig. 119), is the most lateral part of the erector spinae muscle. It starts from the iliac crest, the inner surface of the superficial plate of the thoracolumbar fascia. Passes upward along the posterior surface of the ribs laterally from the corners of the latter to the transverse processes of the lower (VII- IV) cervical vertebrae. According to the location of individual parts of the muscle in different areas, it is divided into the iliocostal lumbar muscle, the iliocostal muscle of the chest and the iliocostal muscle of the neck.

The iliocostal lumbar muscle, i.e.iliocostalis lumbo-git, starts from the iliac crest, the inner surface of the superficial plate of the thoracolumbar fascia, and is attached by separate flat tendons to the corners of the lower six ribs.

Iliocostal muscle of the chest, i.e.iliocostalis thoracis, starts from the six lower ribs, medially from the attachment points of the iliocostal lumbar muscle. Attaches to the upper six ribs in the area of ​​the angles and to the posterior surface of the transverse process VII cervical vertebra.

Iliocostal muscle of the neck, i.e.iliocostalis cervicis, starts from the corners III, IV, V and VI ribs (inward from the attachment points of the iliocostal muscle of the chest). Attaches to the posterior tubercles of the transverse processes of the VI-IV cervical vertebrae.

Function: together with the rest of the erector spinae muscle, straightens the spine; with unilateral contraction, tilts the spine in its direction, lowers

ribs The lower bundles of this muscle, pulling and strengthening the ribs, create support for the diaphragm.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves (Civ-Lin).

/ tx. Longissimus muscleT.longissimus, - the largest of the three muscles that form the erector spinae muscle. It is located medial to the iliocostal muscle, between it and the spinalis muscle. It contains the longissimus muscles of the chest, neck and head.

Longissimus thoracis muscle, i.e.longissimus thoracis (see Fig. 119), has the greatest extent. The muscle originates from the posterior surface of the sacrum, the transverse processes of the lumbar and lower thoracic vertebrae. Attached to the posterior surface of the lower nine ribs, between their tubercles and angles, and to the tips of the transverse processes of all thoracic vertebrae (muscle bundles).

Longissimus colli muscle, i.e.longissimus cervicis, begins with long tendons from the tips of the transverse processes of the upper five thoracic vertebrae. Attached to the posterior tubercles of the transverse processes VI-II cervical vertebrae.

Longissimus capitis muscle, i.e.longissimus capitis, begins with tendon bundles from the transverse processes of I- III infants and III-VII cervical vertebrae. It is attached to the posterior surface of the mastoid process of the temporal bone under the tendons of the sternocleidomastoid muscle and the splenius capitis muscle.

Function: the longissimus muscles of the chest and neck extend the spine and tilt it to the side; The longissimus capitis muscle extends the latter and turns the face in its direction.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves (Ci - Lv).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores, aa. lumbales.

spinalis muscle,T.spindles (see Fig. 119) is the most medial of the three parts of the erector spinae muscle. Adjacent directly to the spinous processes of the thoracic and cervical vertebrae. It is divided into the spinalis thoracis muscle, the spinalis muscle of the neck and the spinalis capitis muscle, respectively.

spinalis thoracis muscle,m. spindles thoracis, begins with 3-4 tendons from the spinous processes II and I lumbar, XII and XI thoracic vertebrae. Attaches to the spinous processes of the upper eight thoracic vertebrae. The muscle is fused with the deeper semispinalis muscle of the chest.

spinalis muscle of the neck,m. spinalis cervicis, starts from the spinous process I and II infant VII cervical vertebra and the lower segment of the nuchal ligament. Attaches to the spinous process II(Sometimes III and IV) cervical vertebra.

spinalis capitis muscle,m. spinalis capitis, begins in thin bundles from the spinous processes of the upper thoracic and lower cervical vertebrae, rises upward and attaches to the occipital bone near the external occipital protuberance. Often this muscle is missing.

Function: straightens the spine

Innervation: posterior branches of the cervical, thoracic and upper lumbar spinal nerves (Csh-Ln).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores.

Function of all erector spinae muscleT.erector spinae, quite accurately reflects its name. Since the component parts of the muscle originate on the vertebrae, it can act as an extensor of the spine and head, being an antagonist of the anterior muscles of the body. Contracting in separate parts on both sides, this muscle can lower the ribs, straighten the spine, and throw the head back. With unilateral contraction, the spine tilts in the same direction. The muscle also exhibits greater strength when bending the torso, when it performs yielding work and prevents the body from falling forward under the action of ventrally located muscles, which have a greater lever of action on the spinal column than dorsally located muscles.

Transverse spinalis muscle,T. transversospindlis . This muscle is represented by many layer-by-layer muscle bundles that run obliquely upward from the lateral to the medial side from the transverse to the spinous processes of the vertebrae. The muscle bundles of the transverse spinalis muscle are of unequal length and, spreading across a different number of vertebrae, form separate muscles: the semispinalis, multifidus and rotator cuff muscles.

At the same time, according to the area occupied along the spinal column, each of these muscles is in turn divided into separate muscles, named after their location on the dorsal side of the torso, neck and occipital region. In this sequence, individual parts of the transverse spinalis muscle are considered.

semispinalis muscle,T.semispinalis, has the form of long muscle bundles, starts from the transverse processes of the underlying vertebrae, spreads across four to six vertebrae and is attached to the spinous processes. Divided into the semispinalis muscles of the chest, neck and head.

Semispinalis muscle of the chest,m. semispinalis thoracis, starts from the transverse processes of the lower six thoracic vertebrae; attaches to the spinous processes of the four upper thoracic and two lower cervical vertebrae.

The semispinalis muscle of the neck, i.e.semispinalis cervicis, originates from the transverse processes of the six upper thoracic vertebrae and the articular processes of the four lower cervical vertebrae; attaches to the spinous processes of the V-II cervical vertebrae.

semispinalis capitis muscle,m. semispinalis capitis, wide, thick, starting from the transverse processes of the six upper thoracic and articular processes of the four lower cervical vertebrae (outward from the long muscles of the head and neck); attaches to the occipital bone between the superior and inferior nuchal lines. The muscle at the back is covered by the splenius and longissimus capitis muscles; deeper and anterior to it lies the semispinalis muscle of the neck.

Function: the semispinalis muscles of the chest and neck extend the thoracic and cervical sections of the spinal column; with unilateral contraction, the indicated sections are rotated in the opposite direction. The semispinalis capitis muscle throws the head back, turning (with unilateral contraction) the face in the opposite direction.

Innervation: posterior branches of the cervical and thoracic spinal nerves (Csh-Thxii).

Blood supply: a. cervicalis profunda, aa. intercos-tales posteriores.

Multifidus muscles,mm. multifidi, They are muscle-tendon bundles that start from the transverse processes of the underlying vertebrae and are attached to the spinous processes of the overlying ones. These muscles, spreading across two to four vertebrae, occupy grooves on the sides of the spinous processes of the vertebrae along the entire length of the spinal column, starting from the sacrum to the second cervical vertebra. They lie immediately anterior to the semispinalis and longissimus muscles.

Function: rotate the spinal column around its longitudinal axis, participate in its extension and tilt to the side.

Innervation: posterior branches of the spinal nerves (C„,-Si).

Blood supply: a. cervicalis profunda, aa. inter-costales posteriores, aa. lumbales.

Muscles - rotators of the neck, chest and lower back,vol.rotators cervicis, thoracis et lumborum, They constitute the deepest layer of the back muscles, occupying the groove between the spinous and transverse processes. The rotator cuff muscles are better defined within the thoracic spinal column. According to the length of the fascicles, the rotator muscles are divided into long and short. The long rotator muscles start from the transverse processes and attach to the bases of the spinous processes of the overlying vertebrae, spreading across one vertebra. The rotator cuff muscles are located between adjacent vertebrae.

Function: rotate the spinal column around its longitudinal axis.

Blood supply: a. cervicalis profunda, aa. intercos-tales posteriores, aa. lumbales.

Interspinous muscles of the neck, chest and lower back,vol.interspi- nales cervicis, thordcis et lumborum, connect the spinous processes of the vertebrae with each other, starting from the second cervical and below. They are better developed in the cervical and lumbar parts of the spinal column, which are characterized by the greatest mobility. In the thoracic part of the spine, these muscles are weakly expressed (may be absent).

Function: participate in the extension of the corresponding parts of the spine.

Innervation: posterior branches of the spinal nerves.

Blood supply: a cervicalis profunda, aa. intercos-tales posteriores, aa. lumbales.

Intertransversemuscleslower back, breastsAndneck, mm, intertransversarii lumborum, thordcis et cervicis, are represented by short fascicles spreading between the transverse processes of adjacent vertebrae. Better expressed at the level of the lumbar and cervical spine.

The intertransverse lumbar muscles are divided into lateral and medial, vol.intertransversarii laterdles et media­ tes lumborum. In the neck area, there are anterior (spread between the anterior tubercles of the transverse processes) and posterior intertransverse muscles of the neck, vol.intertransversarii anteriores et posteriores cervicis. The latter have a medial part, pars medialis, and the lateral part, pars lateralis.

Function: tilt the corresponding parts of the spinal column in their direction.

Innervation: posterior branches of the cervical, thoracic and lumbar spinal nerves.

Blood supply: a. cervicalis profunda, aa. intercosta-les posteriores, aa. lumbales.

BACK FASCIA

The superficial fascia covering the trapezius and latissimus dorsi muscles is poorly expressed. Well developed lumbar-thoracic fascia, fascia thoracolumbalis, which covers the deep muscles of the back.

At different levels this fascia is expressed differently. It is most developed in the lumbar region, where it is represented by superficial and deep plates that form the fascial sheath for the erector spinae muscle.

The superficial plate of the thoracolumbar fascia is attached to the spinous processes of the lumbar vertebrae, to the supraspinous ligaments and the median sacral crest. The deep plate of this fascia on the medial side is attached to the transverse processes of the lumbar vertebrae and intertransverse ligaments, below - to the iliac crest, above - to the lower edge of the XII rib and the lumbocostal ligament.

At the lateral edge of the erector spinae muscle, the superficial and deep plates of the thoracolumbar fascia are united into one. The deep plate of the thoracolumbar fascia separates the erector spinae muscle from the quadratus lumborum muscle. Within the chest wall, the thoracolumbar fascia is represented by a thin plate that separates the erector spinae muscle from more superficially located muscles. Medially, this fascia is attached to the spinous processes of the thoracic vertebrae, laterally - to the angles of the ribs. In the posterior (nuchal) region of the neck between the muscles located here there is a nuchal fascia, fascia nuchae

The thoracolumbar fascia (THF) is a dense, multi-layered system of connective tissue located in the lower back. It forms a dense fibrous connection in which the deep back muscles lie.

This fascia consists of two layers - deep (anterior) and superficial (posterior).

The deep layer of the thoracolumbar fascia stretches between the transverse processes of the lumbar vertebrae, the iliac crest and the 12th rib. It is present only in the lumbar region and lies in the space between the quadratus lumborum muscle, m. qudratus lumborum , and the erector spinae muscle m. erector spinae .

The superficial layer of the thoracolumbar fascia is attached below to the iliac crests, laterally reaches the corners of the ribs and medially is attached to the spinous processes of all vertebrae, except the cervical ones. It reaches its greatest thickness in the lumbar region, and in the upper sections it becomes significantly thinner. Laterally, along the lateral edge of m. erector spenae, the superficial leaf fuses with the deep one. In this way, a fibrous junction is formed in which the lumbar part lies m. erectoris spinae ; the upper sections of this muscle are located in the osteo-fibrous junction of the back.

The latissimus muscles and the posterior inferior serratus muscles begin from the superficial leaf. The transverse abdominal muscle begins from the deep layer of fascia, as well as from the place of its fusion with the superficial layer.

Some muscles influence the configuration and structure of the PGF. The erector spinae muscle creates tension caudally through the fibrous junction. The latissimus dorsi, trapezius, rhomboids, and serratus muscles exert a strong influence from above. The transverse abdominis muscle exerts a lateral influence; it is obvious that the internal oblique muscles can also influence the thoracolumbar fascia. The lower extremities act through the gluteal fascia, from the iliac crest laterally through the gluteal muscle, and medially from the posterior superior ilium.

Function

The PGF forms a stable, relatively inelastic support, which ensures stabilization of the pelvis, torso and limbs, and also distributes the load between different zones.

When the transverse abdominis muscles are activated to pull the iliacus muscles toward the midline, the mesh structure of the thoracolumbar fascia limits the lateral movement of the pelvic bones and stabilizes the sacroiliac joints.

The horizontal tension created by the transverse abdominis muscles and thoracolumbar fascia effectively compresses the abdominal cavity and stabilizes the pelvis and lumbar spine.

Different muscles contribute to balanced tension in the rhomboid
thoracolumbar fascia, including the erector spinae muscle groups (purple arrows), latissimus dorsi (blue arrows), transverse abdominis (green arrows), and gluteal muscles (white arrows).

Dysfunction

Maintaining proper mobility and stability in the thoracolumbar fascia is critical in preventing injury, pain, and dysfunction of the pelvis and lower back. Deviations in body position, asymmetrical muscle tension, and impaired movement patterns all contribute to distorted and ineffective functioning of the fascial system. Proper identification and elimination of tension in the PMF contributes to normal and effective muscle function.

• Sit on the floor, stretch your legs forward.
• Pull your socks towards you.
• Extend both arms forward, lean forward, and try to touch your stomach to your hips.
• Stay in this position and take a few deep breaths.

This pose helps relieve tension in the psoas, iliacus, rectus femoris, and lower back.
Additionally, this exercise helps restore a neutral position in the pelvis and lumbar spine by increasing vertical height and decreasing horizontal pressure in the thoracolumbar fascia; exercise improves sacroiliac and lumbar stability.