Lumbar Multifidus: Difference between revisions

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<div class="editorbox"> '''Original Editor '''­ [[User:Andeela Hafeez|Andeela Hafeez]]
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'''Original Editor '''- [[User:Lucindahampton|Lucinda hampton]]
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== Description  ==
[[File:Multifidus.png|thumb|Multifidus muscle|alt=Multifidus muscle|321x321px]]


The [[Multifidus Muscle|multifidus muscle]] is from the deep [[Back Muscles|muscles of the back]] that together with the semispinalis and rotatores form the [[transversospinales]] muscles group. Multifidusi lies deep to the semispinalis and superficial to the rotatores. 
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  &nbsp; 
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== Introduction ==
[[File:Muscles of the Back.png|thumb|364x364px|Multifidius, shown with back muscles ]]
The Multifidus [[muscle]] is a series of small, triangular muscular and tendinous bundles located on either side of the spinal column, where they fill the groove between the transverse and spinous processes of the vertebrae. <ref name=":1">Very well health [https://www.verywellhealth.com/multifidus-muscle-296470 Role of the Multifidus Muscle] Available: https://www.verywellhealth.com/multifidus-muscle-296470 (accessed 29.1.2022)</ref><ref name=":0">Darby S, Cramer G. [https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans Clinical anatomy of the spine, spinal cord, and ANS.] St. Louis, Mo.: Elsevier. 2014.Available: https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans (accessed 29.1.2022)</ref>


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.<ref name=":0">Drake R, Vogl AW, Mitchell AW. Gray's Anatomy for Students E-Book. Elsevier Health Sciences; 2009 Apr 4.</ref>
These fasciculi ascend two to four (or sometimes five) vertebral segments before ending on a spinous process. Multifidi muscles insert onto all the vertebrae except the [[atlas]]. <ref name=":0" />


The multifidus muscle spans the whole length of the vertebral column but is most developed in the [[Lumbar Anatomy|lumbar area]].<ref name=":0" /> The multifidus muscle is a local [[Core Muscles|core stabilizers]] , playing an important role in the static and dynamic [[Spinal Stabilization|spinal stability]]. Weakness in the multifidus muscle is associated with low back pain.<ref>Zheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ 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.</ref><ref name=":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.</ref>
Multifidus is part of the deep Intrinsic [[Back Muscles|back muscles]], known as the [[transversospinales]], which consist of 3 major subgroups: [[Semispinalis]], Multifidus, and [[Rotatores Muscles|Rotatores]]. They are the thickest muscles in the transversospinal group, and are shorter than semispinalis, but longer than rotatores<ref name=":2">Ken Hub Mulrifidius Available: https://www.kenhub.com/en/library/anatomy/multifidus-muscle<nowiki/>(accessed 29.1.2022)</ref>.  
== Anatomy  ==
[[File:Muscles of the Back.png|thumb|505x505px|Multifius, deep back muscles.]]


=== Origin ===
== Origin, Insertion, Nerve Supply ==
The lumbar multifidus muscle is a long muscle having several points of origin:
[[File:Lumbar vertebra.jpg|thumb|Lx Vertebrae, processes etc.|alt=|310x310px]]
Origin: Posterior [[sacrum]], [[Pelvic Landmarks|posterior superior iliac spine]], [[aponeurosis]] of the [[Erector Spinae|erector spinae]], sacroiliac ligament, mammillary processes of the [[Lumbar Vertebrae|lumbar vertebrae]], transverse processes of [[Thoracic Vertebrae|T1-3]], articular processes of [[Cervical Vertebrae|C4-C7]].


* The back surface of the [[Sacrum|sacrum.]]
Insertion: The multifidus muscle fibers pass upwards and medially to insert onto the spinous process of each vertebrae in the spinal column, except for the very top cervical vertebrae (C1)<ref name=":3">Radiopedia Transversospinalis Available:https://radiopaedia.org/articles/transversospinalis-muscle-group?lang=us (accessed 29.1.2022)</ref>.
* The [[Pelvic Landmarks|posterior superior iliac spine.]]
* The mammillary processes of the lumbar vertebrae (bony prominences at the dorsal superior aspect of the [[Lumbar Vertebrae|lumbar vertebrae]]).  
* The transverse processes of the [[Thoracic Vertebrae|thoracic vertebrae]].<ref>Study,com Multifidus Available:https://study.com/academy/lesson/multifidus-muscle-origin-insertion-action.html (accessed 29.1.2022)</ref>


=== Insertion  ===
[[Neurone|Nerve]] Supply: The intrinsic/deep back primarily nerve supply arises from dorsal rami of the spinal nerves.. The medial branches of dorsal rami of spinal nerves specifically supply multifidus.<ref name=":2" />


Base of spinous process of all vertebrae from L5 to T8, 2-4 levels above origin.<ref name=":0" />
== Actions ==
[[File:Multifidi.png|thumb|Muiltifidius muscle|alt=|300x300px]]All of the transversospinalis muscles, which multifidus is one of, are extensors of the back and neck.


The multifidus is connected with the transversus abdominis via the thoracolumbar fascia.  
# The multifidus and semispinalis muscle group has also been identified as rotators by some texts and refuted in others.<ref name=":3" />
# Evidence points to the multifidus muscle being continuously active in upright [[Posture|postures]]. In fact, the multifidus is probably active in all anti-gravity activity.<ref>Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, Volume 2 E-Book: The Lower Body. Elsevier Health Sciences; 2011 Jul 5.Available:https://www.sciencedirect.com/book/9780443068157/clinical-application-of-neuromuscular-techniques (accessed 29.1.2022)</ref>
# The multifidus stabilizes the vertebrae as the spine moves. It is thought that the unique design of the multifidus endows it with extra strength.<ref name=":0" />
# When the [[External Abdominal Oblique|oblique abdominal muscles]] contract to produce trunk rotation, some flexion of the trunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.<ref name=":0" />


=== Nerve and Blood Supply ===
== Physiotherapy ==
[[File:Core activation 4point kneeling alternate legs.jpeg|thumb|Core activation exercise]]
The multifidus is one of the important [[Core Muscles|core muscles]] stabilizers,  playing an important role in the static and dynamic spinal stability.


* Medial ramus of the dorsal root of the spinal nerve.<ref name=":2" />
* [[Core Stability|Core stabilization programs]] are suggested to increase multifidus cross section area and decrease low back pain, weakness in the multifidus muscle being associated with low back pain<ref>Zheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ 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. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ (accessed 29.1.2022)</ref> <ref>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.</ref>  
* Branches of lumbar and sacral arteries.<ref name=":0" />
* Core muscles are noted for their contribution to [[Core Stability|spinal stability]] and are important in [[Adherence to Home Exercise Programs|home exercise programs]] given to  people with [[Low Back Pain|low back pain]] in physical therapy.
[[File:Minna-hamalainen-Mgx1oe2vlVY-unsplash.jpeg|thumb|Plank core exercise]]
Investigators have categorized multifidus fiber types by layers:  


=== Viewing ===
* The deepest layer appears to contributes more [[Strength Training|strength]] and [[Spinal Stabilization|stability]] to the spine than do superficial layers. Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). The resulting shorter "excursion" of the deep layer of the multifidus means that when the muscle contracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.<ref name=":1" />
This 1 minute video is a good watch re the multifidus{{#ev:youtube|https://www.youtube.com/watch?v=c-_Y9q-kLdc|width}}<ref>J Fitzgordon The mutifidus muscle available from: https://www.youtube.com/watch?v=c-_Y9q-kLdc (last accessed 9.6.2019)</ref>
== Action ==


# [[File:Minna-hamalainen-Mgx1oe2vlVY-unsplash.jpeg|thumb|Multifidus hard a work]]Bilateral contraction extends the vertebral column.
== References  ==
# Unilateral contraction contralaterally rotates the vertebral coloumn to the opposite side.<ref name=":0" />
# Evidence points to the multifidus muscle being continuously active in upright [[Posture|postures]]. In fact, the multifidus is probably active in all anti-gravity activity.
# The multifidus stabilizes the vertebrae as the spine moves. It is thought that the unique design of the multifidus endows it with extra strength.
# When the oblique abdominal muscles contract to produce trunk rotation, some flexion of the trunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.<ref>Physiopedia [[Multifidus Muscle]] Available:[[Multifidus Muscle]] (accessed 29.1.2022)</ref>


== Clinical Relevance  ==
<references />
[[File:Core activation 4point kneeling alternate legs.jpeg|thumb|532x532px|Core activation 4point kneeling alternate legs]]
[[Category:Anatomy]]
The multifidus muscle is an important stabilizer of the lumbar spine. It functions together with [[Transversus Abdominis|transversus abdominis]] and [https://physio-pedia.com/Pelvic_Floor_Muscle_Function_and_Strength?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal pelvic floor muscles] for spine stability. <ref>Lynders C. [https://link.springer.com/article/10.1007/s11420-019-09717-8 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.</ref>
 
Multifidus muscle weakness and atrophy is associated with chronic [[Low Back Pain|low back pain]]. [[Core Stability|Core stabilization programs]] are suggested to increase multifidus cross section area and decrease low back pain.<ref name=":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.</ref><ref name=":1" />
 
[[Trigger Points|Trigger points]] in the multifidus decreases the contraction efficiency of the transversus abdominis due to decreased reciprocal inhibition. Dry needling of the multifidus trigger points increased the thickness of tansversus abdominus during contraction, suggesting that multifidus dry needling can be used for treatment of [[Low Back Pain|low back pain]].<ref name=":2" />
 
Length Tension Relationship: 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.<ref>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</ref> Investigators have categorized multifidus fiber types by layers:
 
* The deepest layer appears to contributes more [[Strength Training|strength]] and [[Spinal Stabilization|stability]] to the spine than do superficial layers. Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). The resulting shorter "excursion" of the deep layer of the multifidus means that when the muscle contracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.<span class="reference" id="cite_ref-:1_1-1"></span><ref>Physiopedia [[Multifidus Muscle|Multifidus]] Available: [[Multifidus Muscle]] (accessed 29.1.2022)</ref>
 
== Physiotherapy==
[[File:Phy20.jpg|thumb|Side-lying body lift,]]
Treatment: Retraining the stabilising muscles of the core is done in a series of steps.The first step is to learn to isolate the muscle.&nbsp;The second step is to learn to co‐contract it in&nbsp;conjunction with the other muscles of the core.&nbsp;The final step is to co‐contract the entire core (connect&nbsp;simultaneously to the pelvic floor, transversus abdominis &amp; multifidus) in coordination with the larger superficial muscle during functional activities.<ref name="p1">diane lee [https://dianelee.ca/article-training-deep-core-muscles.php Empower through Knowledge, Movement &amp; Awareness] Available from: https://dianelee.ca/article-training-deep-core-muscles.php (last accessed 9.6.2019)</ref>
 
See [[Exercises for Lumbar Instability]]
 
'''Recruitment Training for the Deep Fibers of Lumbosacral Multifidus (dMF)'''[[File:Training-multifidus-1.jpg|alt=|right|200x200px]]
Lie on your back or side with your spine in a neutral posture, (gentle curve in your low back):'''&nbsp;<ref name="p1" /> '''
 
*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).<ref name="p1" />
*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'''[[File:Training-multifidus-2.jpg|alt=|right|200x200px]]
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.<ref name="p1" />
* 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.<ref name="p1" />
* 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.<br>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<br>'''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.
 
== Multifidus and back Pain ==
Have a look at this 2 min 30 sec. video for some good information of evidence regarding multifidus and low back problems.
{{#ev:youtube|https://www.youtube.com/watch?v=jjAWBiO7h4E|width}}<ref>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)</ref>
 
== Reference  ==
 
<references />  
 
[[Category:Anatomy]]  
[[Category:Muscles]]
[[Category:Muscles]]
[[Category:Lumbar Spine]]
[[Category:Lumbar Spine - Anatomy]]
[[Category:Lumbar Spine - Muscles]]
[[Category:Lumbar Spine - Muscles]]

Revision as of 15:05, 13 July 2023

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Kim Jackson  

Introduction[edit | edit source]

Multifidius, shown with back muscles

The Multifidus muscle is a series of small, triangular muscular and tendinous bundles located on either side of the spinal column, where they fill the groove between the transverse and spinous processes of the vertebrae. [1][2]

These fasciculi ascend two to four (or sometimes five) vertebral segments before ending on a spinous process. Multifidi muscles insert onto all the vertebrae except the atlas. [2]

Multifidus is part of the deep Intrinsic back muscles, known as the transversospinales, which consist of 3 major subgroups: Semispinalis, Multifidus, and Rotatores. They are the thickest muscles in the transversospinal group, and are shorter than semispinalis, but longer than rotatores[3].

Origin, Insertion, Nerve Supply[edit | edit source]

Lx Vertebrae, processes etc.

Origin: Posterior sacrum, posterior superior iliac spine, aponeurosis of the erector spinae, sacroiliac ligament, mammillary processes of the lumbar vertebrae, transverse processes of T1-3, articular processes of C4-C7.

Insertion: The multifidus muscle fibers pass upwards and medially to insert onto the spinous process of each vertebrae in the spinal column, except for the very top cervical vertebrae (C1)[4].

Nerve Supply: The intrinsic/deep back primarily nerve supply arises from dorsal rami of the spinal nerves.. The medial branches of dorsal rami of spinal nerves specifically supply multifidus.[3]

Actions[edit | edit source]

Muiltifidius muscle

All of the transversospinalis muscles, which multifidus is one of, are extensors of the back and neck.

  1. The multifidus and semispinalis muscle group has also been identified as rotators by some texts and refuted in others.[4]
  2. Evidence points to the multifidus muscle being continuously active in upright postures. In fact, the multifidus is probably active in all anti-gravity activity.[5]
  3. The multifidus stabilizes the vertebrae as the spine moves. It is thought that the unique design of the multifidus endows it with extra strength.[2]
  4. When the oblique abdominal muscles contract to produce trunk rotation, some flexion of the trunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.[2]

Physiotherapy[edit | edit source]

Core activation exercise

The multifidus is one of the important core muscles stabilizers, playing an important role in the static and dynamic spinal stability.

Plank core exercise

Investigators have categorized multifidus fiber types by layers:

  • The deepest layer appears to contributes more strength and stability to the spine than do superficial layers. Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). The resulting shorter "excursion" of the deep layer of the multifidus means that when the muscle contracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.[1]

References[edit | edit source]

  1. ↑ 1.0 1.1 Very well health Role of the Multifidus Muscle Available: https://www.verywellhealth.com/multifidus-muscle-296470 (accessed 29.1.2022)
  2. ↑ 2.0 2.1 2.2 2.3 Darby S, Cramer G. Clinical anatomy of the spine, spinal cord, and ANS. St. Louis, Mo.: Elsevier. 2014.Available: https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans (accessed 29.1.2022)
  3. ↑ 3.0 3.1 Ken Hub Mulrifidius Available: https://www.kenhub.com/en/library/anatomy/multifidus-muscle(accessed 29.1.2022)
  4. ↑ 4.0 4.1 Radiopedia Transversospinalis Available:https://radiopaedia.org/articles/transversospinalis-muscle-group?lang=us (accessed 29.1.2022)
  5. ↑ Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, Volume 2 E-Book: The Lower Body. Elsevier Health Sciences; 2011 Jul 5.Available:https://www.sciencedirect.com/book/9780443068157/clinical-application-of-neuromuscular-techniques (accessed 29.1.2022)
  6. ↑ 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. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ (accessed 29.1.2022)
  7. ↑ 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.
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