Sunday, April 4, 2010
Location, Function & Dysfunction
Multifidus is a deep muscle located along the back of the spine very close to the midline. The deep fibers are short and span single vertebral segments. This muscle functions together with transversus abdominis & pelvic floor muscles to stabilize the low back and pelvis BEFORE
movement of the arms and/or legs occurs. When healthy, this muscle anticipates motion consequently we can use “intention” or imagery to retrain its function. Low back pain causes a delay or absence in the anticipatory contraction of multifidus. If this muscle contraction
delay/absence is not corrected, this dysfunction will remain even after an individual’s pain has subsided increasing the incidence of re‐injury. Rehabilitation Principles
Retraining the stabilizing muscles of the core is different than most exercises you will have been used to in
the past. The first step is to learn to isolate the muscle. The second step is to learn to co‐contract it in conjunction with the other muscles of the core. The final step is to co‐contract the entire core (connect simultaneously to the pelvic floor, transversus abdominis & multifidus) in coordination with the larger superficial muscle during functional activities.
Step 1: Isolation of Multifidus
- Lie on your back or side with your spine in a neutral posture, (gentle curve anterior in your lumbar
- Palpate the multifidus you are trying to isolate, (find the spine bone and then fall off into the gutter
just sideways from the bone). If you have a multifidus deficit it will feel like a hole or soft spot
compared to the opposite side.
- Breathe in and on the breath out contract the multifidus with your image or connect the leg firmly
along the guy wire (think about drawing the thigh into the pelvis). No actual movement of the hip,
pelvis or spine should occur.
- The contraction of the multifidus should feel like a slow, firm, ‘swelling’ under your fingers much like air filling up a balloon. You should not feel a rapid contraction.
- Hold the contraction without becoming rigid, and continue to breathe. It is not uncommon for other muscles to co‐contract in an attempt to compensate for a dysfunctional core. It is critical that you take the time to focus on your technique and achieve a correct multifidus contraction
BEFORE moving on to any loading through the arms or legs. Watch for the following substitution
1. Anterior tilting or rotation of the pelvis
2. Flexion of the hip joint
3. Gripping with the big buttock muscles
Step 2: Strengthen/Train co-activation of the Core
Once you can isolate the multifidus, practice this isolation in many different positions – i.e. sitting, standing, bending over etc. Once you can turn the muscle on easily you can progress to the following exercises. Each progression below begins with a good core contraction (which includes transversus abdominis) and this connection should be held throughout the movement.
Remember to MOVE WITH YOUR BREATH ‐ Exert with exhalation, breathe in to rest or hold.
With all these exercises maintain the leg lift for 3-5 seconds, build to 10 reps before moving on.
In side lying
1. While maintaining your connection to multifidus, keep your ankles together and lift your top
knee (only as high as you can control multifidus), by focusing on turning your inner thigh
outwards. Return your knee.
2. While maintaining your connection to multifidus, keep your ankles together, lift your top knee an then lift your ankle. Return your ankle and then your knee.
3. While maintaining your connection to multifidus, keep your ankles together, lift your top knee,
then your ankle, then extend your leg, then flex your leg, return your ankle and finally your knee.
Lying on your back – connect to your deep multifidus, add on a gentle contraction of the more superficial
fibers and then hold while you work through these progressions.
1. Slowly let your right knee move to the right, keeping your low back and pelvis level. Return to
the center and repeat with the left.
2. Slide the right foot along the floor, straightening the knee. Slide the foot back towards the hip,
and repeat with the left. Be sure that the floor supports the weight of the leg and that the foot
does not lift off of the floor. Try putting a plastic bag around your foot to help it slide easily.
3. Lift the right foot off the floor keeping the knee bent. Don’t hold your breath and don’t bulge
your lower abdomen. Return the foot to the floor and repeat with the left foot.
4. Lift the right foot off the floor and then straighten the leg only as far as you can control your core with a proper strategy. Slowly bend the knee and return the foot to the floor. Repeat with the left leg.
5. Lift the right foot off the floor and then the left foot off the floor. Alternate leg extensions making sure a proper strategy for core stabilization is used. Exert with exhalation, breathe in to rest or hold.
Step 3: Incorporate into Other Activities
The final step is to remember to use the core during regular life activities. Each time you get out of the chair, lift, bend or reach, this local stabilizing system should be working at a low level. The goal is to teach the body to resume its normal stabilization strategy of connecting to the core BEFORE movement