{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:13:56Z","timestamp":1789395236729,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Modern abdominal wall hernia surgery is centered on the biomechanics of the fascial-aponeurotic framework and on intra-abdominal pressure (IAP) control; neuromuscular regulation of the wall remains outside perioperative planning. This review reframes the abdominal wall as a coordinated neuromuscular system and outlines a framework in which ventral herniation is hypothesized to represent a compensatory response to altered regulation of elevated IAP, while discoordinated contraction of the muscular layers is proposed as a potential predisposing factor. A structured literature search was performed in PubMed\/MEDLINE, Embase and the Cochrane Library from inception to March 2026 across four thematic blocks: basal tone and innervation, spinal pathology and coordination, skeletal muscle memory, and electromyographic and clinical models of denervation. Synthesis followed SANRA criteria. This is not a formal systematic review or meta-analysis. Basal tone of the abdominal muscles is individual and depends on spinal innervation, lifestyle, comorbidity, and hernia duration; obstructive pulmonary disease yields a hypertonic phenotype, and persistent meteorism a hypotonic one. In a patient predisposed to herniation, elevated IAP may be partially accommodated through redistribution of abdominal contents; within the proposed framework, herniation is hypothesized to function as a pressure-relief mechanism. Discoordination of the muscular layers may reduce the capacity of the abdominal wall to adapt to rapid or unfamiliar loading, potentially contributing to hernia formation in predisposed patients. Six meta-analyses of preoperative botulinum toxin type A confirm lateral muscle elongation; none assessed basal-tone recovery after toxin washout. Each hernia patient presents with an individual neuromuscular phenotype shaped by basal tone, intermuscular coordination and muscle memory. The proposed framework complements mechano-fascial concepts with a neurophysiological dimension and provides a hypothesis-generating rationale for investigating phenotype-tailored prehabilitation and postoperative rehabilitation. Prospective electromyographic mapping with functional maneuvers is the immediate research priority.<\/jats:p>","DOI":"10.3390\/pathophysiology33030069","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Basal Tone, Muscle Memory and Denervation: Pathophysiological Foundations of Abdominal Wall Hernia Development and Recovery"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4335-3987","authenticated-orcid":false,"given":"Zelimkhan G. M.","family":"Berikkhanov","sequence":"first","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1938-9481","authenticated-orcid":false,"given":"Zakhar A.","family":"Akulov","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4792-4353","authenticated-orcid":false,"given":"Maria A.","family":"Sukhanova","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexey L.","family":"Shestakov","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksey G.","family":"Kotelnikov","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrey M.","family":"Nikolaev","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vadim S.","family":"Razumovsky","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1847-711X","authenticated-orcid":false,"given":"Evgeniy A.","family":"Tarabrin","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9917-6230","authenticated-orcid":false,"given":"Milena Yu.","family":"Ivanova","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1493-0351","authenticated-orcid":false,"given":"Sergey Yu.","family":"Muraviev","sequence":"additional","affiliation":[{"name":"Sechenov First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/bjs\/znad284","article-title":"Midline incisional hernia guidelines: The European Hernia Society","volume":"110","author":"Sanders","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10029-009-0518-x","article-title":"Classification of primary and incisional abdominal wall hernias","volume":"13","author":"Muysoms","year":"2009","journal-title":"Hernia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10029-013-1168-6","article-title":"Criteria for definition of a complex abdominal wall hernia","volume":"18","author":"Slater","year":"2013","journal-title":"Hernia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10029-009-0560-8","article-title":"A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain","volume":"14","author":"Tanaka","year":"2009","journal-title":"Hernia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s10029-025-03270-6","article-title":"Complex abdomen: A scoping review","volume":"29","author":"Stabilini","year":"2025","journal-title":"Hernia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1152\/jappl.2000.89.3.967","article-title":"Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm","volume":"89","author":"Hodges","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_7","unstructured":"Ganong, W.F. (1995). Review of Medical Physiology, Appleton and Lange. [17th ed.]."},{"key":"ref_8","unstructured":"Hodges, P.W. (2003). Neuromechanical Stiffness of the Spine. [Doctoral Dissertation, Karolinska Institute]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/00002517-199802000-00008","article-title":"Delayed Postural Contraction of Transversus Abdominis in Low Back Pain Associated with Movement of the Lower Limb","volume":"11","author":"Hodges","year":"1998","journal-title":"J. Spinal Disord."},{"key":"ref_10","unstructured":"Culbertson, H. (2013). Denervation supersensitivity. Encyclopedia of Neuroscience, Springer."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/01.sla.0000251267.11012.85","article-title":"Incisional Herniation Induces Decreased Abdominal Wall Compliance via Oblique Muscle Atrophy and Fibrosis","volume":"245","author":"DuBay","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_12","unstructured":"Adams, C.M. (2022). Skeletal muscle responses to denervation. Muscle Biology, Academic Press."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s10974-019-09504-2","article-title":"Increase in phospholamban content in mouse skeletal muscle after denervation","volume":"39","author":"Komatsu","year":"2018","journal-title":"J. Muscle Res. Cell Motil."},{"key":"ref_14","first-page":"E423","article-title":"Coordination Between Trunk Muscles, Thoracolumbar Fascia, and Intra-Abdominal Pressure Toward Static Spine Stability","volume":"47","author":"Driscoll","year":"2021","journal-title":"Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1242\/jeb.124495","article-title":"Muscle memory and a new cellular model for muscle atrophy and hypertrophy","volume":"219","author":"Gundersen","year":"2016","journal-title":"J. Exp. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e13465","DOI":"10.1111\/apha.13465","article-title":"The concept of skeletal muscle memory: Evidence from animal and human studies","volume":"229","author":"Snijders","year":"2020","journal-title":"Acta Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15111","DOI":"10.1073\/pnas.0913935107","article-title":"Myonuclei acquired by overload exercise precede hypertrophy and are not lost on detraining","volume":"107","author":"Bruusgaard","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Castillo, \u00cd.M., Ruiz-Caride, S.R., Rueda, R., L\u00f3pez-Chicharro, J., Segura-Ortiz, F., and Bouzamondo, H. (2025). Skeletal muscle memory: Implications for sports, aging and nutrition. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1701520"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1002\/jcsm.13043","article-title":"Myonuclear permanence in skeletal muscle memory: A systematic review and meta-analysis of human and animal studies","volume":"13","author":"Rahmati","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1038\/s41598-018-20287-3","article-title":"Human Skeletal Muscle Possesses an Epigenetic Memory of Hypertrophy","volume":"8","author":"Seaborne","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"C1274","DOI":"10.1152\/ajpcell.00099.2023","article-title":"Skeletal muscle memory","volume":"324","author":"Sharples","year":"2023","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5476","DOI":"10.1002\/jcp.29535","article-title":"Transcriptional memory in skeletal muscle. Don\u2019t forget (to) exercise","volume":"235","author":"Beiter","year":"2020","journal-title":"J. Cell. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e13578","DOI":"10.1016\/j.heliyon.2023.e13578","article-title":"Abdominal paresis and pseudo-hernia secondary to herpes zoster infection: A case report and systematic analysis","volume":"9","author":"Chiew","year":"2023","journal-title":"Heliyon"},{"key":"ref_24","first-page":"e87299","article-title":"Post-herpetic Abdominal Pseudohernia With Underrecognized Characteristics of Male Predominance and Co-occurring Fatal Visceral Herniation: A Case Report and a Literature Review","volume":"17","author":"Kishimoto","year":"2025","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jns.2017.12.019","article-title":"Paraspinal muscle involvement in herpes zoster-induced abdominal wall pseudohernia revealed by electrophysiological and radiological studies","volume":"385","author":"Mitsutake","year":"2018","journal-title":"J. Neurol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e24973","DOI":"10.1097\/MD.0000000000024973","article-title":"A novel assessment of abdominal pseudohernia after thoracolumbar vertebral compression fractures using surface electromyography and ultrasonography","volume":"100","author":"Choi","year":"2021","journal-title":"Medicine"},{"key":"ref_27","first-page":"262","article-title":"Acquired neurogenic abdominal wall weakness simulating abdominal hernia","volume":"4","author":"Kesler","year":"2002","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_28","first-page":"rjae822","article-title":"Abdominal pseudohernia caused by thoracic disk herniation: Case series and review of the literature","volume":"2025","author":"Schwenter","year":"2025","journal-title":"J. Surg. Case Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1186\/s12891-023-06536-1","article-title":"Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: A case report and literature review","volume":"24","author":"Cho","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s10029-021-02499-1","article-title":"A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction","volume":"25","author":"Timmer","year":"2021","journal-title":"Hernia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s10029-023-02816-w","article-title":"Systematic review and meta-analysis of the pre-operative application of botulinum toxin for ventral hernia repair","volume":"27","author":"Dias","year":"2023","journal-title":"Hernia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.surg.2021.03.027","article-title":"Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum: A systematic review and meta-analysis","volume":"170","author":"Yurtkap","year":"2021","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1007\/s10029-025-03384-x","article-title":"Effect of preoperative botulinum toxin injection in the treatment of giant incisional hernias: A systematic review and meta-analysis","volume":"29","year":"2025","journal-title":"Hernia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s10029-023-02892-y","article-title":"Botulinum toxin A in complex incisional hernia repair: A systematic review","volume":"28","author":"Barretto","year":"2023","journal-title":"Hernia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s10029-025-03287-x","article-title":"Preoperative botulinum toxin for complex abdominal wall reconstruction: A meta-analysis of propensity-score matched studies with trial sequential analysis","volume":"29","author":"Bertolino","year":"2025","journal-title":"Hernia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3200","DOI":"10.1073\/pnas.96.6.3200","article-title":"Functional repair of motor endplates after botulinum neurotoxin type A poisoning: Biphasic switch of synaptic activity between nerve sprouts and their parent terminals","volume":"96","author":"Meunier","year":"1999","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2521427","DOI":"10.1080\/07853890.2025.2521427","article-title":"Research progress in the use of botulinum toxin type a for post-stroke spasticity rehabilitation: A narrative review","volume":"57","author":"Xu","year":"2025","journal-title":"Ann. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/00006534-199009000-00023","article-title":"\u201cComponents Separation\u201d Method for Closure of Abdominal-Wall Defects","volume":"86","author":"Ramirez","year":"1990","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.amjsurg.2012.02.008","article-title":"Transversus abdominis muscle release: A novel approach to posterior component separation during complex abdominal wall reconstruction","volume":"204","author":"Novitsky","year":"2012","journal-title":"Am. J. Surg."},{"key":"ref_40","first-page":"003","article-title":"Relation of Transversus Abdominis to Rectus Abdominis Muscle in Various Anatomical Landmark Levels: A Cadaveric Study","volume":"52","author":"Surichamorn","year":"2024","journal-title":"Arch. Plast. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Pedrique, M.M., de Lersundi, \u00c1.R.V., Oliveros, A.A., Ruiz, S.M., L\u00f3pez-Moncl\u00fas, J., Munoz-Rodriguez, J., Hernando, L.A.B., Caballero, J.M., and Garc\u00eda-Urena, M.\u00c1. (2023). Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen. J. Abdom. Wall Surg., 2.","DOI":"10.3389\/jaws.2023.11123"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1097\/01.prs.0000475778.45783.e2","article-title":"Posterior Component Separation with Transversus Abdominis Release","volume":"137","author":"Jones","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"De Luca, M., Pedrique, M.M., Ruiz, S.M., Munoz-Rodriguez, J.M., de Lersundi, A.R.V., Lopez-Monclus, J., Hernando, L.A.B., and Garcia-Urena, M.A. (2024). The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias. J. Abdom. Wall Surg., 3.","DOI":"10.3389\/jaws.2024.12928"},{"key":"ref_44","first-page":"PC10","article-title":"Assessment of Abdominal Muscle\u2019s Maximal Force of Contraction Using Surface E MG in Inguinal Hernia Patients","volume":"10","author":"Sreenath","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10029-025-03337-4","article-title":"Biomechanics of the abdominal wall before and after ventral hernia repair using dynamic MRI","volume":"29","author":"Joppin","year":"2025","journal-title":"Hernia"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s10029-025-03517-2","article-title":"A scoping review of abdominal wall functional assessment in patients with hernias","volume":"30","author":"Shen","year":"2025","journal-title":"Hernia"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Martins, R.T., Elstner, K.E., Skulina, C., Rodriguez-Acevedo, O., Read, J.W., Rowe, D.B., and Ibrahim, N. (2019). Limitations of Electromyography in the Assessment of Abdominal Wall Muscle Contractility Following Botulinum Toxin A Injection. Front. Surg., 6.","DOI":"10.3389\/fsurg.2019.00016"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1089\/lap.2024.0319","article-title":"Is Sarcopenia Associated with Worse Outcomes Following Ventral Hernia Repair? A Systematic Review and Meta-Analysis","volume":"35","author":"Rasador","year":"2025","journal-title":"J. Laparoendosc. Adv. Surg. Tech."}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/33\/3\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:14:21Z","timestamp":1789391661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/33\/3\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["pathophysiology33030069"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology33030069","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}