- 1 Description
- 2 Anatomy
- 3 Origin
- 4 Function
- 5 Trigger Point Referral Pattern
- 6 Treatment
- 7 Evidence
- 8 Reference
The multifidus muscle is one of the smallest yet most “powerful” muscle that gives support to the spine. Most people have the misconception that small is insignificant but it is not the case when it comes to this particular muscle. Multifidus muscle is a series of muscles that are attached to the spinal column. These series of muscles are further divided into two groups which include the superficial muscle group and the deep muscle group.
The muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. The multifidus is a very thin muscle. Deep in the spine, it spans three joint segments, and works to stabilise the joints at each segmental level.The stiffness and stability makes each vertebra work more effectively, and reduces the degeneration of the joint structures.
Posterior sacrum (next to foramina), superior iliac spine, mamillary process of lumbar vertebrae, transverse process of thoracic vertebrae and articular process of c4-c6
Spinous process of vertebrae (except C1), 2-4 bones above origin.
Dorsal rami of spinal nerve
supplied segmentally by deep cervical artery, posterior intercostal arteries, subcostal arteries, lumbar arteries
Bilateral action: extend vertebral column
unilateral action: laterally flexes and contralaterally rotates vertebral column.
It is an important stabilisers of the lumbar spine Functions together with transversus abdominis & pelvic floor muscles to stabilise the low back and pelvis before movement of the arms and/or legs occurs.
Trigger Point Referral Pattern
Pain and tenderness is referred locally to the spinous process of the adjacent vertebrae and/or the vertebrae above it. Lumbar multifidus trigger points may also refer pain to the lateral abdomen region.
The following events or activities may activate or reactivate the multifidus trigger points:
- Automobile accident (rapid deceleration)
- Unaddressed trigger point activity in the larger muscle groups that move the spine (i.e. quadratus lumborum, lumbar paraspinals, abdominal obliques etc)
- Articular dysfunction in the spine (facet syndrome)
- Distorted lumbar lordosis, thoracic kyphosis, or scoliosis
Length Tension Relationship
The architectural design (a high cross-sectional area and a low fibre length-to-muscle length ratio) demonstrates that the multifidus muscle is uniquely designed as a stabiliser to produce large forces. Furthermore, multifidus sarcomeres are positioned on the ascending portion of the length-tension curve, allowing the muscle to become stronger as the spine assumes a forward-leaning posture.
Retraining the stabilising muscles of the core is done in a series of steps.The first step is to learn to isolate the muscle. The second step is to learn to co‐contract it in conjunction with the other muscles of the core. The final step is to co‐contract the entire core (connect simultaneously to the pelvic floor, transversus abdominis & multifidus) in coordination with the larger
superficial muscle during functional activities.
Recruitment Training for the Deep Fibers of Lumbosacral Multifidus (dMF)
Lie on your back or side with your spine in a neutral posture, (gentle curve in your low back): 
- Try the following connect cues to produce a deep contraction of multifidus isolated from the long back extensors.
- For the part of multifidus that supports the SIJ - imagine a line that connects your left and right SIJ and think about connecting, or drawing together, along this line.
- Imagine a line connecting your groin (or back of your pubic bone) to the part of multifidus in your low back you are trying to train (wake up). Connect along this line and then gently think about suspending (lifting) the lumbar vertebra 1 mm above the one below.
- Breathe in and on the breath out contract the deep multifidus with the best connect cue (have your therapist help you determine which is your best connect cue).
- No movement of your hips, pelvis or spine should occur as you gently activate the dMF. If you compare how heavy your leg is to lift with and without this dMF contraction you should find that it is lighter with the proper contraction.
- Hold the contraction for 3- 5 seconds and then release and breathe throughout this exercise. Repeat the contraction and hold for 3 sets of 10 repetitions 3 – 4 times per day for 4 weeks.
Strength Training for Lumbosacral Multifidus
In side lying:
- Maintaining your connection to Transverse Abdominus (TrA), keep your ankles together and lift your top knee (only as high as you can control without breath holding), focus on turning your inner thigh outwards. Return your knee.
- Maintaining your connection to TrA, keep your ankles together, lift your top knee and then lift your ankle. Return your ankle and then your knee.
- Lying on your back with your knees and hips flexed:
- Slowly let your right knee move to the right, keep your low back and pelvis level. Return to the centre and repeat with the left.
- Lift the right foot off the floor keeping the knee bent. Don’t hold your breath and don’t bulge your lower abdomen. Return the foot to the floor and repeat with the left foot. There should be no clicking in your low back.
- Lift the right foot off the floor and then straighten the leg only as far as you can control your core with a proper strategy. Slowly bend the knee and return the foot to the floor. Repeat with the left leg.Lift the right foot off the floor and then the left foot off the floor. Alternate
- leg extensions, exert with exhalation, breathe in to rest or hold.
With all these exercises maintain the leg lift for 10 seconds, build to 3 sets of 10 repetitions before moving on
Incorporate into Other Activities
The final step is to remember to use the core during regular life activities. Each time you get out of the chair, lift, bend or reach, this local stabilising system should be working at a low level. The goal is to teach the body to resume its normal stabilisation strategy of connecting to the core BEFORE movement begins.
Rotation MovesTwisting movements will help with flexibility and strength in your lumbar multifidi. Perform rotation exercises such as holding a broomstick across your shoulders and, standing with your feet shoulder width apart, twist from one side to the other. If your gym has a rotary machine, use that, too. Just place the pin under the amount of resistance you want to use and sit on the seat with your arms secured around the arm pads. Twist from one side to the other in a slow, controlled movement. Do at least 10 reps on each side for a total of 20.
Lateral Flexion Spinal muscles are important for bending your body from side to side, or lateral flexion. Lateral flexion exercises are useful for working your lumbar multifidus muscles. Lie on your side on an incline bench that has been adjusted so that the top of the bench hits you just below your waist. Cross your arms over your chest and bend your torso down to the side so that you're leaning over the top edge of the bench. Keep your back straight, only bending your spine at the waist. Do 10 reps on one side, then repeat with another 10 reps on the other side.
Have a look at this video for some good information of evidence regarding multifidus and low back problems.
- J Fitzgordon The mutifidus muscle available from: https://www.youtube.com/watch?v=c-_Y9q-kLdc (last accessed 9.6.2019)
- Long-Term Lumbar Multifidus Muscle Atrophy Changes Documented With Magnetic Resonance Imaging: A Case SeriesfckLRMark Woodham,1 Andrew Woodham,2 Joseph G Skeate,3 and Michael Freeman4,*
- Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine StabilityfckLRSamuel R. Ward, PT, PhD,1 Choll W. Kim, MD, PhD,1 Carolyn M. Eng, BS,1 Lionel J. Gottschalk, IV, BS,1 Akihito Tomiya, MD, PhD,1 Steven R. Garfin, MD,1 and Richard L. Lieber, PhD1
- diane lee Empower through Knowledge, Movement & Awareness Available from: https://dianelee.ca/article-training-deep-core-muscles.php (last accessed 9.6.2019)
- Chris Centeno Multifidus Back Pain: Why Your Doctor Never Discussed It Available from: https://www.youtube.com/watch?v=jjAWBiO7h4E (last accessed 8.6.2019)