Sunday, May 16, 2010

Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.

After injuring your spine, your multifidus muscles may not recover without specific rehabilitation  exercises:

Thursday, February 11, 2010

What is the Multifidus Muscle?

Multifidus muscle
Deep muscles of the back. (Multifidus shaded in red.)
Sacrum, dorsal surface. (Multifidus attachment outlined in red.)
Latin musculus multifidus
Gray's subject #115 400
Origin Sacrum, Erector spinae Aponeurosis, PSIS, and Iliac crest
Insertion    spinous process
Nerve Posterior branches
Actions Stabilizes vertebrae in local movements of vertebral column
The multifidus (multifidus spinae : pl. multifidi ) 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.
These fasciculi arise:
Each fasciculus, passing obliquely upward and medialward, is inserted into the whole length of the spinous process of one of the vertebræ above.
These fasciculi vary in length: the most superficial, the longest, pass from one vertebra to the third or fourth above; those next in order run from one vertebra to the second or third above; while the deepest connect two contiguous vertebrae.
Multifidus lies deep to the Spinal Erectors, Transverse Abdominus, and Internal/External Obliques.

From Wikipedia, the free encyclopedia

Wednesday, February 10, 2010

Sitting on an exercise ball is no more stimulating to core muscles than sitting on a chair

For years therapists and trainers have been encouraging their patients to sit on exercise balls as a form of therapy.  It had been thought that this activity stimulated the muscles of the core (namely the multifidus and the transverse abdominis muscles).   Researchers from the University of Waterloo put this notion to the test* and found that sitting on a ball was no more therapeutic (at least in regards to activating the deep muscles of the core) than sitting on a chair.  While more studies would be helpful in understanding the principles of balance and core muscle activation, this study dispels the notion that sitting on an exercise ball is a sufficient therapy for exercising the muscles of the core.

*Clin Biomech (Bristol, Avon). 2006 May;21(4):353-60. Epub 2006 Jan 10.

Sitting on a chair or an exercise ball: various perspectives to guide decision making.

Clinical Biomechanics, Department of Kinesiology, University of Waterloo, Ont., Canada.
BACKGROUND: Prolonged sitting is recognized as a risk factor for the reporting of low back troubles. Despite the use of exercise balls in replacement of the office chair, little quantitative evidence exists to support this practice and hence motivated this research. Given the potential for several biological effects and mechanisms this study was approached with several layers of instrumentation to quantify differences in muscle activation, spine posture, spine compression and stability while sitting on an exercise ball versus a stable seat surface. Also, differences in the pressure distribution at the seat-user interface were quantified for the different seat surfaces to provide an objective perspective on the mechanism influencing perceived comfort levels. METHODS: Eight male subjects volunteered to sit for 30 min on an exercise ball and on a wooden stool. Muscle activity and spine position were used to model spine load and stability. An additional seven sat on an exercise ball and chair to examine pressure distribution over the contact area.
FINDINGS: There was no difference in muscle activation profiles of each of the 14 muscles between sitting on the stool and ball. Calculated stability and compression values showed sitting on the ball made no difference in mean response values. The contact area of the seat-user interface was greatest on the exercise ball.
INTERPRETATION: The results of this study suggest that prolonged sitting on a dynamic, unstable seat surface does not significantly affect the magnitudes of muscle activation, spine posture, spine loads or overall spine stability. Sitting on a ball appears to spread out the contact area possibly resulting in uncomfortable soft tissue compression perhaps explaining the reported discomfort.
PMID: 16410033 [PubMed - indexed for MEDLINE]

Core Stiffness and Cross Fitness

Without the Stiffness There Is No Fitness

By William E. Morgan, DC

Editor's note: This is the third in a continuing series on cross-fitness training. The first article appeared in the Sept. 9 issue; the second in the Oct. 7 issue.

The rising tide of cross-fitness popularity, for all of its potential fitness benefits, has the potential to cause a tsunami of lumbar spine injures if improperly implemented. In this third installment in our series on cross-fitness, let's discuss the importance of core muscle activation during cross-fitness exercise. Much has been written about the role of the core muscles in protecting the spine from injury in recent years, but this information is taking too long to trickle down to the gyms and cross-fitness clubs around the world. Properly engaging the core can enhance athleticism and reduce the risk of injury when performing rigorous exercise.

The Core

Muscle Direction Figure 1: The posterior/superficial fibers of the thoracolumbar fascia angle up and away from the spine. Though these fibers are continuous with the latisimus dorsi, they are connected to the transverse abdominis (TrA) through the lateral raphe (based on Bogduk11). The term core is bantered about in all corners of the health and fitness industry, yet to most people who use this word it remains a vague, almost nebulous description of supportive stomach and back muscles. We would like to solidify the term and provide a workable definition of the core, at least as we currently understand the term: The core muscles are the truncal muscles that support and stabilize the torso, protect the spine, and allow power transfer through the torso.

The core includes global stabilization muscles such as the transverse abdominis (TrA), the internal oblique (IO), and external oblique (EO); and intersegmental stabilizers such as the multifidus muscles.1 Since the list of muscles composing the core is a moving target depending on authorship, we would rather concentrate on core function than try to generate a composite list of the core muscles. However, certain muscles are central to any discussion of the core: the TrA, OI, OE, multifidus, rectus abdominis (RA), quadratus lumborum (QL), and the muscles of the erector spinae. Some would add the iliopsoas, latisimus dorsi, gluteal muscles, hip adductors, and hamstrings to this list.

The individual muscles of the core are each capable of contributing to several different functions, and no function is isolated to an individual muscle. The core is a complex and integrated network of muscles that work in synchrony to support the torso with stiffness and strength. It is impractical to try to isolate the function of individual muscles such as the TrA. In fact, when the core muscles stiffen in concert, their total strength surpasses the sum of the individual muscles.

Muscle Cross Section Figure 2: The anterior/deeper fibers of the thoracolumbar fascia angle downward and away from the spine from L2- L5. They are also connected to the TrA and the internal oblique (IO) by means of the lateral raphe (based on Bogduk11). In recent years, there has been a movement afoot that promotes abdominal hollowing,1 pulling in the abdominal muscles in an attempt to isolate the TrA and indirectly activate the multifidus muscles. Stuart McGill, PhD, has found that core bracing is superior to abdominal hollowing in regards to protecting the spine from injury. Vera-Garcia (with McGill as a co-author) found that hollowing actually inhibits the multifidus' response to perturbation,2 actually reducing core stabilization.

Your Internal Weight-Lifting Belt

Weight-training belts are no longer the rage they once were and their use is ebbing in most of the realm of physical culture. This is due in part to the knowledge that weight-lifting belts are not necessary. One study revealed that the advantage in using belts may come from perceived rather than actual protection and performance enhancement.3 Belts essentially increase the amount that lifters are willing to lift. Belts interfere with the natural intrinsic stabilization of the trunk without substantial benefit and should generally be avoided.4-9

Thoracolumbar Figure 3: When the TrA and IO contract, the anterior and posterior layers of the thoracolumbar fascia are pulled taut, approximating the spinous processes [from L2-L5], and a stiffening effect takes place (based on Bogduk11). We each possess a natural, built-in weight belt that is activated by the muscles of the core. Your intrinsic stabilization corset consists of a combination of the TrA and the thoracolumbar fascia. The posterior layer of the thoracolumbar fascia angles up away from the spine (Figure 1), whereas the anterior layer of the thoracolumbar fascia angles down and away from the spine (Figure 2). They both are joined to the TrA by the lateral raphe. So, when the TrA stiffens, the contraction produces a Poisson's effect,10 which causes the spinous processes to approximate in a protective manner (Figures 3 and 4).11

A collateral benefit of TrA contraction is activation of the multifidus muscle.12 The multifidus provides intersegmental stabilization through its stiffening effect, but is difficult to contract voluntarily. Together, the global and intersegmental stabilizers protect the spine from excessive shear and torsional forces.13

Bracing the Core With Muscular Stiffness

Learning to brace the core is an important component in protecting the spine and enhancing athletic performance. While many athletes intuitively brace their core during athletic exertion, others require training. It takes only a few minutes to learn how to coax the core muscles into a protective stiffened brace, but may take months to imbed a permanent neurological groove of bracing into a particular athletic motion pattern.

Thoracolumbar Fascia Figure 4: This schematic amplifies the concept of Poisson's effect. The contraction of the transverse and oblique abdominal muscles pulls on the lateral raphe, which produces a mild approximating tension of the lumbar spinous processes. Begin in a relaxed standing posture; place the fingertips of one hand on the lumbar paraspinal muscles just to the side of the spinous processes. The other hand should be positioned on the abdominal muscles at the level of the ASIS. Bend at the waist until you feel the muscles of your lower back contract under the fingers on your back. Note how this feels and then arch your spine until the spinal muscles relax under your fingers. While maintaining this position, stiffen the abdominal muscles as if you were about to be punched in the gut. You should feel your spinal muscles contract like they did when you bent over at the waist. Note how this feels with both hands. Practice engaging these muscles until it takes little conscious effort.

If bracing in this manner aggravates a spinal condition, reduce the degree of abdominal contraction. Maximal stiffness is not required. Practice in the range of 10 percent to 25 percent of maximal stiffening. Stiffening should accompany strenuous athletic exertion. When establishing neurological groove patterns for compound motor patterns, make sure to include bracing. For squatting motions, stiffen the core throughout the entire motion, even when no weight is used.

A dilemma that often accompanies core stiffening exercises is interference with diaphragmatic breathing. When first learning to stiffen the core, consciously engage in diaphragmatic breathing until it becomes routine. Once core bracing and diaphragmatic breathing are mastered, they should be practiced or rehearsed while in exertion-induced respiratory distress until it becomes natural. Practice performing cardiovascular interval training while concentrating on core bracing and diaphragmatic breathing. In time, these two activities will be imbedded in your neurology to the point of not requiring conscious intercession.

Core Stiffness Is Fundamental to Cross Fitness

Core bracing fits into one of the creeds of the cross-fitness movement: integration of compound motion patterns rather than muscle isolation. A properly functioning and reactive core is required for high levels of athleticism whether you are an elite athlete, a cross-fitness devotee, or even an average weekend golfer. Certainly cross-fitness injuries will be curtailed if athletes maintain proper form and utilize core bracing when performing athletic activities such as squatting, tire flipping, dead-lifting, plyometric jumping drills, kettlebell drills and agility drills. If our patients are going to engage in cross-fitness programs, it is our duty to prepare them properly through treatment, prevention and education.


  1. Richardson C, Jull G, et al. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain. Churchill Livingstone, Edinburgh, 1999:22-25.
  2. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol, 2006 Sep 20;17(5):556-67.
  3. McCoy MA, Congleton JJ, Johnston WL, Jiang BC. The role of lifting belts in manual lifting. Int J Ind Ergonomics, 1988;2:259-266.
  4. Majkowski GR, Jovag BW, Taylor BT, Taylor MS, Allison SC Stetts DM, Clayton RL. The effect of back belt use on isometric lifting force and fatigue of the lumbar paraspinal muscles. Spine, 1998;23(19):2104-2109.
  5. National Institute for Occupational Safety and Health. Workplace Use of Back Belts: Review and Recommendations. Rockville, MD: Department of Health and Human Services (National Institute of Occupational Safety and Health), Publication No. 94-122, 1994.
  6. Mitchell LV, Lawler FH, Bowen D, Mote W Asundi P, Purswell J. Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury. J Occup Med, 1994 Jan;36(1):90-94.
  7. Thomas JS, Lavender SA, Corcos DM, Andersson GB. Effect of lifting belts on trunk muscle activation during a suddenly applied load. Hum Factors, 1999 Dec;41(4):670-6.
  8. Reyna JR, Leggett SH, Kenny K, Holmes B, Mooney V. The effect of lumbar belts on isolated lumbar muscle strength and dynamic capacity. Spine, 1995;20(1)68-73.
  9. McGill SM, Norman RW, Sharratt MT. The effect of an abdominal belt on trunk muscle activity and intra-abdominal pressure during squat lifts. Ergonomics, 1990 Feb;33(2):147-60.
  10. See
  11. Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum, 3rd Edition. Churchill Livingstone, Edinburgh, 2001.
  12. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine, 2001;26:E243-8.
  13. Moseley GL, Hodges PW, Gandevia SC. Deep & superficial fibers of lumbar multifidus are differentially active during voluntary arm movements. Spine, 2002;27(2):E29-36.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the U.S. government. This is the third in a series of articles addressing cross-fitness. Future articles will present foundational components of core stabilization and gluteal activation, as well as the prevention of shoulder injuries.

Dr. William Morgan, who served in Naval and Marine Corps Special Warfare units, is credentialed at Bethesda's National Naval Medical Center and Walter Reed Army Medical Center. He serves as a chiropractic consultant to various U.S. government executive health clinics in Washington, D.C., and is the team chiropractor for the U.S. Naval Academy's football team.

This article originally posted in Dynamic chiropractic & is subject to there copyright protection

Sunday, May 3, 2009

The Multifidus Muscles

Following a spinal injury, particularly an injury to the disc, certain spinal stabilizing muscles begin to weaken or deactivate. When these muscles lose their ability to protect the spine from further injury, then a downward spiral of injury-weakness-fear-activity avoidance-weakness-re-injury occurs. To prevent this downward spiral from occurring, it is advisable to begin core stabilizing exercises as early as they can be tolerated after an injury. This line of exercise is based on the ability to contract the corset of muscles composing the “core.”
The multifidus muscle in particular seems to be a sentinel of weakening of the protective muscles of the core. Research has indicated that the multifidus muscle does not always recover after injury. The multifidus has been singled out from all of the other important muscles of the spine because it is the only muscle whose primary function is to protect the spine from injury and because it is the easiest muscle to see atrophy after spinal injury.
Before beginning this exercise program it is important to understand that there is a fine-line between beneficial therapy and injurious overexertion.
This program is a phased-approach to spinal stabilization. Be patient. It may take weeks or months to realize the benefits of these stabilization exercises.
Of course, if these exercises increase your pain, discontinue them immediately.
What are the multifidus muscles?
The multifidus muscles are small muscles that are not major movers of the spine, but act to stiffen and protect the spine from injury. MRI, EMG, Ultrasound and biopsy have shown that these muscles are prone to atrophy after injury or surgery.

How is multfidus pronounced?