Why is the Multifidus so prone to injury?

The Multifidus plays a major role in maintaining vertebral stability and upright posture during everyday movement, and its constant ‘on’ setting puts great demands on this specific muscle.

The anatomy of the Multifidus reveals short muscle fibre length in comparison with other lumbar muscles, but with a high cross-sectional area (CSA). Its anatomy allows the Multifidus to produce stabilising forces over a small operating range (typically spanning two vertebral segments) and act as stabilisers rather than prime movers.

Research has identified reduced strength and endurance in the Multifidus musculature in people with chronic back and neck pain. When strength and endurance are reduced, the Multifidus strains to provide vertebral stability and will eventually ‘give way’, resulting in spasm and shut down.

When the Multifidus are injured or de-conditioned, larger superficial muscles are called upon to act in a manner they were not designed for.  These superficial muscles attempt to act as controllers (mainly through compression) which has a flow-on impact to facet joints and ligaments.

The Multifidus’ critical role in providing spinal stability should therefore not only be a focus for rehabilitation, but also in prevention of low back pain.

Watch: the role and function of the Multifidus muscle

Why do people injure the Multifidus muscles so frequently?

Patients without any back pain show very few abnormalities in the Multifidus musculature. Conversely, the vast majority of research studies correlate atrophy (weakness and size reduction) of the Multifidus with pain and functional problems.

The CDC has now recognised Multifidus atrophy and its replacement by fat after injury as a pathologic process that causes Lower Back Pain (LBP). (See pages 97 -99).

The Multifidus is required to maintain stability and postural control while we move, stand and sit during daily activities. With increasing sedentary lifestyles we place even more strain on our lower backs and necks, for example, when the spine tilts forward as we spend hours looking at screens.

If we aren’t actively exercising and strengthening our spinal musculature, everyday issues such as dehydration, vibration during driving, poor sitting posture and inactivity all predispose us to injuring our spinal musculature.

Optimal functioning of the spinal muscle system is necessary to control and protect the spinal segments following injury. Following an acute episode of back pain and even after resolution of symptoms, the deep Multifidus does not return to full function without intervention.

This ongoing lack of protection for spinal segments can then increase the likelihood of a recurrence of symptoms.

Why does the Multifidus need specific exercise?

There is overwhelming consensus of the need for active reconditioning exercise in the treatment of chronic spinal pain. Unfortunately, there is less agreement on the most effective exercise regimens, other than strength development in the deep spinal musculature.

The David devices deliver specific and measurable back strength programs using devices that provide specific, targeted and isolated rehabilitation exercise.

The most difficult aspect however is how to specifically isolate and strengthen the Multifidus. Normal freestanding strength training is less than effective as the gluteal muscles (hip flexors) ‘take over’ as the prime mover, by-passing Multifidus involvement to a large degree. Similarly, other floor exercises and gym machines are unable to safely isolate, target and progressively strengthen by staged measurable overload.

At David we use certified medical devices to provide a rehabilitation system that is specific, targeted, measurable, valid and reliable.

Another difficult aspect of recovery rehabilitation is addressing strength development in every spinal movement plane. In many instances, injuries occur when people perform compound movements, such as bending forward and rotating (for example, while gardening).

Ongoing functional strength is essential for these everyday movements. We design our devices to provide specific, targeted, and isolated rehabilitation exercises in all movement planes, including flexion and extension, lateral flexion, and rotation.

Disclaimer: This blog is originally from our partner, getback. You can find the original blog here.