Studies show that nearly 80% of the population will experience lower back pain at some point in their life. The term "core stabilization" has become widely understood and used by doctors and fitness professionals to help address back pain under conservative management or post operatively. Through physical therapy and exercise programs such as Pilates, many are familiar with the idea of abdominal stabilization as a means of managing lower back pain. Less widely understood, but also an important consideration in spine stabilization programs, is the multifidus.

The multifidus is a deep spinal stabilizer, located right on top of the posterior aspect of the spine and composed of multi-segmented portions to protect and control spinal motion. In the lumbar region, the multifidi originate from the mammilary processes of the vertebrae and insert a few levels above the origination segment onto the spinous process of the insertion segment. While this muscle group is composed of thin and individually small groupings, the multifidi serve as an important stabilizer and component of spinal health.

Like all muscle groups, the function of the multifidi can be compromised by injury, trauma, disuse, congenital conditions, or biomechanical errors. Examples of spinal conditions that may weaken the multifidi and cause impairments in motor control include disc herniations, whiplash injury, spondylolisthesis, scoliosis, muscle strains, degenerative joint disease, or nerve compression. When the body experiences pain, the surrounding muscle tissue function becomes impaired as the body compensates to protect the spinal condition. As pain reduces or the acute flareup of a condition resolves, the function of the multifidus doesn't return on its own. To regain strength and motor control after weeks to months of compensatory patterns and disuse, the multifidus needs rehabilitation.

To locate the multifidus, take your hand onto the middle of your lower back and feel the bony protuberances along the spine (your spinous processes). Then move your fingertips slightly to the side of the spinous process and feel a groove just off to the side. This is where the multifidus resides.

To engage the multifidus take your hands and feel your lower back, one hand on each side of the back. You should feel a protuberance on each side of the lower back, which is part of your pelvis. To begin working on strengthening, create an action that you are drawing these two protuberances together. No movement of your body should actually occur, as it is a subtle and deep sensation. Another way to begin improving strength and motor control of the multifidus is to take your hand to the groove where the multifidus resides as you lie on your back with your legs straight. Create an action as though you are drawing your right hip up to your right shoulder, leading with engagement from the muscle group underneath your fingertips. You should feel the muscle engage. Repeat on each side. As you become better able to engage the multifidus, exercises are progressed into more challenging and dynamic motions to train the multifidus to engage during daily activities and recreation.

The multifidus is not an easy muscle to self identify or to strengthen. The purpose of this article is to draw awareness to a commonly overlooked muscle group, and to educate those with spinal conditions to inquire about multifidus strengthening with their treating health care provider. If you have a spinal condition, we recommend seeking consultation from a physical therapist or qualified fitness professional to help you rehabilitate this muscle group. For complete spine stabilization, we also recommend a gluteal and transverse abdominus stabiilzation program.

Carla Pryor PT, DPT, OCS, RYT 200. Co Owner of Redefine Health and Fitness located in North County San Diego. Redefine is a wellness based company focused on providing excellent comprehensive and research driven care to assist clients in meeting their fitness and nutrition goals. Contact carla@redefinehealthandfitness.com for further inquiry.