Those Multifidi

The multifidi are important proprioceptive sentinels for the low back, as well as the rest of the body, for virtually every activity you do weight bearing, including gait. They are implicated in many instances of low back pain, especially folks with flexion or extension intolerance, since their fiber orientation and thus mechanical advantage (or disadvantage) is dependent upon whether or not you are maintaining a normal lumbar lordosis.

Modalities which boost their function are an excellent adjunct to the rehabilitation process. Since they are not under volitional control (go ahead, try and contract your L2/L3 multifidus), they are innervated by the vestibulospinal tract and we must use proprioceptive work to engage them. Dry Needling is one modality that can help them to become functional again.

“Significant difference was found in the percentage of change of muscle activation post needling between groups on the right side at level L4-5. A slight increase in the percentage of muscle activity, post procedure was observed in the dry needling group compared with the control group, although not significant in other segments examined. An improvement of back muscle function following dry needling procedure in healthy individuals was found. This implies that dry needling might stimulate motor nerve fibers and as such increase muscle activity.”

see also our post here.

J Back Musculoskelet Rehabil. 2015 Sep 6. [Epub ahead of print]
The immediate effect of dry needling on multifidus muscles’ function in healthy individuals. Dar G1,2, Hicks GE3.

The Lumbar Lordosis and Pelvic Stabilization Exercises

We had an inquiry regarding maintenance of the lumbar lordosis during exercise: Do you keep the spine flexed or in a “neutral” posture?

Here was our response:

“A decreased lumbar lordosis increases shear forces in the lumbar spine, as the plane of the multifidus and rototores with lumbar flexion become more parallel with the lumbar spine (see above: from McGill). This changes the angle of insertion of the muscles and they cannot stop the forward movement of the vertebrae, creating shear, which can be damaging to the discs. If they are experiencing pain during an exercise with increased flexion, that may indicate discogenic pain, poor stabilization or both.
Placing the spine in too much extension will cause the facet joints to bear too much weight (normally they are to bear approximately 20%: Kirkaldy Willis) resulting in facet irritation. If they are experiencing pain during an exercise with increased extension, that may indicate a facet issue or poor stabilization (or both).
We would emphasize that the patient needs to be in a NEUTRAL spine, not necessarily extension. Exercises should be minimized to a pain free range of motion or removed from their rehab program until they are able to perform the motion competently and in a pain free range.

Sometimes , patients need to “slow down” and though they are anxious to proceed, we must make sure they have adequate stabilization and appropriate technique.”

The Gait Guys. Giving you the facts and the info you need to make great decisions.