Anatomic connections of the diaphragm: influence of respiration on the body system

Bruno Bordoni, Emiliano Zanier, Bruno Bordoni, Emiliano Zanier

Abstract

The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.

Keywords: diaphragm; fascia; pelvis; phrenic nerve; vagus nerve.

Figures

Figure 1
Figure 1
The area above the diaphragm: the dotted line for the support of heart 3: inferior vena cava; 10: esophagus; 9: aorta; 8: tendinous center; 5: lumbar area. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Several authors, Human Anatomy, Fourth Edition, edition EdiErmes]. www.eenet.it.
Figure 2
Figure 2
The sub-diaphragmatic area: 2: tendinous center or phrenic; 16: inferior vena cava; 3: esophagus; 5: aortic orifice; 15: medial pillar; 14: intermediate pillar; 13: pillar lateral; 6: pillar arcuate medial; 7: lateral arcuate ligament; 10: quadratus lumborum muscle; 11: psoas major muscle. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes [Several authors, Human Anatomy, Fourth Edition, edition EdiErmes], Milano. www.eenet.it
Figure 3
Figure 3
The cervico-cranial area: 1: lesser occipital nerve or C2; 19: cranial nerve XII; 4: cranial nerve X; 5: cranial nerve XI; 17: geniohyoid muscle; 10: phrenic nerve. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, [Several authors, Human Anatomy, Fourth Edition, edition EdiErmes], Milano. www.eenet.it.

References

    1. Downey R. Anatomy of the normal diaphragm. Thorac Surg Clin. 2011;21(2):273–279.
    1. Anraku M, Shargall Y. Surgical conditions of the diaphragm: anatomy and physiology. Thorac Surg Clin. 2009;19(4):419–429.
    1. Clugston RD, Greer JJ. Diaphragm development and congenital diaphragmatic hernia. Semin Pediatr Surg. 2007;16(2):94–100.
    1. Arráez-Aybar LA, González-Gómez CC, Torres-García AJ, Morgagni-Larrey Parasternal diaphragmatic hernia in the adult. Rev Esp Enferm Dig. 2009;101(5):357–366.
    1. Debergh I, Fierens K. Laparoscopic repair of a Bochdalek hernia with incarcerated bowel during pregnancy: report of a case. Surg Today. Jan 5, 2013. [Epub ahead of print.]
    1. Dakwar E, Ahmadian A, Uribe JS. The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach. J Neurosurg Spine. 2012;16(4):359–364.
    1. Shaw HM, Santer RM, Watson AH, Benjamin M. Adipose tissue at entheses: the innervation and cell composition of the retromalleolar fat pad associated with the rat Achilles tendon. J Anat. 2007;211(4):436–443.
    1. Mirjalili SA, Hale SJ, Buckenham T, Wilson B, Stringer MD. A reappraisal of adult thoracic surface anatomy. Clin Anat. 2012;25(7):827–834.
    1. Drake R, Vogl AW, Mitchell AWM. Gray’s Anatomy for Students. 2nd ed. New York, NY: Elsevier-Churchill-Livingstone; 2009.
    1. Gest TR, Hildebrandt S. The pattern of the thoracic splanchnic nerves as they pass through the diaphragm. Clin Anat. 2009;22(7):809–814.
    1. Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512–522.
    1. Ozel A, Toksoy G, Ozdogan O, Mahmutoglu AS, Karpat Z. Ultrasonographic diagnosis of median arcuate ligament syndrome: a report of two cases. Med Ultrason. 2012;14(2):154–157.
    1. Cai W, Li HZ, Zhang X, et al. Medial arcuate ligament: a new anatomic landmark facilitates the location of the renal artery in retroperitoneal laparoscopic renal surgery. J Endourol. 2013;27(1):64–67.
    1. Silverman PM, Cooper C, Zeman RK. Lateral arcuate ligaments of the diaphragm: anatomic variations at abdominal CT. Radiology. 1992;185(1):105–108.
    1. Loukas M, Shoja MM, Thurston T, Jones VL, Linganna S, Tubbs RS. Anatomy and biomechanics of the vertebral aponeurosis part of the posterior layer of the thoracolumbar fascia. Surg Radiol Anat. 2008;30(2):125–129.
    1. Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P. Transversalis, endoabdominal, endothoracic fascia: who’s who? Am Surg. 2006;72(1):16–18.
    1. Peiper C, Junge K, Prescher A, Stumpf M, Schumpelick V. Abdominal musculature and the transversalis fascia: an anatomical viewpoint. Hernia. 2004;8(4):376–380.
    1. Wang NS. Anatomy of the pleura. Clin Chest Med. 1998;19(2):229–240.
    1. Goenka AH, Shah SN, Remer EM. Imaging of the retroperitoneum. Radiol Clin North Am. 2012;50(2):333–355.
    1. Finley DJ, Rusch VW. Anatomy of the pleura. Thorac Surg Clin. 2011;21(2):157–163.
    1. Apaydin N, Uz A, Evirgen O, Loukas M, Tubbs RS, Elhan A. The phrenico-esophageal ligament: an anatomical study. Surg Radiol Anat. 2008;30(1):29–36.
    1. van der Zypen E, Révész E. Investigation of development, structure and function of the phrenicocolic and duodenal suspensory ligaments. Acta Anat (Basel) 1984;119(3):142–148.
    1. Kim SK, Cho CD, Wojtowycz AR. The ligament of Treitz (the suspensory ligament of the duodenum): anatomic and radiographic correlation. Abdom Imaging. 2008;33(4):395–397.
    1. Restrepo CS, Eraso A, Ocazionez D, Lemos J, Martinez S, Lemos DF. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008;28(5):1289–1305.
    1. Roan E. The effect of Glisson’s capsule on the superficial elasticity measurements of the liver. J Biomech Eng. 2010;132(10):104504.
    1. Paoletti S. The Fasciae: Anatomy, Dysfunction and Treatment. 1st ed. Seattle, WA: Eastland Press; 2006.
    1. Pickering M, Jones JF. The diaphragm: two physiological muscles in one. J Anat. 2002;201(4):305–312.
    1. Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing – a dynamic MRI investigation in healthy females. Int Urogynecol J. 2011;22(1):61–68.
    1. Mantilla CB, Sieck GC. Phrenic motor unit recruitment during ventilatory and non-ventilatory behaviors. Respir Physiol Neurobiol. 2011;179(1):57–63.
    1. Boers J, Ford TW, Holstege G, Kirkwood PA. Functional heterogeneity among neurons in the nucleus retroambiguus with lumbosacral projections in female cats. J Neurophysiol. 2005;94(4):2617–2629.
    1. Sadler TW. Langman’s Medical Embryology. 12th ed. Philadelphia, PA: Wolters Kluwer Health Lippincott Williams & Wilkins; 2012.
    1. Nicaise C, Hala TJ, Frank DM, et al. Phrenic motor neuron degeneration compromises phrenic axonal circuitry and diaphragm activity in a unilateral cervical contusion model of spinal cord injury. Exp Neurol. 2012;235(2):539–552.
    1. Jones SE, Saad M, Lewis DI, Subramanian HH, Dutschmann M. The nucleus retroambiguus as possible site for inspiratory rhythm generation caudal to obex. Respir Physiol Neurobiol. 2012;180(2–3):305–310.
    1. Banneheka S. Morphological study of the ansa cervicalis and the phrenic nerve. Anat Sci Int. 2008;83(1):31–44.
    1. Kolar P, Sulc J, Kyncl M, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. 2010;109(4):1064–1071.
    1. Kwan CS, Worrilow CC, Kovelman I, Kuklinski JM. Using suboccipital release to control singultus: a unique, safe, and effective treatment. Am J Emerg Med. 2012;30(3):514.e5–e7.
    1. Giles PD, Hensel KL, Pacchia CF, Smith ML. Suboccipital decompression enhances heart rate variability indices of cardiac control in healthy subjects. J Altern Complement Med. 2013;19(2):92–96.
    1. An X, Yue B, Lee JH, Lee MS, Lin C, Han SH. Intramuscular distribution of the phrenic nerve in human diaphragm as shown by Sihler staining. Muscle Nerve. 2012;45(4):522–526.
    1. Correa D, Segal SS. Neurovascular proximity in the diaphragm muscle of adult mice. Microcirculation. 2012;19(4):306–315.
    1. Townend RE, McConnell P. The right inferior phrenic artery: path of its ascending branch at the vena caval foramen. Clin Anat. 2012;25(5):656–658.
    1. Young RL, Page AJ, Cooper NJ, Frisby CL, Blackshaw LA. Sensory and motor innervation of the crural diaphragm by the vagus nerves. Gastroenterology. 2010;138(3):1091–1101. e1–e5.
    1. Niedringhaus M, Jackson PG, Evans SR, Verbalis JG, Gillis RA, Sahibzada N. Dorsal motor nucleus of the vagus: a site for evoking simultaneous changes in crural diaphragm activity, lower esophageal sphincter pressure, and fundus tone. Am J Physiol Regul Integr Comp Physiol. 2008;294(1):R121–R131.
    1. Zhao T, Li Y, Dai X, et al. Effects of retrograde gene transfer of brain-derived neurotrophic factor in the rostral spinal cord of a compression model in rat. Mol Biol Rep. 2012;39(8):8045–8051.
    1. Yampolsky C, Hem S, Bendersky D. Dorsal column stimulator applications. Surg Neurol Int. 2012;3( Suppl 4):S275–S289.
    1. Russell FD, Koishi K, Jiang Y, McLennan IS. Anterograde axonal transport of glial cell line-derived neurotrophic factor and its receptors in rat hypoglossal nerve. Neuroscience. 2000;97(3):575–580.
    1. Helke CJ, Adryan KM, Fedorowicz J, et al. Axonal transport of neurotrophins by visceral afferent and efferent neurons of the vagus nerve of the rat. J Comp Neurol. 1998;393(1):102–117.
    1. Mantilla CB, Sieck GC. Trophic factor expression in phrenic motor neurons. Respir Physiol Neurobiol. 2008;164(1–2):252–262.
    1. Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8(8):457–465.
    1. Barraclough A, Triplett J, Tuch P. Brachial neuritis with phrenic nerve involvement. J Clin Neurosci. 2012;19(9):1301–1302.
    1. Prakash Prabhu LV, Madhyastha S, Singh G. A variation of the phrenic nerve: case report and review. Singapore Med J. 2007;48(12):1156–1157.
    1. Zhang Z, Dellon AL. Facial pain and headache associated with brachial plexus compression in the thoracic inlet. Microsurgery. 2008;28(5):347–350.
    1. Laulan J, Fouquet B, Rodaix C, Jauffret P, Roquelaure Y, Descatha A. Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact. J Occup Rehabil. 2011;21(3):366–373.
    1. Ferrante MA. The thoracic outlet syndromes. Muscle Nerve. 2012;45(6):780–795.
    1. Franko OI, Khalpey Z, Gates J. Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis. Emerg Med J. 2008;25(9):614–615.
    1. Bałkowiec A, Szulczyk P. Properties of postganglionic sympathetic neurons with axons in phrenic nerve. Respir Physiol. 1992;88(3):323–331.
    1. Nozdrachev AD, Fateev MM, Jiménez B, Morales MA. Circuits and projections of cat stellate ganglion. Arch Med Res. 2003;34(2):106–115.
    1. Lachman N, Syed FF, Habib A, et al. Correlative anatomy for the electrophysiologist, Part II: cardiac ganglia, phrenic nerve, coronary venous system. J Cardiovasc Electrophysiol. 2011;22(1):104–110.
    1. Messlinger K, Fischer MJ, Lennerz JK. Neuropeptide effects in the trigeminal system: pathophysiology and clinical relevance in migraine. Keio J Med. 2011;60(3):82–89.
    1. Eherer AJ, Netolitzky F, Högenauer C, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012;107(3):372–378.
    1. da Silva RC, de Sá CC, Pascual-Vaca AO, et al. Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux. Dis Esophagus. 2012 Jun 7; [Epub ahead of print.]
    1. Kemp WJ, 3rd, Tubbs RS, Cohen-Gadol AA. The innervation of the cranial dura mater: neurosurgical case correlates and a review of the literature. World Neurosurg. 2012;78(5):505–510.
    1. Haines DE. Neuroanatomy An Atlas of Structures, Sections, and System. 6th ed. Lippincott Williams & Wilkins; p. 2044.
    1. Bae YJ, Kim JH, Choi BS, Jung C, Kim E. Brainstem pathways for horizontal eye movement: pathologic correlation with MR imaging. Radiographics. 2013;33(1):47–59.
    1. Sakaie K, Takahashi M, Dimitrov I, et al. Diffusion tensor imaging the medial longitudinal fasciculus in INO: opportunities and challenges. Ann N Y Acad Sci. 2011;1233:307–312.
    1. Zwergal A, Strupp M, Brandt T, Büttner-Ennever JA. Parallel ascending vestibular pathways: anatomical localization and functional specialization. Ann N Y Acad Sci. 2009;1164:51–59.
    1. Kushiro K, Bai R, Kitajima N, Sugita-Kitajima A, Uchino Y. Properties and axonal trajectories of posterior semicircular canal nerve-activated vestibulospinal neurons. Exp Brain Res. 2008;191(3):257–264.
    1. Grgić V. Cervicogenic headache: etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy. Lijec Vjesn. 2007;129:6–7. 230–236. Croatian.
    1. Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India. 2001;49(4):355–359.
    1. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 2012;92(4):1651–1697.
    1. Messlinger K, Lennerz JK, Eberhardt M, Fischer MJ. CGRP and NO in the trigeminal system: mechanisms and role in headache generation. Headache. 2012;52(9):1411–1427.
    1. Meng Q, Zhang W, Yang Y, Zhou M, Li X. Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia. J Neurosurg Anesthesiol. 2008;20(2):131–135.
    1. Adeeb N, Mortazavi MM, Tubbs RS, Cohen-Gadol AA. The cranial dura mater: a review of its history, embryology, and anatomy. Childs Nerv Syst. 2012;28(6):827–837.
    1. Upadhyay J, Knudsen J, Anderson J, Becerra L, Borsook D. Noninvasive mapping of human trigeminal brainstem pathways. Magn Reson Med. 2008;60(5):1037–1046.
    1. Kahkeshani K, Ward PJ. Connection between the spinal dura mater and suboccipital musculature: evidence for the myodural bridge and a route for its dissection – a review. Clin Anat. 2012;25(4):415–422.
    1. Dean NA, Mitchell BS. Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. Clin Anat. 2002;15(3):182–185.
    1. Tubbs RS, Salter EG, Wellons JC, Blount JP, Oakes WJ. Landmarks for the identification of the cutaneous nerves of the occiput and nuchal regions. Clin Anat. 2007;20(3):235–238.
    1. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–536.
    1. Lin K, Uzbelger Feldman D, Barbe MF. Transverse cervical nerve: implications for dental anesthesia. Clin Anat. 2013 Jan 29; [Epub ahead of print.]
    1. Banneheka S. Anatomy of the ansa cervicalis: nerve fiber analysis. Anat Sci Int. 2008;83(2):61–67.
    1. Bademci G, Yaşargil MG. Microsurgical anatomy of the hypoglossal nerve. J Clin Neurosci. 2006;13(8):841–847.
    1. Borel JC, Melo-Silva CA, Gakwaya S, Sériès F. Influence of CO2 on upper airway muscles and chest wall/diaphragm corticomotor responses assessed by transcranial magnetic stimulation in awake healthy subjects. J Appl Physiol. 2012;112(5):798–805.
    1. Rice A, Fuglevand AJ, Laine CM, Fregosi RF. Synchronization of presynaptic input to motor units of tongue, inspiratory intercostal, and diaphragm muscles. J Neurophysiol. 2011;105(5):2330–2336.
    1. Wang W, Similowski T, Sériès F. Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans. Exp Physiol. 2007;92(4):739–747.
    1. Aleksandrova NP. Respiratory function of pharyngeal muscles. Usp Fiziol Nauk. 2006;37(3):11–24. Russian.
    1. Cheng S, Butler JE, Gandevia SC, Bilston LE. Movement of the tongue during normal breathing in awake healthy humans. J Physiol. 2008;586(Pt 17):4283–4294.
    1. Uysal H, Kizilay F, Unal A, Güngör HA, Ertekin C. The interaction between breathing and swallowing in healthy individuals. J Electromyogr Kinesiol. 2013;23(3):659–663.
    1. Cifra A, Nani F, Nistri A. Respiratory motoneurons and pathological conditions: lessons from hypoglossal motoneurons challenged by excitotoxic or oxidative stress. Respir Physiol Neurobiol. 2011;179(1):89–96.
    1. Grace KP, Hughes SW, Horner RL. Identification of the mechanism mediating genioglossus muscle suppression in REM sleep. Am J Respir Crit Care Med. 2013;187(3):311–319.
    1. Luo YM, Tang J, Jolley C, et al. Distinguishing obstructive from central sleep apnea events: diaphragm electromyogram and esophageal pressure compared. Chest. 2009;135(5):1133–1141.
    1. Lee KZ, Fuller DD, Lu IJ, Lin JT, Hwang JC. Neural drive to tongue protrudor and retractor muscles following pulmonary C-fiber activation. J Appl Physiol. 2007;102(1):434–444.
    1. Lee KZ, Fuller DD, Hwang JC. Pulmonary C-fiber activation attenuates respiratory-related tongue movements. J Appl Physiol. 2012;113(9):1369–1376.
    1. Jiang S, Xu WD, Shen YD, Xu JG, Gu YD. An anatomical study of the full-length phrenic nerve and its blood supply: clinical implications for endoscopic dissection. Anat Sci Int. 2011;86(4):225–231.
    1. Lidierth M. Long-range projections of Adelta primary afferents in the Lissauer tract of the rat. Neurosci Lett. 2007;425(2):126–130.
    1. Wild JM, Zeigler HP. Central projections and somatotopic organisation of trigeminal primary afferents in pigeon (Columba livia) J Comp Neurol. 1996;368(1):136–152.
    1. Cervero F, Connell LA. Distribution of somatic and visceral primary afferent fibres within the thoracic spinal cord of the cat. J Comp Neurol. 1984;230(1):88–98.
    1. Lidierth M, Wall PD. Dorsal horn cells connected to the Lissauer tract and their relation to the dorsal root potential in the rat. J Neurophysiol. 1998;80(2):667–679.
    1. Wall PD, Lidierth M, Hillman P. Brief and prolonged effects of Lissauer tract stimulation on dorsal horn cells. Pain. 1999;83(3):579–589.
    1. Nakano M, Kishida R, Funakoshi K, et al. Central projections of thoracic splanchnic and somatic nerves and the location of sympathetic preganglionic neurons in Xenopus laevis. J Comp Neurol. 2003;456(4):321–337.
    1. Mørch CD, Hu JW, Arendt-Nielsen L, Sessle BJ. Convergence of cutaneous, musculoskeletal, dural and visceral afferents onto nociceptive neurons in the first cervical dorsal horn. Eur J Neurosci. 2007;26(1):142–154.
    1. Levinthal DJ, Bielefeldt K. Pain without nociception? Eur J Gastroenterol Hepatol. 2012;24(3):336–339.
    1. Barrall JP, Mercier P. Visceral Manipulation. Revised Edition, Volume I. Seattle, WA: Eastland Press; 2006.
    1. Barrall JP, Mercier P. Visceral Manipulation. Revised Edition, Volume II. Seattle, WA: Eastland Press; 2007.
    1. Byeon K, Choi JO, Yang JH, et al. The response of the vena cava to abdominal breathing. J Altern Complement Med. 2012;18(2):153–157.
    1. Kimura BJ, Dalugdugan R, Gilcrease GW, 3rd, Phan JN, Showalter BK, Wolfson T. The effect of breathing manner on inferior vena caval diameter. Eur J Echocardiogr. 2011;12(2):120–123.
    1. Chiappa GR, Roseguini BT, Vieira PJ, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol. 2008;51(17):1663–1671.
    1. Abu-Hijleh MF, Habbal OA, Moqattash ST. The role of the diaphragm in lymphatic absorption from the peritoneal cavity. J Anat. 1995;186(Pt 3):453–467.
    1. Negrini D, Moriondo A. Lymphatic anatomy and biomechanics. J Physiol. 2011;589(Pt 12):2927–2934.
    1. Moriondo A, Bianchin F, Marcozzi C, Negrini D. Kinetics of fluid flux in the rat diaphragmatic submesothelial lymphatic lacunae. Am J Physiol Heart Circ Physiol. 2008;295(3):H1182–H1190.
    1. Stecco C, Stern R, Porzionato A, et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. 2011;33(10):891–896.
    1. Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther. 2012;16(4):503–519.
    1. Lee SL, Ku YM, Rha SE. Comprehensive reviews of the interfascial plane of the retroperitoneum: normal anatomy and pathologic entities. Emerg Radiol. 2010;17(1):3–11.
    1. Tirkes T, Sandrasegaran K, Patel AA, et al. Peritoneal and retroperitoneal anatomy and its relevance for cross-sectional imaging. Radiographics. 2012;32(2):437–451.
    1. Mihalache G, Indrei A, Tăranu T. The anterolateral structures of the neck and trunk. Rev Med Chir Soc Med Nat Iasi. 1996;100(1–2):69–74.
    1. Hung HC, Hsiao SM, Chih SY, Lin HH, Tsauo JY. An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010;15(3):273–279.
    1. O’Sullivan PB, Beales DJ. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series. Man Ther. 2007;12(3):209–118.
    1. Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–282.
    1. Soljanik I, Janssen U, May F, et al. Functional interactions between the fossa ischioanalis, levator ani and gluteus maximus muscles of the female pelvic floor: a prospective study in nulliparous women. Arch Gynecol Obstet. 2012;286(4):931–938.
    1. Schomacher J, Dideriksen JL, Farina D, Falla D. Recruitment of motor units in two fascicles of the semispinalis cervicis muscle. J Neurophysiol. 2012;107(11):3078–3085.
    1. Schuenke MD, Vleeming A, Van Hoof T, Willard FH. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. J Anat. 2012;221(6):568–576.
    1. Hodges PW, Eriksson AE, Shirley D, Gandevia SC. Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005;38(9):1873–1880.
    1. Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R. The fascia: the forgotten structure. Ital J Anat Embryol. 2011;116(3):127–138.
    1. Day JA, Copetti L, Rucli G. From clinical experience to a model for the human fascial system. J Bodyw Mov Ther. 2012;16(3):372–380.
    1. Hu H, Meijer OG, Hodges PW, et al. Control of the lateral abdominal muscles during walking. Hum Mov Sci. 2012;31(4):880–896.
    1. Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352–362.
    1. Warshafsky D, Goldenberg D, Kanekar SG. Imaging anatomy of deep neck spaces. Otolaryngol Clin North Am. 2012;45(6):1203–1221.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren