In my fellowship course this weekend, the instructors were discussing the role of the multifidi muscles in relation to low back pain. During the conversation they stated that while pain often decreases acutely, the muscles remain atrophied if not specifically trained. They cited articles from Hides et al (1996, 2001) who found that individuals with specific multifidi training had reduced recurrences of low back pain 3 years after initial onset.
To review, the multifidi are the most medial and largest muscles of the low back. They run the entire length of the spine and play a vital role in protecting the low back. The main function of these muscles is to oppose the abdominal muscles as they produce rotation (not produce rotation as commonly thought).
Why does this matter?
In the initial stages of treatment, use your standard low back interventions (repeated movements, spinal manipulation, dry needling). These interventions help decrease pain, decreased fear avoidance, improve mobility, and more. Once the individual's pain has decreased, incorporate core strengthening and movement pattern re-education to ensure these muscles are properly supporting spine to prevent recurrence of symptoms.
While many of us do a great job treating the acute pain, are we appropriately managing the problem from reoccurring?
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