Accidents and Injuries

For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan?

Multifidus Muscle

The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019)

Anatomy

Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at:

• The thoracic spine of the middle back.
• The lumbar spine of the lower back.
• The iliac spine - the base of the wing-shaped iliac bone of the pelvis.
• Sacrum - series of bones at the base of the spine connected to the tailbone.
• When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)

Muscle Function

The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently.

• This protects against spinal deterioration and the development of arthritis. (Jeffrey J Hebert et al., 2015)
• The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
• The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
• The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
• The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)

Lower Back Pain

A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019)

• Herniated discs - also bulging or slipped discs.
• Nerve entrapment or compression pinched nerve.
• Sciatica
• Referred pain - nerve pain originating from the spine felt in other areas.
• Osteoarthritis - wear-and-tear arthritis
• Spinal osteophytes - bone spurs
• Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.

Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities.

Can Core Exercises Help with Back Pain?

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888. https://doi.org/10.2522/ptj.20120457

Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopedic and sports physical therapy, 49(6), 464–476. https://doi.org/10.2519/jospt.2019.8827

Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterized by larger type I muscle fibers compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150. https://doi.org/10.5115/acb.20.009

Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in Preventing and Treatment Low Back Pain. HSS journal: The Musculoskeletal Journal of Hospital for Special Surgery, 15(3), 214–220. https://doi.org/10.1007/s11420-019-09717-8

Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764. https://doi.org/10.1186/s12891-020-03791-4

Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The Spine Journal: official North American Spine Society journal, 15(6), 1196–1202. https://doi.org/10.1016/j.spinee.2013.08.05

Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071. https://doi.org/10.1097/BRS.0000000000000972

Sometimes low back pain comes out of nowhere, but that sudden twinge in the lower back does have a cause. With some cases, there’s a trigger, like picking up a heavy object/furniture from an awkward position.  But sometimes it can be a mystery and a challenge to diagnose.

It is important to know the cause of lower back pain to figure out the proper treatment plan.

Otherwise, one could receive treatment for the wrong diagnosis and possibly exacerbate the existing injury.

Why do I need to know what triggers my back pain

Knowing what triggers back pain is the first step toward prevention and how to treat it.

Muscle spasms can stop you cold, and so I'm sure you don’t want another one.

Acute Back Pain

Acute low back pain typically comes on suddenly and lasts for a short time.

It often resolves on its own with self-care and a little time.

Back pain that lasts longer than three months, is considered chronic.

Chronic back pain can be more complex and require doctor/spine specialist-directed treatment, like physical therapy.

Lower Back Pain Is Common

Over 90 percent of adults will have some type of low back pain during their life.

It happens to be the number one cause of job disability globally and the leading contributor to missed work.

Lower back pain happens more often, compared to mid or upper back pain because of the location and all of the movement.

The lower back supports the upper body's weight.

The low back known as the (lumbar spine) absorbs and distributes all of the forces and stress when we move:

• Walking
• Standing
• Rest
• Sitting
• Sleeping

Spinal and abdominal muscles that are weakened heighten injury risk.

These factors combined make the lower back vulnerable to painful spinal conditions.

Common Triggers

When the lumbar spine:

• Muscles
• Tendons
• Ligaments

And other connective tissues get:

• Pulled
• Strained
• Sprained

Is when lower back pain happens.

Small tears in the disc can also contribute to back pain.

Basically, any number of activity and non-activity can cause damage to the spinal discs depending on the movement.

A study published in Arthritis Care & Research saw 999 people from 300 clinics in Australia, to examine their pain triggers.

The most common triggers include:

Manual tasks performed in an awkward posture

This includes:

• Lifting boxes with the back and not bending the knees
• Lifting something too heavy
• Moderate physical activity
• Vigorous physical activity

High intense strength training, long bike rides without proper conditioning, handling people or animals, and picking up children can be triggers and cause injury.

Other triggers include:

• Overstretching
• Twisting
• And Trauma

From:

• Falls
• Vehicle accidents
• Sports 

Triggers You Might Not Know About

Although we don't think about it being Distracted can increase the odds of low back pain.

When we're not paying attention,  we are more likely to lift and carry something too far from our body or distribute the weight unevenly.

Feeling tired and Fatigued is associated with lower back pain.

Getting the proper amount of sleep is vital to restore our bodies to optimal performance.

When we don't sleep the right amount of hours we make our bodies more susceptible to injury.

Treatment

Thankfully most cases are not serious and typically resolve within a few days to, four weeks healing on its own.

But if not, then there are these conservative treatments that can help you feel better and speed up healing.

Continue to Move Around

Depending on how much pain your body will allow, keep doing regular activities and exercise, as best as you can.

Activity increases blood flow, that moves oxygen and minerals/nutrients through the body.

Activity and movement help reduce muscle tension and inflammation.

Heat/Ice

This will not cure a strain or sprain, but they do help in pain reduction.

Heat helps loosen tight muscles.

This can be done by making warm compresses by soaking a towel in hot water.

Fold it to the size you need and wrap it around your lower back up to 20 minutes.  Then rest, massage and re-apply.

Therapy

Physical and manual therapies like:

• Chiropractic care
• Therapeutic UltraSound 
• Massage can bring temporary relief from short-term back pain.

If the pain is intense and interferes with daily activities, a chiropractor/physical therapist can offer exercises and stretches to:

• Improve posture
• Increase mobility
• Correct muscle imbalances

Acute lower back pain can stop you cold with its intensity.

Understanding triggers can take steps to maintain a healthy spine and avoid unpleasant surprises.

Medication

Both acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain.

These need to be taken, specifically as directed by your doctor. We've seen the opioid crisis going on and now this type of treatment is now a last resort. Various medical associations are now pushing towards natural and alternative therapies before turning to medication.

Prolonged use of NSAIDs (Aleve, Advil) can be associated with an upset stomach, kidney damage and gastrointestinal conditions and bleeding, among other conditions.

*BACK PAIN* Rehabilitation | El Paso, Tx (2019)

Back pain is one of the most common health issues frequently diagnosed by healthcare professionals. Approximately 80 percent of the population will experience some type of back pain throughout their lifetimes. Because back pain can occur due to a wide array of health issues, diagnosis is essential to follow-up with the proper treatment approach. Dr. Alex Jimenez, chiropractor or doctor of chiropractic in El Paso, TX, utilizes chiropractic care to help treat back pain. Patients describe how their back pain affected their quality of life, and how Dr. Jimenez helped them improve their overall health and wellness with chiropractic. Patients highly recommend Dr. Jimenez and his staff as the non-surgical choice for back pain, among other common health issues.