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Stretch reflex

From Wikipedia, the free encyclopedia

The patellar reflex is an example of the stretch reflex.

The stretch reflex (myotatic reflex), or more accurately "muscle stretch reflex", is a muscle contraction in response to stretching a muscle. The function of the reflex is generally thought to be maintaining the muscle at a constant length but the response is often coordinated across multiple muscles and even joints.[1] The older term deep tendon reflex is now criticized as misleading. Tendons have little to do with the response, and some muscles with stretch reflexes have no tendons. Rather, muscle spindles detect a stretch and convey the information to the central nervous system.[2]

As an example of a spinal reflex, it results in a fast response that involves an afferent signal into the spinal cord and an efferent signal out to the muscle. The stretch reflex can be a monosynaptic reflex which provides automatic regulation of skeletal muscle length, whereby the signal entering the spinal cord arises from a change in muscle length or velocity. It can also include a polysynaptic component, as in the tonic stretch reflex.[3]

When a muscle lengthens, the muscle spindle is stretched and its nerve activity increases. This increases alpha motor neuron activity, causing the muscle fibers to contract and thus resist the stretching. A secondary set of neurons also causes the opposing muscle to relax.

Gamma motoneurons regulate how sensitive the stretch reflex is by tightening or relaxing the fibers within the spindle. There are several theories as to what may trigger gamma motoneurons to increase the reflex's sensitivity. For example, alpha-gamma co-activation might keep the spindles taut when a muscle is contracted, preserving stretch reflex sensitivity even as the muscle fibers become shorter. Otherwise the spindles would become slack and the reflex would cease to function.

This reflex has the shortest latency of all spinal reflexes including the Golgi tendon reflex and reflexes mediated by pain and cutaneous receptors.[4]

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Transcription

Voiceover: In this video, I'm gonna talk about the muscle stretch reflex. The nervous system performs many reflexes. And a reflex is a response to a stimulus that doesn't require the involvement of consciousness. All reflexes have two parts. The first part is called the afferent part, afferent. And that involves bringing information about a stimulus in to the central nervous system. So there'll be some sort of receptor somewhere in the body that can detect the stimulus. And then there'll be some sort of neuron that brings that information in to the central nervous system. The other part of a reflex is called the efferent part of the reflex. Efferent, which carries information away from the central nervous system to cause a response somewhere in the periphery. So there will be some sort of neuron that'll carry that information away from the central nervous system out into the periphery to cause some sort of response. Now, some reflexes, like the muscle stretch reflex that I'm just about to describe happen on the same side so that the afferent part of the reflex brings information in from one side of the body. And the efferent part of the reflex brings information back to that same side of the body to cause the response. Other reflexes, particularly those up in the brain stem, have an afferent limb that comes in on one side, and then efferent responses that come out to both sides. So there's some variety for how the information travels in reflexes, depending on the reflex. One of the simplest reflexes that's a good example and that happens to be one of the most medically useful is called the muscle stretch reflex, muscle stretch reflex. If a skeletal muscle, like in this drawing, here's a skeletal muscle in the arm. If this is rapidly stretched, the muscle stretch relfex will cause it to contract very quickly after it stretched presumably as a protective response to prevent injury to a muscle from being stretched too rapidly. But let's go over the one that happens around the knee. And that's also called the knee-jerk. Because most of us are probably familiar with this one. Because a lot of us, when we're in our doctor's office, have had the experience where we're sitting in a chair. So here, I've drawn a person. And we're looking at their right side. And here's their trunk and their leg. And if you're in the clinic, often your doctor will take a little, rubber hammer. And they'll take that little, rubber hammer. And they'll hit you right below the kneecap. And to your surprise, when they hit you below the kneecap with the little, rubber hammer, your leg will often kick out without you telling your leg to kick out. There's this involuntary response of the leg kicking out to the stimulus of the rubber hammer hitting you just below the kneecap. So why does this happen? Well, the place that your doctor's hitting you at the little, rubber hammer is not actually in the kneecap, itself. But it's in the tendon that's just below the kneecap. So let me draw that here in orange. And that tendon hooks onto the bones in the lower leg. And connected to the kneecap on the other side from the tendon is a large group of muscles in the front of the thigh. And when your doctor hits you in that tendon, it actually stretches this large group of muscles. Because for just a moment, the little, rubber hammer bends this tendon, and that pulls on the kneecap like this. And that pulls on this muscle, and it stretches it. Now, it doesn't stretch it very far. But it does stretch it rapidly. And there are receptors in skeletal muscle that can detect muscle stretch. I'll just write a big "R" here to represent one of the receptors. And there are lots of these receptors spread out throughout all of the skeletal muscle in the body. And these receptors are called muscle spindles. Muscle spindles, and here's a drawing of a muscle spindle. So here's a skeletal muscle. And they've magnified this little receptor. And we won't go into the details. But there are these specialized, little fibers inside the muscle spindle that gets stretched when the rest of the muscle gets stretched. And then there are neuron axons that are wrapped around these special fibers that can detect that stretch of these fibers and send that information back into the central nervous system. So that these axons that are leaving the muscle spindle here will travel back through nerves of the peripheral nervous system. And then they'll enter either the spinal cord or the brain stem. And these are somatosensory neurons that tend to have their somas and ganglia close to the spinal cord or the brain stem. And since these are neurons carrying information into the central nervous system, we can call them afferent neurons. And they make up the afferent part of the muscle stretch reflex. Let me just write that out. That for the muscle stretch reflex, the afferent part or the somatosensory neurons, somatosensory neurons inside the central nervous system. Like here in the spinal cord, these somatosensory neurons carrying that muscle stretch information, that information about the stimulus, are gonna form an excitatory synapse. So let me just draw a little plus sign here to represent an excitatory synapse with another neuron, whose soma is in the central nervous system. And this neuron is gonna send an axon out through nerves of the peripheral nervous system back to the same muscle that was stretched. And it's gonna synapse on and excite skeletal muscle cells in that same muscle. Causing the muscle to contract, causing the response. And the neurons that synapse on and control skeletal muscle cells are lower motor neurons. Lower motor neurons. And for the muscle stretch reflex, the lower motor neurons make up the efferent part of the reflex that causes the response of contraction of the muscle that was stretched. In the video where we went over the motor unit, we talked about lower motor neuron signs that can appear with abnormalities of the lower motor neurons. And we talked about hyporeflexia, meaning a decrease in the muscle stretch reflexes. And I think you could see why that would happen. If the lower motor neuron is not able to communicate with the muscle, then it can't tell it to contract in response to the stimulus of muscle stretch. But it turns out that you can also have diminished muscle stretch reflexes if there's a problem with these somatosensory neurons, bringing information about the muscle stretch back to the lower motor neurons. So that if there's a problem with either the lower motor neurons or the somatosensory neurons, you can have a diminished muscle stretch reflex. And it turns out this is true for all reflexes. If there's a problem with either the afferent part of the reflex, bringing stimulus information into the central nervous system, or if there's a problem with the efferent part of the reflex carrying response information out to the periphery. A problem with either the afferent or efferent part of a reflex can cause a diminished or a lost reflex. Because both parts have to be working for the reflex to occur. Now, one important thing to notice about reflexes is how all of this just occurs down here. In this case, in the spinal cord. Or it could occur in the brain stem if it was a brain stem reflex. But the higher parts of the nervous system, the cerebrum, where a lot of the higher functions of the nervous system like cognition, emotion and consciousness, they don't have to get involved for a reflex like this to occur. And this is the reason we say reflexes are responses to stimuli that don't require the involvement of consciousness. Because the wiring tends to occur at these lower parts of the central nervous system and peripheral nervous system without having to involve the higher parts of the nervous system way up in the cerebrum. Now, this is all you need for the muscle stretch reflex. But there is another part to it that isn't necessary. But does add something, because it turns out that while this muscle is contracting, in response to the stretch of the muscle, the muscle on the opposite side, in this example, the muscle on the back of the thigh that bends the knee when it contracts. This muscle actually relaxes. So while the muscle on the front of the thigh is contracting, the muscle on the back is relaxing. The way this occurs is that this same somatosensory neuron that's exciting the lower motor neuron back to the muscle that was stretched is also sending axon terminals to other neurons. And it's gonna excite those neurons. So I'll draw a little plus sign. But these neurons are actually inhibitory neurons. So they're gonna form a synapse that's inhibitory. So I'll draw a little minus sign to represent that they're inhibitory. And what they inhibit are lower motor neurons to the muscles on the opposite side. So these lower motor neurons would normally be exciting the muscles here in the back of the thigh that would cause the knee to bend. But when they're being inhibited by this other neuron, these lower motor neurons aren't exciting that muscle in the back of the thigh, so it relaxes. Now, this isn't necessary for the reflex to occur. You just need the afferent and the efferent part of the reflex for it to occur. But because this muscle, when it's contracting, isn't fighting against this muscle in the back of the thigh since it's relaxing, that does increase the response. So there's more straightening of the leg at the knee and kicking outward. And a lot of the reflexes in the nervous system have some similarities to this sort of setup. Where you can almost think of a balance between responses that the nervous system can choose from. And that the reflex tips the balance in favor of a response in one direction.

Structures

The stretch reflex is accomplished through several different structures. In the muscle, there are muscle spindles, whose intrafusal muscle fibers lie parallel to the muscle and sense changes in length and velocity. The afferent sensory neuron is the structure that carries the signal from the muscle to the spinal cord. It carries this action potential to the dorsal root ganglion of the spinal cord. The efferent motor neuron is the structure that carries the signal from the spinal cord back to the muscle. It carries the action potential from the ventral root of the spinal cord to the muscle down the alpha motor neuron.[5] This synapses on the first structure discussed, the extrafusal fibers of the muscle spindle.

Examples

A person standing upright begins to lean to one side. The postural muscles that are closely connected to the vertebral column on the opposite side will stretch. The muscle spindles in those muscles will detect this stretching, and the stretched muscles will contract to correct posture.

Other examples (followed by involved spinal nerves) are responses to stretch created by a blow upon a muscle tendon:

Another example is the group of sensory fibers in the calf muscle, which synapse with motor neurons innervating muscle fibers in the same muscle. A sudden stretch, such as tapping the Achilles' tendon, causes a reflex contraction in the muscle as the spindles sense the stretch and send an action potential to the motor neurons which then cause the muscle to contract; this particular reflex causes a contraction in the soleus-gastrocnemius group of muscles. Like the patellar reflex, this reflex can be enhanced by the Jendrassik maneuver.

Spinal control

Spinal control of the stretch reflex means the signal travels between the muscle and spinal cord. The signal returns to the muscle from the same spinal cord segment as where it entered the spinal cord. This is the shortest distance for a reflex signal to travel, thus creating a fast response. These responses are often referred to as short latency stretch reflexes.[6]

Supraspinal control

Supraspinal control of the stretch reflex means the signal travels above the spinal cord before traveling back down to the same segment it entered the spinal cord from. The responses from these pathways are often termed medium or long latency stretch reflexes, because the time course is longer due to distance it needs to travel.[7] The central nervous system can influence the stretch reflex via the gamma motoneurons, which as described above control the sensitivity of the reflex.

Clinical significance

The patellar reflex (knee jerk) is an example of the stretch reflex and it is used to determine the sensitivity of the stretch reflex. Reflexes can be tested as part of a neurological examination, often if there is an injury to the central nervous system. To test the reflex, the muscle should be in a neutral position. The muscle being tested needs to be flexed for the clinician to locate the tendon. After the muscle is relaxed, the clinician strikes the tendon. The response should be contraction of the muscle. If this is the knee jerk reflex, the clinician should observe a kick. The clinician rates the response.[8]

Grading of stretch reflexes upon tapping muscle tendon[9]
Grade Response Significance
0 no response always abnormal
1+ slight but definitely present response may or may not be normal
2+ brisk physiologic response normal
3+ very brisk response may or may not be normal
4+ clonus always abnormal

The clasp-knife response is a stretch reflex with a rapid decrease in resistance when attempting to flex a joint. It is one of the characteristic responses of an upper motor neuron lesion.[10]

See also

References

  1. ^ Reschechtko S; Pruszynski JA (2020). "Stretch Reflexes". Curr Biol. 30 (18): R1025–R1030. doi:10.1016/j.cub.2020.07.092. PMID 32961152.
  2. ^ Evidence-Based Physical Diagnosis; McGee; Chapter 63. 2018
  3. ^ Neilson PD (December 1972). "Interaction between voluntary contraction and tonic stretch reflex transmission in normal and spastic patients". J Neurol Neurosurg Psychiatry. 35 (6): 853–60. doi:10.1136/jnnp.35.6.853. PMC 494192. PMID 4346023.
  4. ^ Spirduso, Waneen Wyrick (1978). "Hemispheric Lateralization and Orientation in Compensatory and Voluntary Movement". Information Processing in Motor Control and Learning. pp. 289–309. doi:10.1016/B978-0-12-665960-3.50019-0. ISBN 9780126659603.
  5. ^ Dolbow, James; Bordoni, Bruno (2019), "Neuroanatomy, Spinal Cord Myotatic Reflex", StatPearls, StatPearls Publishing, PMID 31869093, retrieved 2019-12-30
  6. ^ Feher, Joseph (2012). "Spinal Reflexes". Quantitative Human Physiology. pp. 332–340. doi:10.1016/B978-0-12-382163-8.00036-0. ISBN 9780123821638.
  7. ^ Eldred E; Granit R; Merton PA (1953). "Supraspinal control of the muscle spindles and its significance". J Physiol. 122 (3): 498–523. doi:10.1113/jphysiol.1953.sp005017. PMC 1366137. PMID 13118557.
  8. ^ Walkowski, A. D.; Munakomi, S. (2019). "Monosynaptic Reflex". StatPearls. PMID 31082072.
  9. ^ Walker, H. K. (1990). Walker, H. K.; Hall, W. D.; Hurst, J. W. (eds.). "Deep Tendon Reflexes". Clinical Methods: The History, Physical, and Laboratory Examinations. PMID 21250237. [1]
  10. ^ Ashby Pl; Mailis Al; Hunter J (1987). "The evaluation of "spasticity"". Can J Neurol Sci. 14 (3 Suppl): 497–500. doi:10.1017/s0317167100037987. PMID 3315151.

External links

This page was last edited on 11 May 2024, at 16:16
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