Tuesday, March 17, 2009

Multifidi and Low Back Pain


Everyone at some point or another will have low back pain. The statistics don't lie. 80% of Americans will experience it at some point and 90% of those will have repeated bouts. Low Back pain can have many, many causes. To many to go over in this blog post. But one that comes to mind is the paraspinal muscle dysfunction. Paraspinals refer to the rotatores and multifidi. They are small muscles that run from the sacrum up to C2. We're going to talk specifically about the multifidi around the lumbar spine. While the errector spinae will have more of a gross movement roll, big moves, big motions, the multifidi will have more of a segmental stability role. They have also been shown to have a large roll with proprioception. So when these muscles get tight and short they can compress the lumbars and create a facet hypomobility. If they become inhibited and weak they can lead to disc dysfunction.

So how can you tell if your tight or weak and inhibited? A short and tight multifidi will usually be present in and exaggerated lordosis. The lordosis will sometimes even be present when you bend forward. A weak, inhibited multifidi will often present with a bit of muscular atrophy. So more of a visual assessment. When there is weakness here, you won't have the ability to resist flexion/rotation and will have increased loading on the disc. Over time this can lead to disc symptoms like sciatica.

I usually see the tight short muscles first. Over time with increasing pain and lack of mobility at the segment that is locked. You will start to get atrophy of the multifidi and even some fatty penetration of the muscle fibers. So short, tight, local pain, becomes weak, inhibited radiating pain.

The good news is that joint mobilization has been shown to fascilitate the multifidi. A good chiropractor or manual therapist can work wonders and finally some proof!
http://www.jospt.org/issues/articleID.1303,type.2/article_detail.asp

After getting adjusted (mobilized), then you can start on some strengthening, rehab protocols. More on that later. Until then, if your having back pain, see if your in the short, tight category or the weak and inhibited one. So you know what to do about it!

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