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Neuroanatomy, Spinal Cord Myotatic Reflex Cite this Page
James Dolbow; Zachary Throckmorton.
Author Information
Last Update: September 18, 2021.
In this Page
Introduction
Introduction Go to: Structure and Function
The myotatic reflex is monosynaptic, induced by the sudden passive muscle belly fiber stretch, and Embryology
produces a muscle contraction in the agonist muscle or muscle group with simultaneous antagonist
Clinical Significance
muscle (or muscle group) relaxation.[1] As with all reflexes, it is involuntary, reproducible, and
likely is positively selected evolutionarily, specifically to prevent the forceful stretching or pulling of Other Issues
a muscle beyond its normal passive range. This reflex also has utility in helping maintain upright
Review Questions
posture by detecting postural muscle group stretch and reflexively correcting accordingly in the
common cases of leaning or postural instability, which conserves expended energy.[2] Additionally References
called the deep tendon, stretch, and jerk reflex, the myotatic reflex is a fundamental and essential
part of the neurological examination since the work by Joseph Babinski, Wilheim Erb, and William
Gowers in the late 1800s.[3][4] Related information
PMC
Structure and Function Go to:
PubMed
The neuroanatomy of the myotatic reflex follows a model of five main paired neurological structures
and actions. These structures are the muscle spindle, primary afferent sensory neuron, inhibitory
interneuron, efferent alpha motor neuron, and gamma motor neuron. Before the reflex initiates, it Similar articles in PubMed
must be induced either by the unconscious passive stretch of postural muscles or performed
Review The history of examination of reflexes.
clinically by a medical provider. Tools such as reflex hammers produce a sudden passive stretch to a [J Neurol. 2014]
tendon or muscle belly.
Modulation of postural reflexes by voluntary movement.
II. Modulation at an inactive
[J Neurol
joint.Neurosurg Psychiatry....]
1: The Muscle Spindle. The myotatic reflex begins when mechanical stretch gets detected by a
fusiform-shaped microstructure called the muscle spindle, located within the muscle belly and lying Response to sudden torques about ankle in man:
myotatic reflex. [J Neurophysiol. 1979]
between and parallel with the extrafusal striated muscle fibers of a muscle or muscle group. Muscle
spindles consist of an outer connective tissue sheath containing spiral treads, six to eight intrafusal Review The stretch reflex and the contributions of C
David Marsden. [Ann Indian Acad Neurol. 2017]
specialized muscle fibers, and nerve endings.[5] Because the positioning of the intrafusal fibers of
the muscle spindle is in parallel with the extrafusal muscle fibers, they stretch and contract with the The early history of the knee-jerk reflex in neurology.
[J Hist Neurosci. 2022]
extrafusal striated muscle fibers. Muscle spindles monitor the elongation velocity of surrounding
muscle fibers. When the muscle is lengthened too far or too quickly, the myotatic reflex initiates. See reviews...
[6] Though every skeletal muscle contains several muscle spindles, muscles that provide fine
See all...
movement contain a larger concentration of muscle spindles than muscle more utilized for coarse
movement and posture.[7]

Intrafusal muscle fibers organize into three main types based on shape, function, and innervation, Recent Activity
with the majority of spindle fibers containing all three types of intrafusal fibers. Turn Off Clear
Neuroanatomy, Spinal Cord Myotatic Reflex -
Nuclear Chain Fibers: Muscle spindles typically have two-seven nuclear chain fibers that detect StatPearls
and signal information about the static length of the chain fiber itself and thus the surrounding
extrafusal muscle fibers. These intrafusal fibers are thinner and shorter than other types of intrafusal See more...

fibers and contain fewer, linearly-oriented nuclei giving them the name nuclear chain fibers. They
receive innervation by all three types of intrafusal nerves: Ia, II, and gamma motor neurons (GMN).
This article covers these nerves and their functions in a later section.[5]

Static Nuclear Bag Fibers: Named due to their centrally-clustered nuclei, these fibers also function
to relay information on the static length of the intrafusal and extrafusal muscle fibers. Longer than
the chain fibers, bag fibers extend beyond the muscle spindle sheath and attach longitudinally to the
connective tissue of the adjacent extrafusal muscle fibers. Ia, II, and GMNs innervate these fibers.[5]

Dynamic Nuclear Bag Fibers: Though structurally similar to static nuclear bag fibers, these serve a
different functional purpose of relaying information on the velocity (rate of change in length) of
muscle stretch. Ia and GMNs only innervate these fibers.[5]

The innervation of muscle spindle intrafusal fibers grossly group into two main categories, afferent
nerves (type 1a and II) that relay information about the intrafusal fibers to the spinal cord, and
efferent nerves (GMNs) that project from the spinal cord to the intrafusal fibers and function to
change the length of the intrafusal fibers for maintained reflex sensitivity.

Group 1a Afferents: Also called primary afferents, this nerve type has specialized annulospiral
nerve endings that wrap around the central nuclei-containing portion of all three types of intrafusal
fibers and relay information on both the static length and velocity of these intrafusal fibers. Because
the action potential relayed to the spinal cord from group Ia afferent is more rapid than group II
afferents and is both length and velocity-dependent, the action potential sent along Ia fibers is the
primary afferent signal utilized in the myotatic reflex.[6]

Group II Afferents: Also called secondary afferents, these have specialized flower spray endings
that attach to the ends of only nuclear chain fibers and static nuclear bag fibers, and relay a much
slower, less dynamic action potential-dependent on intrafusal muscle length only, thus not utilized in
the myotatic reflex.[6]

Gamma Motor Neurons: An in-depth explanation of the GMN appears later as it functions later in
the myotatic reflex arc.

2: The Afferent Sensory Neuron. An afferent action potential is then carried along a 1a primary
sensory neuron, passing its cell body located paravertebrally at the dorsal root ganglion, and entering
the spinal cord via the dorsal root(s) at the corresponding spinal levels (for example L2-L4 for the
patellar reflex). After entering the spinal cord posteriorly through the dorsal horn gray matter, the
afferent primary sensory neuron’s axon bifurcates before synapsing.[1]

3: The Interneuron. Once separated inside the spinal cord, one afferent sensory neuron axon will
travel anteriorly through the spinal cord to the ipsilateral ventral horn to synapse directly with an
activating alpha motor neuron (AMN) using the neurotransmitter glutamate within the lamina IX
spinal cord location. The other will synapse with an inhibitory interneuron using the
neurotransmitter acetylcholine in lamina III of the dorsal horn. This inhibitory interneuron will exit
the gray matter laterally, ascend or descend the spinal cord via the white matter of the propriospinal
tract, also called the fasciculus propius, and re-enter the gray matter to synapse with and inhibit a
separate AMN in the lamina IX of the anterior horn using the neurotransmitter glycine at the
corresponding spinal level of the antagonist muscle group. For example, an action potential from the
quadriceps will enter the spinal cord and synapse with an interneuron at the L4 level, then descend
along the interneuron to inhibit the activation AMNs to the level of the hamstrings’ innervation at L5
or S1.[8][9]

4: The Efferent Alpha Motor Neuron. After synapsing with the 1a afferent sensory fibers, an
action potential from the activated AMN exits the spinal cord via the ventral root(s) at the same
spinal level and travels along an efferent AMN axon that innervates the extrafusal fibers via
attachment to the motor endplate of the same muscle or muscle group from which the reflex
initiated. With the antagonist muscle AMN action potential inhibited by the interneuron, no reflexive
action potential will travel along the AMN of the antagonist muscle or muscle group, which will
eventually induce a brisk, reflexive contraction in the agonist muscle or muscle group while
allowing relaxation in the antagonist.

5: The Gamma Motor Neuron. These efferent nerves also project from the lamina IX portion of the
anterior horn of the spinal cord to the polar regions of the intrafusal fibers. They are responsible for
the contraction of the intrafusal fibers, functioning to improve the sensitivity of the intrafusal fibers
and, consequently, the myotatic reflex. These are called fusomotor neurons. Though GMN are much
smaller in diameter than AMNs, their function is highly important as after the intrafusal fibers have
stretched and the Ia afferents have sent the action potential to the spinal cord signaling the need for a
reflexive contraction; the intrafusal fibers will also need to contract, to maintain their sensitivity to
their extrafusal environment. This simultaneous firing of the AMN and GMN is called alpha-gamma
coactivation.[10]

Nerves of Reflexes Commonly Encountered Clinically

The specific nerves utilized in the myotatic reflex depend on where the examiner initiates the reflex.
Additionally, there can be slight anatomical differences between individuals in the innervation of
their muscle groups. Below are the most commonly elicited myotatic reflex arcs, as well as the most
frequently-occurring neuroanatomy associated with each circuit.

The biceps brachii reflex is elicited by inducing rapid stretch in the biceps brachii tendon, sending
an afferent action potential to the spinal cord via the musculocutaneous nerve and dorsal nerve roots
C5-C6 (primarily C5). A post-synaptic efferent action potential returns via ventral nerve roots C5-C6
to the same muscle group provoking a reflexive muscle contraction of the biceps. An action
potential is inhibited in the ventral nerve roots C6-C8, allowing for relaxation of the antagonist
muscle group, the triceps.

The triceps reflex is elicited by inducing rapid stretch in the triceps tendon, sending an afferent
action potential to the spinal cord via the radial nerve and dorsal nerve roots C6-C8 (primarily C7).
A post-synaptic efferent action potential returns via ventral nerve roots C6-C8 to the same muscle
group provoking a reflexive muscle contraction of the triceps. An action potential is inhibited in the
ventral nerve roots C5-C6, allowing for relaxation of the antagonist muscle group, the biceps.

The brachioradialis reflex is elicited by inducing rapid stretch in the brachioradialis tendon,
sending an afferent action potential to the spinal cord via the radial nerve and dorsal nerve roots C5-
C6 (primarily C6). A post-synaptic efferent action potential returns via ventral nerve roots C5-C6 to
the same muscle group provoking a reflexive muscle contraction of the brachioradialis. An action
potential is inhibited in the ventral nerve roots C6-C8, allowing for relaxation of the antagonist
muscle group, the triceps.

The extensor digitorum reflex, also called the Braunecker-Effenberg reflex, is elicited by inducing
rapid stretch in the common extensor digitorum tendon of the forearm, sending an afferent action
potential to the spinal cord via the radial/posterior interosseous nerves and dorsal nerve roots C6-C7.
A post-synaptic efferent action potential returns via ventral nerve roots C6-C7 to the same muscle
group provoking a reflexive muscle contraction of the extensor digitorum. An action potential is
inhibited in the ventral nerve roots C8-T1, allowing for relaxation of the antagonist muscle group,
the flexor digitorum profundus.

The quadriceps femoris reflex also called the patellar reflex, is elicited by inducing rapid stretch in
the common quadriceps tendon distal to the patella (technically the patellar ligament, but in this
functional context, the quadriceps femoris tendon), sending an afferent action potential to the spinal
cord via the femoral nerve and dorsal nerve roots L2-L4, (primarily L4). A post-synaptic efferent
action potential returns via ventral nerve roots L2-L4 to the same muscle group provoking a
reflexive muscle contraction of the quadriceps. An action potential is inhibited in the ventral nerve
roots L5-S1, allowing for relaxation of the antagonist muscle group, the hamstring muscle group.

The Achilles reflex, also called the ankle jerk reflex is elicited by inducing rapid stretch in the
calcaneal tendon, found distal to the triceps surae, sending an afferent action potential to the spinal
cord via the femoral nerve and dorsal nerve roots S1-S2, (primarily S1). A post-synaptic efferent
action potential returns via ventral nerve roots S1-S2 to the same muscle group provoking a
reflexive muscle contraction of the triceps surae. An action potential is inhibited in the ventral nerve
roots L2-L4, allowing for relaxation of the antagonist muscle group, the tibialis anterior muscle
group.[11]

Embryology Go to:

The most basic type of motor coordination is a spinal reflex. From the neuroectoderm, the neural
plate (central thickening of cells) originates, which subsequently turns into a neural groove and
neural tube. During the formation of the tube, the cells that form the neural crests differentiate,
bordering on the ectoderm (at the level of the neural folds) and from the neural tube originates the
spinal cord and the encephalon, while from the neural crests originate the peripheral nervous system
and the spinal ganglia.

Between the fifth and seventh week of gestation, the myotatic reflex of primitive stretching begins to
develop.

Clinical Significance Go to:

In the clinical setting, the myotatic reflex receives a grade on a scale, with a number score given
based on the physical quality of the muscle contraction and subsequent limb flexion or extension
elicited by the initial induced mechanical stretch. This score, ranging from zero to four, can help
clinicians not only diagnosis neurological and system diseases but also accurately predict disease
outcomes and grossly locate neurological lesions.

Myotatic Reflex Scoring:

0: No contraction. This lack of response is always considered pathological, though not

definitive, for any specific neurological disease.

1: Weak, slight response. This response can be pathological or physiological.

2: Brisk reflex. The normal, non-pathological reflex.

3: Increased, greater than brisk response, with the absence of clonus. This response can be
pathological or physiological.

4: Elicitation of clonus. Characterized by repeated rhythmic contractions in the agonist

muscle group, clonus is always considered a pathological finding.

In addition to this basic reflex scoring system, the number score designated to an elicited reflex can
also have a “+“ or “-” to additionally help characterize reflexes that the provider considers slightly
greater than or less than a particular numerical value.

The myotatic reflex has vital utility in helping physicians localize a neurological lesion or pathology
to either the central nervous system (CNS) or the peripheral nervous system (PNS). Hyperreflexia,
designated by a reflex score of 3 or 4, is often a supportive exam finding in patients with upper
motor neuron (UMN) lesions or injury, grossly meaning an injury to the CNS. An UMN lesion is
also frequently concomitant with exam findings of muscle spasticity and the absence of muscle
fasciculations and commonly associated with conditions such as paraplegia, tetraplegia, hemiplegia,
and diplegia[12][13][14]. Hyporeflexia, designated by a reflex score of zero or one is often a
supportive exam finding in patients with lower motor neuron (LMN) lesions or injury, grossly
meaning damage to the PNS, for example, the anterior horn cells of the spinal cord, nerve roots,
peripheral nerves, or the neuromuscular junction or the muscle itself. A LMN lesion is also
frequently concomitant with exam findings of muscle flaccidity, hypotonia, and fasciculations and
commonly associated with conditions such as myopathies and neuropathies.

Hypo- and hyperreflexia can also be normal physiological exam variation as a result of aging, with
children and young individuals commonly having more brisk reflexes and elderly individuals having
non-pathological decreased reflexes. These same findings can also be representative of metabolic
dysfunction, including electrolyte imbalance, thyroid dysfunction, liver and/or kidney disease,
medication toxicity, and neoplastic process.

Other Issues Go to:

A recent study has shown that the muscles subjected to stretching have a higher threshold of
activation of the myotatic reflex. Furthermore, the contralateral muscle also undergoes the same
adaptation.[15]

From recent research on an animal model, there seems to be a close relationship between
nociceptive afferent pathways, the monosynaptic reflex, and serotonin. The latter would induce a
reduction in the reflex muscle response indirectly by acting on the C-fibers.[16]

Review Questions Go to:

Access free multiple choice questions on this topic.

Comment on this article.

Figure
Myotatic reflex, spinal cord, sensory receptor, spinal cord,
motor efferent axons. flexor muscle, extensor muscle,
interneuron synapse. Illustration by Emma Gregory

References Go to:

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