Dooley Noted: 11/3/2015
The multifidii group of musculature is part of the deep intrinsic spinal stabilization system.
The multifidii belong to a subset of back muscles called transversospinalis. These muscles usually attach from the transverse processes to the spinous processes of vertebrae.
The multifidii cross 2-4 vertebral segments, attaching to the respective transverse process. This makes multifidii a fantastic local intersegmental stabilizer, as well as a local mover for extension, lateral flexion, and contralateral rotation.
The multifidii muscles are particularly robust in the lumbosacral region, attaching to the sacrum and iliac crest and anchoring themselves to a special lumbar landmark called the mamillary process, as well as the spinous and transverse processes.
Because the muscles cross 2-4 segments, they act as a perfect stabilizer in extension for the five lumbar vertebra and SI joint.
Because of the muscle attachment to the deeper layers of the thoracolumbar fascia (TLF), this muscle can help act as an intrinsic core stabilizer and as an exhalation muscle.
This muscle is often overridden by more global extensors, such as erector spinae. In particular, the thoracolumbar erectors tend to hypertrophy near the thoracolumbar junction, creating a fulcrum for movement that inhibits the stabilization abilities of multifidii lumborum.
Things that are wired together don’t always fire together. Sometimes, a synergist can overpower a partner in movement.
To make matters more complicated, the person without multifidus intrinsic control of the lumbar spine may end up at risk for disc herniation. In fact, I’ve seen a fair share of multifidii lumborum atrophy on MRIs of patients with lumbar disc herniations, particularly at L4-L5 and L5-S1 segments.
This can be seen in patients with lower cross syndrome, as well as patients with inabilities to counternutate the pelvis.
This is a visible loss of local lumbar control in exchange for global spinal extension. This leads to low back and SI joint pain.
To more properly engage the multifidii lumborum, one must work on more localized control of intersegmental movement of the lumbar spine.
Better overall spinal coordination and more intrinsic control can result in proper prevention and rehabilitation of flexion-intolerant and extension-intolerant low back pain.
In the transverse and coronal plane, work on smaller, more controlled lumbar lateral flexion with rotation. Think bobble-head movement, only for the low back. I practice this on the subway,
when I’m standing in a line, or when I am forced to sit on an airplane.
It looks like I’m fidgeting – so I let people believe that as I do my rehab.
Also, consider not letting powerful antagonists – like iliacus and other hip flexors – inhibit multifidii motor control. Pop out of your seat and extend your hips, while you gently nudge the sacrum forward. This can help demand more action out of multifidus lumborum.
To better coordinate the lumbar multifidii, consider watching my modification of the Cat Camel drill. This spinal coordination drill helps wake up the multifidii in both eccentric and concentric positions (in the sagittal plane).
My Croc-and-Roll video will help you use the multifidii as breathing muscles, as well as train intersegmental rotation.
Enjoy!
As always, it’s your call.
– Dr. Kathy Dooley
P.S. Check the YouTube channel (drdooleynoted) tomorrow for another multifidus drill to train healthy lumbar segmental extension.