Lumbar multifidus

Original Editor ­ Andeela Hafeez Top Contributors - Andeela Hafeez


Description

The multifidus muscle is one of the smallest yet most “powerful” muscle that gives support to the spine. Most people have the misconception that small is insignificant but it is not the case when it comes to this particular muscle.Multifidus muscle is a series of muscles that are attached to the spinal column. These series of muscles are further divided into two groups which include the superficial muscle group and the deep muscle group.[1]

muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. The multifidus is a very thin muscle.Deep in the spine, it spans three joint segments, and works to stabilize the joints at each segmental level.The stiffness and stability makes each vertebra work more effectively, and reduces the degeneration of the joint structures.[2]

Anatomy

Origin

posterior sacrum(next to foramina), superior iliac spine,mamillary process of lumbar vertebrae,transverse process of thoric vertebrae,and articular process of c4-c6[3]

Insertion

spinous process of vertebrae(except c1),2-4 bones above origin.[3]

Nerve Supply

Dorsal rami of spinal nerve[3]

Blood Supply

supplied segmentally by deep cervical artery, posterior intercostal arteries, subcostal arteries, lumbar arteries

Function

Action

Bilateral action: extend vertebral coloumn

unilateral action: laterally flexes and contralatterally rotates vertebral column.[3]

Functional Contributation

it is  important stabilizers of the lumbar spine[4],functions together with transversus abdominis & pelvic floor muscles to stabilize the low back and pelvis BEFORE movement of the arms and/or legs occurs.[5]

Trigger Point Referral Pattren

Pain and tenderness is referred locally to the spinous process of the adjacent vertebrae and/or the vertebrae above it. Lumbar multifidi trigger points may also refer pain to the lateral abdomen region.[5]


               Lumbar multifidus trigger points referred pain.jpg                          Thoracic multifidus trigger points referred pain.jpg


The following events or activities may activate or reactivate the multifidi trigger points:[5]

  1. Automobile accident (rapid deceleration)
  2. Unaddressed trigger point activity in the larger muscle groups that move the spine (i.e. quadratus lumborum, lumbar paraspinals, abdominal obliques etc)
  3. Articular dysfunction in the spine (facet syndrome)
  4. Distorted lumbar lordosis, thoracic kyphosis, or scoliosis

Techniques

Palpation

Lie on your back or side with your spine in a neutral posture, (gentle curve anterior in your lumbar spine).
- 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. [6]

Length Tension Relationship

The architectural design (a high cross-sectional area and a low fiber length-to-muscle length ratio) demonstrates that the multifidus muscle is uniquely designed as a stabilizer to produce large forces. Furthermore, multifidus sarcomeres are positioned on the ascending portion of the length-tension curve, allowing the muscle to become stronger as the spine assumes a forward-leaning posture.[7]

Treatment

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.[6]

Recruitment Training for the Deep Fibers of Lumbosacral Multifidus (dMF)
Lie on your back or side with your spine in a neutral posture, (gentle curve in your low back) [6]

  • 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).[6]
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.
                                                             Training-multifidus-1.jpg

Strength Training for Lumbosacral Multifidus

In side lying
Maintaining your connection to 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.[6]
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 center 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.[6]
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
                                                           Training-multifidus-2.jpg

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
begins.

Exercises

Rotation Moves
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.[8]

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.[8]

Recent Related Research (from Pubmed)


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Resources

http://www.teachpe.com/anatomy/muscles/multifidus.php

http://www.massagetoday.com/mpacms/mt/article.php?id=14189

http://kimawellness.com/blog_post/why-does-my-back-pain-keep-coming-back/

http://www.smiss.org/abstract/analysis-multifidus-muscle-atrophy-after-minimally-invasive-laminotomy

Reference

  1. http://www.coreconcepts.com.sg/mcr/multifidus-smallest-yet-most-powerful-muscle/
  2. https://en.wikipedia.org/wiki/Multifidus_muscle
  3. 3.0 3.1 3.2 3.3 http://www.getbodysmart.com/ap/muscularsystem/back_muscles/multifidus/tutorial.html
  4. Long-Term Lumbar Multifidus Muscle Atrophy Changes Documented With Magnetic Resonance Imaging: A Case SeriesfckLRMark Woodham,1 Andrew Woodham,2 Joseph G Skeate,3 and Michael Freeman4,*
  5. 5.0 5.1 5.2 http://www.dianelee.ca/article-training-deep-core-muscles.php
  6. 6.0 6.1 6.2 6.3 6.4 6.5 diane lee Empower through Knowledge, Movement & Awareness http://suncoastseminars.com/sitebuildercontent/sitebuilderfiles/multifidus.pdf
  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 http://www.livestrong.com/article/480591-3-best-lumbar-multifidus-exercises/