Creating Hypertrophy in Lumbar Multifidi

Eight out of ten of us will have back pain in our lives.  Chances of having low back pain are significantly higher if you have had low back pain before.  Take away, it comes around again if you don't do anything about it.

One of the main reasons in the research and therapy world is that after the first bout of acute low back pain (LBP) the lumbar multifidi start to atrophy.  Not only atrophy,  but they start to get fatty infiltration.  It can be one sided atrophy on the side of the pain as well.  So not only will we have asymmetrical function from the back, but asymmetrical form as well.

The role of the multifidi was long thought to be that of a rotator/extensor.  It is probably too short to be much of a power producer but it has a high amount of muscle spindles.  This means it sends a lot of information to the brain about position and movement.  So with atrophy we get loss of form and function and lack communication with our most important organ, the brain.  It most likely alters its relationship with another important communication system as well, connective tissue.  There has been some understanding that the multifidi also play a roll in maintaining a proper lordosis or curve to the back.

The big question then is after back pain, how do we restore hypertrophy to the multifidi?  It's been shown through EMG that although lumbar extension and things like bird dog exercises make the multifidi active, they did not produce any changes in cross sectional area.  

Finally, a study showed that holding a contraction, an isometric hold of 5 seconds, was successful in increasing cross sectional area.  In between the concentric and eccentric phase of a movement, hold the contracted position for 5 seconds.  Do not go to failure.  Also, having an upper body extremity do an isometric hold increased activity of the lumbar multifidi up to 51%.  This may be a great starting point for someone coming off acute LBP or back pain surgery.

Adjustments of the area have shown to increase the lumbar multifidi to contract and activate better.  Not only post adjustment, but one week later as well.  Before an exercise program is begun, creating better mechanics through HVLA adjustment may be the kickstart the body needs.