Lumbar Multifidus

Original Editor ­ Andeela Hafeez

Top Contributors -

Description[edit | edit source]

Multifidus muscle

The multifidus muscle is from the deep muscles of the back that together with the semispinalis and rotatores form the trasversospinales muscles group, it lies deep to the semispinalis and superficial to the rotatores. The trasversospinales muscles group run laterally from the transverse process and attach medially in the spinous process, filling the groove on either side of the spinous process.[1]

The multifidus muscle spans the whole length of the vertebral column but is most developed in the lumbar area.[1] The multifidus muscle is from the local core stabilizers playing an important role in the static and dynamic spinal stability, weakness in the multifidus muscle is associated with low back pain.[2][3]

[4]

Anatomy[edit | edit source]

Origin[edit | edit source]

Posterior sacrum, posterior superior iliac spine, mammillary process of lumbar vertebrae, transverse process of thoracic vertebrae and articular process of lower cervical vertebra C4-C7.[1]

Insertion[edit | edit source]

Base of spinous process of all vertebrae from L5 to C2, inserting 2-4 levels above origin.[1]

Nerve Supply[edit | edit source]

Medial ramus of the dorsal root of the spinal nerve.[5]

Blood Supply[edit | edit source]

Branches of lumbar and sacral arteries.[1]

Action[edit | edit source]

Bilateral contraction extends the vertebral column.

Unilateral contraction contralaterally rotates the vertebral coloumn to the opposite side.[1]

Clinical Relevance[edit | edit source]

The multifidus muscle is an important stabilizer of the lumbar spine. It functions together with transversus abdominis and pelvic floor muscles for spine stability. [6]

Multifidus muscle weakness and atrophy is associated with chronic low back pain. Core stabilization programs are suggested to increase multifidus cross section area and decrease low back pain.[5][3]

The multifidus is connected with the transversus abdominis via the thoracolumbar fascia. Trigger points in the multifidus decreases the contraction efficiency of the transversus abdominis due to decreased reciprocal inhibition. A study by Sarah Buckingham et al, found that dry needling of the multifidus trigger points increased the thickness of tansverse abdominus during contraction, suggesting that multifidus dry needling can be used for treatment of low back pain.[5]

Length Tension Relationship[edit | edit source]

The multifidus muscle has high cross section area so its force generating capacity is high and has a low fiber length so its muscle excursion is low. Showing that the multifidus muscle is designed to provide spinal stability. [7]

Treatment[edit | edit source]

Retraining the stabilising muscles of the core is done in a series of steps.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.[8]

Recruitment Training for the Deep Fibers of Lumbosacral Multifidus (dMF)[edit | edit source]

Training-multifidus-1.jpg


Lie on your back or side with your spine in a neutral posture, (gentle curve in your low back): [8]

  • Try the following connect cues to produce a deep contraction of multifidus isolated from the long back extensors.
  • For the part of multifidus that supports the SIJ - imagine a line that connects your left and right SIJ and think about connecting, or drawing together, along this line.
  • Imagine a line connecting your groin (or back of your pubic bone) to the part of multifidus in your low back you are trying to train (wake up). Connect along this line and then gently think about suspending (lifting) the lumbar vertebra 1 mm above the one below.
  • Breathe in and on the breath out contract the deep multifidus with the best connect cue (have your therapist help you determine which is your best connect cue).[8]
  • No movement of your hips, pelvis or spine should occur as you gently activate the dMF. If you compare how heavy your leg is to lift with and without this dMF contraction you should find that it is lighter with the proper contraction.
  • Hold the contraction for 3- 5 seconds and then release and breathe throughout this exercise. Repeat the contraction and hold for 3 sets of 10 repetitions 3 – 4 times per day for 4 weeks.

Strength Training for Lumbosacral Multifidus[edit | edit source]

Training-multifidus-2.jpg

In side lying:

  • Maintaining your connection to Transverse Abdominus (TrA), keep your ankles together and lift your top knee (only as high as you can control without breath holding), focus on turning your inner thigh outwards. Return your knee.[8]
  • Maintaining your connection to TrA, keep your ankles together, lift your top knee and then lift your ankle. Return your ankle and then your knee.
  • Lying on your back with your knees and hips flexed:
  • Slowly let your right knee move to the right, keep your low back and pelvis level. Return to the centre and repeat with the left.
  • 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. There should be no clicking in your low back.[8]
  • 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.Lift the right foot off the floor and then the left foot off the floor. Alternate
  • leg extensions, exert with exhalation, breathe in to rest or hold.
    With all these exercises maintain the leg lift for 10 seconds, build to 3 sets of 10 repetitions before moving on

Incorporate into Other Activities[edit | edit source]


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 stabilising system should be working at a low level. The goal is to teach the body to resume its normal stabilisation strategy of connecting to the core BEFORE movement begins.

Exercises[edit | edit source]

Rotation and twisting movements will help with flexibility and strength in your lumbar multifidi. Perform rotation exercises such as holding a broomstick across your shoulders and, standing with your feet shoulder width apart, twist from one side to the other. If your gym has a rotary machine, use that, too. Just place the pin under the amount of resistance you want to use and sit on the seat with your arms secured around the arm pads. Twist from one side to the other in a slow, controlled movement. Do at least 10 reps on each side for a total of 20.[9]

Lateral Flexion Spinal muscles are important for bending your body from side to side, or lateral flexion. Lateral flexion exercises are useful for working your lumbar multifidus muscles. Lie on your side on an incline bench that has been adjusted so that the top of the bench hits you just below your waist. Cross your arms over your chest and bend your torso down to the side so that you're leaning over the top edge of the bench. Keep your back straight, only bending your spine at the waist. Do 10 reps on one side, then repeat with another 10 reps on the other side.[9]

Evidence[edit | edit source]

Have a look at this video for some good information of evidence regarding multifidus and low back problems.

[10]

Reference[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Drake R, Vogl AW, Mitchell AW. Gray's Anatomy for Students E-Book. Elsevier Health Sciences; 2009 Apr 4.
  2. Zheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S. Effect of Core Stability Training Monitored by Rehabilitative Ultrasound Image and Surface Electromyogram in Local Core Muscles of Healthy People. Pain Research and Management. 2019;2019.
  3. 3.0 3.1 Kliziene I, Sipaviciene S, Klizas S, Imbrasiene D. Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain. Journal of back and musculoskeletal rehabilitation. 2015 Jan 1;28(4):841-7.
  4. J Fitzgordon The mutifidus muscle available from: https://www.youtube.com/watch?v=c-_Y9q-kLdc (last accessed 9.6.2019)
  5. 5.0 5.1 5.2 Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain physician. 2016;19(7):E985-99.
  6. Lynders C. The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS Journal®. 2019 Oct 1;15(3):214-20.
  7. Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine StabilityfckLRSamuel R. Ward, PT, PhD,1 Choll W. Kim, MD, PhD,1 Carolyn M. Eng, BS,1 Lionel J. Gottschalk, IV, BS,1 Akihito Tomiya, MD, PhD,1 Steven R. Garfin, MD,1 and Richard L. Lieber, PhD1
  8. 8.0 8.1 8.2 8.3 8.4 diane lee Empower through Knowledge, Movement & Awareness Available from: https://dianelee.ca/article-training-deep-core-muscles.php (last accessed 9.6.2019)
  9. 9.0 9.1 http://www.livestrong.com/article/480591-3-best-lumbar-multifidus-exercises/
  10. Chris Centeno Multifidus Back Pain: Why Your Doctor Never Discussed It Available from: https://www.youtube.com/watch?v=jjAWBiO7h4E (last accessed 8.6.2019)