Introduction
About 1/3 of American adults experience low back pain each year, with women affected at a slightly higher rate than men. At times there's a simple explanation, and the pain is short-lived, like when you overdo it at the gym or in the garden.
Sometimes you wake up in the morning full of jokes about getting so old you can't even sleep right. 👵😴👀
Other times, you experience nagging pain with no idea how it started, and it just won't go away.
Pain always has a cause and discovering & healing that cause may be simple or complex.
Multifidus is a hugely important muscle for both movement and stability of the spine. When it isn't working well, symptoms can include:
Localized back pain
Pain with minor movements
Feeling of instability or bones shifting
Increased pain after periods of stillness, such as when getting out of bed or during a long car ride
Pain is often one-sided, but may be bilateral
Sometimes pain is referred to the back of the leg or to the abdomen
Lifestyle and injury are the most common causes of multifidus trouble; age is often mentioned as well, but advancing in years and growing old are not the same thing. That's a topic for another blog post.
Anatomy & Action
In this post, I'll refer to it in the singular, but multifidus is actually an overlapping array of muscles that connect vertebrae several levels apart and also, in the lumbar spine, to the sacrum and pelvic bones. It's a deep muscle that runs along either side of your spine, with layers of muscle, fat, and fascia between it and your skin, so it can't be seen when looking at a person the way your bicep or quads can. It's the thickest muscle in its group and of intermediate length.
Many muscles can be categorized as "movers" or a "stabilizers," but multifidus does double duty. When both right and left sides contract together, the result is back extension; contraction of just one side causes rotation toward the opposite side. This powerful muscle is almost always working; even when you're standing still or sitting upright, multifidus is in action, stabilizing your spine and pelvis.
Dysfunction
When people think of muscle pain, their first idea is usually to stretch.
It may feel great, and there are times when stretching is important, but knots and tightness often result from muscles that can't do their job effectively.
Soft Tissue Changes
Do you remember your mom always telling you to sit up straight and quit slouching? She was onto something!
When you spend a lot of time in weak postures such as slumped over a desk or standing with your weight shifted to one side, the soft tissues that maintain strong posture are changed. Muscle fibers are stretched and weakened, and tendons under constant load become inflamed.
Hard Tissue Changes
Weak postures affect hard tissues, too. Bones are really good at remodeling (think about your child's broken arm that healed in just a couple of months, healing and changing from two separate pieces back into one). That also means that bones change shape over time to accommodate weak postures. A common example of this type of change is grandma's "Dowager's Hump."
Prevention and early intervention are key. The longer any problem is allowed to continue, the longer it takes to heal. Additionally, remodeling activity slows down with age, so reversing those changes becomes more difficult.
Neurological Changes
Beyond these physical changes, weak postures also affect you neurologically. When your brain and muscle don't have to communicate and work together, they stop doing it! The nerve fibers are still present and healthy, but your muscle forgets how to respond to signals from your brain. ðŸ§
This is why reactivation & strengthening feels so difficult at first. When I assign muscle activation exercises, I inevitably see that people perform a much larger movement than is required because they're using neighboring muscles rather than the weak/inactive one that we're trying to target. This is called recruitment.
Chemical Changes
The last consequence of weak or inactive muscle is chemical changes. I've already mentioned inflammation in muscle tendons, but it doesn't stop there. Imbalanced strength in muscle pairs or paired groups leads to abnormal positioning and motion in your joints, which results in inflammation and pain. This is why chiropractic care and muscle therapies are perfect complements. Muscles and joints work as one system, and that system benefits most when both parts are treated.
Now that you understand how important multifidus is for your spine health, you'll want to take care of it. Get started today with the exercises below.
Exercises
Seated, Resisted Extension (beginner)
Sit upright at your dining room table with your sit bones near the front of the seat.
Your hips and knees should be comfortably bent to 90°.
With your elbows near your sides, place your palms face up under the edge of the table.
Push up against the table by extending your low back using a very slight motion. Imagine that you don't want anyone to see that you're contracting the extensor muscles.
Hold for 6 seconds, relax for 6 seconds.
Repeat 6 times, 6 times each day.
Quadruped Hip Lift (intermediate)
Place a cushion or pad on the floor.
Get on all fours, with one knee on the pad. Shoulders should be directly over wrists and hips directly over knees. Keep your spine neutral by maintaining a flat back and eyes toward the floor.
Engage your abdominal muscles by contracting them to lift your belly button toward your spine.
Lift your knee from the floor straight up until your hips are level. All motion should be in your low back & hips. Again, this is a very small movement, though it is visible to an observer.
Hold for several seconds, then slowly lower your knee back to the floor.
Repeat 5-10 times per side, 3 times each day.
Cross-Crawl Multifidus Lift (Advanced)
Begin in the same position as in the Quadruped Hip Lift.
Engage your abdominal muscles.
Activate your multifidus by lifting your hip, then
Slowly extend one leg and the opposite arm until both are straight, parallel with the floor, and level with your back.
Hold for several seconds before returning to the start position.
Repeat 5-10 times per side, 3 times each day.
Need more help?
The multifidus muscle itself may not hurt, but when it's not working well, it causes low back pain for many people. The most common multifidus problem I see in my chiropractic practice is weakness or decreased activity. If stretches and exercises haven't solved your back pain problem, I would love to help you trade that nagging pain for a more vibrant life!
My name is Dr. Amy Crowe, and I bring chiropractic care to women in the comfort and convenience of their own homes on the southeast side of the Kansas City metro. I come to you!
Click here to schedule your free 10-minute phone consult now!
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