The nervous and vascular pathways continue, to cross a space between the clavicle and the first rib costoclavicular space [ 16 ]. The sub-coracoid tunnel, below the tendon of the pectoralis minor muscle, is the third passage portion of the vascular-nervous package [ 16 ]. Inside the upper thoracic diaphragm, we find the pleural dome and the Sibson fascia [ 18 ].
The lingual complex is made up of intrinsic and extrinsic muscles. The intrinsic muscles are: transversalis, verticalis, inferior longitudinalis and superior longitudinalis [ 19 ]. The extrinsic muscles, unlike the previous ones, involve the mandibular bone in particular the genioglossus muscle and the hyoid bone: genioglossus, styloglossus, hyoglossus and palatoglossus.
The intrinsic and extrinsic muscles are in pairs right and left , for a total of 16 muscles [ 19 ]. Some authors consider two other muscles forming the lingual complex, which are part of the extrinsic musculature: glossopharyngeus and chondroglossus.
The first is a muscle strip from the superior pharyngeal constrictor muscle, while the second is a small contractile district, which derives from the hyoglossus muscle [ 19 ]. The innervation of the tongue comes from the lingual nerve and the hypoglossal nerve; the two nerves communicate before reaching the lingual complex [ 20 ]. The hypoglossal nerve with the lateral and medial branches enters the ventrolateral area of the tongue and innervates the genioglossus muscle of the right and left in its posterior portion , building a cross innervation [ 21 ].
The image shows above some portions of the meninges, while the following image below shows the venous sinuses and some arteries. Figure A shows the tentorium cerebelli, occipital bone, corpus callosum, lateral ventricle and cerebellum.
Figure B shows the superior sagital sinus, vein of Galen, internal cerebral vein, inferior sagital sinus, pericallosal artery, cortical veins, straight sinus, ophthalmic artery, confluence of sinuses, superior petrosal sinus, occipital sinus, inferior petrosal sinus, internal carotid artery, internal jugular vein, sigmoid sinus and transverse sinus.
The tentorium cerebelli is located in the posterior cranial fossa with a semilunar shape; it is a transverse septum or tentorial diaphragm. It covers the cerebellum and acts as a support for the occipital lobes of the brain mass.
Above the supratentorial portion and in the center, the falx of the brain merges, to continue below with the falx of the cerebellum [ 22 ]. The anterior portion is concave while its posterior area is convex; the tentorium splits and involves in its path the upper edge of the petrous portion of the temporal bone and posteriorly the squama of the occipital bone and part of the parietal bone, including the upper petrous sinus and the transverse sinus, respectively [ 22 ].
From the outside, we can delimit the tentorium cerebelli with our fingers, as it is possible to imagine a line right and left that starts from the external occipital protuberance up to asterion, a small depression that delimits the intersection of the temporal, parietal and occipital bones. The supratentorial innervation is provided by the nervus tentorii, an ophthalmic branch of the trigeminal nerve [ 22 ].
The subtentorial area is affected by the spinal nerves C1-C3 , which pass through the foramen magnum of the occipital bone and hypoglossal holes, and by the tenth cranial or vagus nerves and twelfth cranial or hypoglossal [ 22 ]. The sympathetic system innervates the above and subtentorial portion via the cervical perivascular plexuses; animal studies show a direct relationship with the stellate ganglion from the thoracic outlet [ 22 ]. The whole human body is a network of connections, a functional continuum, a holobiont that interacts with the inside and the outside as a unit [ 23 - 24 ].
The posterolateral areas of the five diaphragms are connected by a myofascial system connective and muscle tissue : the thoracolumbar fascia. The latter is a complex structure of muscles and ligaments comprising the nuchal area up to the lower limbs and from the surface up to the spine [ 25 ]. In particular, the first three of these muscles form a myodural bridge, which connects them to the subtentorial dura mater cerebellar falx [ 26 ].
The suboccipital muscles are part of the deep muscles of the thoracolumbar fascia [ 25 ]. The nuchal ligament NL , part of the trapezius muscle and the superficial thoracolumbar fascia, has a relationship with the dura mater through a fascia dense and fibrous structure called To Be Named Ligament TBNL ; TBNL, consisting of arcuate or radiated fibers, originates from the posterior and inferior edge of the NL [ 26 ].
TBNL collaborates in the formation of the myodural bridge and the occipital muscles themselves; before the myodural bridge, they send connective tissue fibers to the TBNL [ 26 ]. Throughout the dural tract of the spine, including the cervical tract and in the suboccipital area, we can find the denticulate ligaments or Hoffman's ligaments. These ligaments at the cervical level have a caudocranial direction and have a close relationship with the posterior longitudinal ligament PLL and with the spinal roots, with which roots form a functional system nerve roots and denticulate ligaments or NRDL [ 27 ].
PLL is fused with the periosteum of the vertebrae from the basioccipital area to the coccyx and venous pathways pass through its fibers which will drain into the anterior internal vertebral plexuses [ 28 ]. PLL and NRDL constitute a system that can uniquely influence the dural and muscular system, as the movement of the vertebrae stimulates the change of myofascial and fascial tension muscles and ligaments.
The ligamenta flava has a close relationship with the dural tissue at the cervical level and throughout the vertebral tract, through the posterior epidural ligaments PELs [ 29 ].
The suboccipital muscles merge with the occipitofrontalis or epicranius muscle; this muscle covers the occipital-parietal-frontal area, through a muscular area occipital and frontal and an aponeurosis below the galea capitis or aponeurotic galea [ 7 ].
From an embryological point of view, the musculature of the tongue derives from the occipital area and in adults we find these occipital-cervical relationships in the suprahyoid area, including the perivertebral spaces [ 19 ].
The interpterygoid fascia starts from the base of the skull with a medial vector, covering the oval foramen and the sphenoid spine, involving the tympanosquamous suture and the sphenopetrosal fissure [ 32 ].
The interpterygoid fascia covers the anterior surface of the styloid process, merging with the styloglossus muscle part of the extrinsic musculature of the tongue and with other muscles such as the styloid and stylopharyngeal muscle, the latter two fundamentals for the functioning of the tongue [ 32 - 33 ].
The tensor-vascular styloid fascia from the lower limit of the tensor veli palatine muscle to the styloid process laterally covers the styloid prominence and merges, finally, into the fascial network of the internal carotid artery [ 32 ]. The stylopharyngeal fascia merges into the fascia of the internal carotid artery along with the fascia of the capitis lateralis muscle and the fascia of the digastric muscle [ 32 ].
The interpterygoid fascia involves the fascial system of the internal carotid anterolaterally, where different fascial structures converge [ 32 ]. The palatoglossus muscle is in continuum with the fibers of the superior pharyngeal constrictor muscle and the pharingobasilar fascia; the latter starts from the pharyngeal tubercle of the occipital bone and merges with the buccopharyngeal or visceralis fascia [ 34 - 35 ].
The visceralis fascia covers the pharyngeal muscles and other visceral structures of the neck pharynx, esophagus, larynx, thyroid [ 35 ]. The intercarotic fascia or alar fascia involves the visceralis fascia in its path [ 35 ].
The retropharyngeal bands visceral, alar and prevertebral fascia are in communion with the posterolateral muscles of the neck longus capitis and longus colli, scalene, levator scapulae through the prevertebral fascia; the prevertebral fascia can merge with the anterior longitudinal ligament ALL [ 35 ]. The alaris fascia not to be confused with the alar fascia extends from the base of the skull to the last cervical vertebrae in a caudal direction and is found between the carotid fascia and the prevertebral fascia [ 35 ].
The connective tissue layer that covers the NL or superficial fascia of the neck envelops the neck and inserts on the hyoid bone, up to the lower surface of the mandibular bone; in its path, it wraps the stylohyoid and digastric muscles, the trapezius and sternocleidomastoid muscles SCM , the mylohyoid muscle or buccal floor and the mastoid processes of the occipital bone [ 36 ].
The point of contact between the superficial and deep layer of the fascial continuum is referred to as the superficial muscular and aponeurotic system SMAS , with dense and fibrous adhesions between the two layers at the level of the parotid and preauricular portion [ 37 ].
Reproduced with permission Anastasi et al. The thoracic outlet or upper thoracic diaphragm is in myofascial continuity with the tentorium and the lingual complex through some structures, such as the trapezius muscle and all the deep muscles of the cervical tract; the superficial and deep muscles of the posterior column fall within the system of the thoracolumbar fascia [ 25 ].
The cervical posterior superficial fascial layer continues with the trapezius muscle, overcoming the supraclavicular triangle, and involves the clavicle, acromion and the spine of the scapula [ 36 ]. The posterior cervical layer merges with the superficial layer at the level of the scapula, merging with the connective tissue of the subclavian artery [ 36 ].
The prevertebral fascia covers the deep fascia and divides at the level of the carotid tubercle or Chassaignac tubercle at the height of the sixth cervical vertebra; the fascia follows the deep muscles medial to the longus colli and the lateral portion of the anterior scalene , crosses the lateral cervical triangle through the posterior interscalene space [ 35 ].
When the prevertebral fascia divides, it comes into contact with the epidural space between the yellow ligament and the dura mater , creating another important dural contact site; the prevertebral fascia continues its work of connection between the tentorium cerebelli, the lingual complex, the thoracic outlet [ 35 ]. Through the ALL, the prevertebral fascia touches the suprapleural membrane or Sibson fascia, while laterally it merges with the fasciae of the axilla creating the axillary ligament or axillary arch or Langher arch [ 38 ].
The connective tissue that surrounds each structure not only brings together every anatomical aspect solid and liquid fascia but this fascial continuum allows the movement of the different structures and the transmission of innumerable biochemical and mechanometabolic messages [ 24 ]. The hyoid bone plays an important role in that it connects the base of the skull, the tongue and the buccal floor, and the shoulder girdle thoracic outlet ; the omohyoid muscle connects the myofascial infrahyoid portion, the scapula, and the posterior portion of the thoracolumbar fascia.
The omohyoid muscle can also arise from the mastoid process of the temporal bone and merge with the SCM muscle in the clavicular portion, creating the sternocleid-omomastoid muscle or affect the hyoid bone and clavicle; it can arise from the transverse process of C6 or come into contact and then merge with the sternohyoid muscle or in rare cases, it may be absent [ 39 ].
Usually, the omohyoid muscle runs posterior to the SCM muscle and passes over the internal jugular vein. The infrahyoid muscles are surrounded by the deep fascial layer, which layer touches the SCM muscle laterally [ 40 ]. The fasciae of the cervical tract will form the various connective layers that relate the diaphragm muscle and the previous diaphragms [ 2 , 7 ]. The deep fascia of the neck when it reaches the thoracic outlet divides, wrapping the intercostal muscles and the internal thoracic chest endothoracic fascia ; the latter is in contact with the parietal pleura [ 41 ].
The endothoracic fascia is in communication with all the viscera of the mediastinum through the visceral fascia. The viscera of the mediastinum are covered by a visceral fascia deriving from the deep fascia of the neck: the fascia covering the parietal pleura communicates with the parietal pericardium; the Morosow fascia or interpleural ligament connects the two lungs posteriorly; the esophagus and aorta communicate with the two lungs via fascial ramifications of the meso-esophagal fascia; the latter also connects the bronchi, the parietal pericardium and the trachea [ 41 ].
The broncho-pericardial or tracheobronchial-pericardial fascia connects the bronchi and the parietal pericardium in the area of the left atrium; the pretracheal anterior fascia originates from the thyroid cartilage merges with the posterior portion of the pericardium and the endothoracic fascia that covers the diaphragm muscle [ 41 ]. The parietal pericardium touches the posterior endothoracic fascia of the sternal body and some ribs fourth to the sixth in the left area , the endothoracic fascia that covers the diaphragm muscle or the phrenopericardial ligament; it continues posteriorly to merge with the endothoracic fascia at the level of DD11, enveloping the aorta and esophagus [ 41 ].
The carpals are…. The jejunum is one of three sections that make up the small intestine. Learn about its function and anatomy, as well as the conditions that can affect….
Health Conditions Discover Plan Connect. Diaphragm Overview. Diaphragm anatomy and function. These openings include the: Esophageal opening. The esophagus and vagus nerve , which controls much of the digestive system, pass through this opening.
Aortic opening. The thoracic duct , a main vessel of the lymphatic system, also passes through this opening. Caval opening. The inferior vena cava , a large vein that transports blood to the heart, passes through this opening. Diaphragm diagram. Explore the interactive 3-D diagram below to learn more about the diaphragm.
Diaphragm conditions. A range of health conditions can affect or involve the diaphragm. Hiatal hernia A hiatal hernia happens when the upper part of the stomach bulges through the esophageal opening of the diaphragm. But a larger hiatal hernia may cause some symptoms, including: heartburn acid reflux trouble swallowing chest pain that sometimes radiates to the back Larger hiatal hernias sometimes require surgical repair, but other cases are usually manageable with over-the-counter antacid medication.
Diaphragmatic hernia A diaphragmatic hernia happens when at least one abdominal organ bulges into the chest through an opening in the diaphragm. They may include: difficulty breathing rapid breathing rapid heart rate blueish-colored skin bowel sounds in the chest Both an ADH and CDH require immediate surgery to remove the abdominal organs from the chest cavity and repair the diaphragm. Cramps and spasms A diaphragmatic cramp or spasm can cause chest pain and shortness of breath that can be mistaken for a heart attack.
Diaphragm spasms usually go away on their own within a few hours or days. It is important not to over activate more superficial fibers of the perineum because they contain the anal and urethra sphincters, which are also associated with the downward movement of apana elimination of water and solids.
Try it on a Pilates roll down; the normal way is to exhale as we go towards the fetal position. Now try it on the first part of a sun salutation so inhale down to uttanasana and exhale to ardha uttanasan and feel the difference. We also have additional effects when we use our arms and bodies in Sun salutations. Postural responses of this type are thought to counteract the challenge to postural stability caused by reactive forces from the limb movement. The gateway to the respiratory passage is through the glottis, which is not a structure but the space between the chords.
The glottis is restful and not restricted in more restorative practices in yoga and sleeping. Did you know that adults breathe 21, breaths per day? Fascia will respond to its loading history from our stress and strengths. It has taken many years to develop patterns in our body and so it will take time to develop new patterns and master the art of breathing.
After all many yogis spend a life time just doing this. Now you understand the four diaphragms think of the breath going into every cell of the body, a full degrees.
The breath should move as motion and rhythm echoing and transmitting though all the facial layers of the body. Think of how a baby starts in the womb and adds cavities and layers as it grows bigger and bigger developing as a whole.
Breathing Part 3 — The 4 Diaphragms. Previous Next. View Larger Image. About the Author: Nisha Srivastava. Nisha is a certified Chek practitioner and holistic lifestyle coach.
The pelvic diaphragm or pelvic floor is associated with this junction Fig. It is composed of muscle fibres of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. In myofascial release, the function of the diaphragms is evaluated by feeling for the quality—its volume and smoothness of flow—of the tide flowing through each diaphragm.
The amplitude and the quality of the tide is more important rather than its frequency. Place one hand below the area under the client and one hand over the area of the diaphragm.
Apply a gentle pressure focussing on the diaphragm, and follow any inherent tissue motion. It is important not to allow the tissue to go back in the direction from which it has just moved.
This hold will produce a softening and lengthening of tissues. Sometimes it can increase the breath, build-up of heat, and stomach gurgling. It can also encourage unwinding or unconscious movement of limbs.
When a pulse, or energetic repelling is felt, it signals that the release is complete and the therapist should remove their hands. This myofascial release treatment aims to decreases tissue hypertonus, promotes energy and fluid exchange, and restores mobility and balance to their constituent structures. Eastland Press.
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