Kinetic Integrations Blog

Lumbar Multifidi With Low Back Pain

Several studies have been performed pertaining the lumbar multifidi (MT) in individuals with LBP. Starting 1994, Hides et al. reported finding significant ipsilateral atrophy in the lumbar multifidi in this population. Hides followed-up with similar subjects for 10 weeks and found that those that were treated with a specific exercise program had more substantial recovery of the MT muscle mass than others.

The literature makes a solid case that MT recovery after LBP does not spontaneously occur, even 5 years later. Based on this, the speculation is made that if the MT provides a key role in spinal stability, its inactivity could increase the chance of reinjury.

Spinal Stability

Wilke et al. have shown that the MT contributes to spinal stability, a finding that is supported by the recent work of others. Also, a significant body of research is emerging that associates significant changes in the composition and neurologic responses in the MT if LBP is present. An example is the influence of the MT on local spinal segmental control. Couple this with the nerve-muscle relationship and you can understand that this has led to the proposition that inhibition of the MT limits the ability of the CNS to fine tune the control of the lumbar intersegmental movements. Many of times my clients that have suffered low back pain are surprised that they cannot feel their MT contract, that it contracts later than their MT on their non-injured side and that atrophy is obvious in the regional musculature.

Now, why is this muscle inactivity and atrophy happening we should ask ourselves. More and more it seems that reflex inhibition is the major contributing factor for local segmental MT atrophy following LBP. For example,

  • Reflex inhibition protects the body from injury by turning muscle activity off when others are activated. For instance, when you flex your bicep, the triceps needs to be turned off in order for the arm to bend, and this in summary, is reflex inhibition.
  • Muscle inhibition describes the failure to completely activate all motor units in a given motor neuron pool. Muscle inhibition is an important component of motor control during human movement and is vital for proper functioning.
People with LBP commonly exhibit weak or unbalanced trunk muscles and tend to experience a quicker rate of fatigue during sustained lumbar extension exercise. This muscular deficiency may impose lower extremity muscular adaptations during fatiguing exercise to maintain stability and preserve normal function.

 

Based on the research above, through its specific restoration and augmentation exercise methods KI restores neuromuscular control of the MT and other local and global stabilizers and mobilizers. Through its advanced training methodology KI also intervenes to repair the MT reflex control.

References

  • Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology 1984;26:9-13.
  • Zhu XZ, Parnianpour M, Nordin M, et al. Histochemistry and morphology of erector spinae muscle in lumbar disc herniation. Spine 1989;14:391-7
  • Mattila M, Hurme M, Alaranta H, et al. The multifidus muscle in patients with lumbar disc herniation. A histochemical and morphometric analysis of intraoperative biopsies. Spine 1986;11:732-8
  • Ford D, Bagnall KM, McFadden KD, et al. Analysis of vertebral muscle obtained during surgery for correction of a lumbar disc disorder. Acta Anat (Basel) 1983;116:152-7
  • Stokes M, Young A. The contribution of reflex inhibition to arthrogenous muscle weakness. Clin Sci (Lond) 1984;67:7-14