I recently experienced back pain while on a multi-day trip. Was it from too much driving? Hefting luggage? Dehydration? Hotel treadmill? Extended conference sitting? A poor-quality mattress? Everything combined? Who knows? But it was unexpected, and my hours were tightly scheduled ones in which I took little time to improve my condition. I should know better. I was not stopping to think about solutions already familiar to me, which frankly I could have done easily during the meeting sessions. “Knowing better,” and not following your own advice, makes matters worse of course. Nevertheless, my general overall conditioning helped me to function somewhat normally and without being noticed, despite discomfort. Most of us know this discomfort; many of us know real back pain as well.
Approximately, 80% of the US population suffers from back pain at one time or another. While there are various ‘reasons,’ there are not numerous structures involved. Basically there’s three prime structures implicated – small joints in our spine (called facet joints), along with discs and muscles. And the winner of the tortuous trio (when pain is present) is most often the muscles.
If your suffering is bad enough to find you in a physician’s office, the epidemiology of the onset is habitually listed as sports injury, back strain, prolonged postural dysfunction, auto accident – on and on. But generally, the problem started long before that triggering event. One of the reasons patients may find relief in spinal manipulation (or ‘adjustment’) is that the treatment can release the tension on touching facets, allow restructuring for correct biomechanics or it can release a restricted muscle. The latter is true of massage and physical therapy (PT) as well. They all offer a jump-start to pain-relief and proper functioning. Yet, we have to do more ourselves. Self-care is key, which not everyone wants to hear.
I exaggerate when I speak of a ‘secret’ muscle. My reason for doing so is that the muscle in question is one often overlooked – you may never have even heard the name – and yet it is vital for a pain-free back. Keeping it (and its actions) in mind can prevent pain and improve our conditioning. This small consideration is even more important as we age, since the ill-uses can pile up.
So….the secret? It is the Multifidus muscle. It travels the length of our spine, attaches to each and every vertebra – on both sides – and with its many tendons provides us stability and support. It allows us to bend sideways, forward and rotate our spinal column. People who have been diagnosed with facet syndrome or hypertrophic changes to facets (where tissue builds up around the joint, shrinking the nerve opening) often have the multifidus to blame, at least in part.
Research noted in the reference section below (and from other sources) can be summarized in lay-terms to reveal the problem. Chronic back pain is often accompanied by atrophy (weakened ability) of this muscle, or decreased amount of multifidus activity compared to study participants without pain. To clarify, when an issue is diagnosed as arising from muscle and its related “soft-tissue,” it is not the same as saying the pain is not severe. It can be. Surprisingly so. Overwhelmingly so.
Granted, when all ‘parts’ work in symphony, we are less prone to any pain. Still, the multifidus is a major performer and plays in concert with many body parts.
Okay. If you are following me so far, you are doubtless ready for the bottom line.
…..What would you have to do?
…..Does it cost?
…..How much time does it require?
…..How difficult is it?
The answers? Not much – nothing –couple minutes, along with other activities – not difficult.
5 Simple Tips
It’s often suggested that one must first learn to activate or “recruit” the muscle. That’s so. And the first 3 movements below do that – help recruit and stabilize the multifidus. Even better, is that they can be accomplished within your day without taking extra time.
- When: waiting in line, standing for a short break, looking out the window at fresh blooming flowers, watching for a water pot to boil….you get it.
What: stand with hands on waist, fingers splayed along the back (as high as comfortable). Breathe. SLIGHTLY bend back. [No one should notice, since it is that slight. It might look like you’re just straightening up.]
Feel the muscle contract under your fingers. Hold a few seconds. Repeat several times.
- When: getting ready for bedtime or a nap.
What: lay face down with a pillow under stomach/hips; put your hands in same position as #1.
Suck your stomach in, rock one hip into the pillow or bed. Hold 3-5 seconds; repeat on the other side. Do it a few times (up to 10x).
- When: doing the dishes, in the shower, waiting for paint to dry, any time standing, or immediately following #1 above.
What: stand with hands in same position as #1 above. SLOWLY lean forward about 2-4 inches and feel the muscle contract. Hold 3-5 seconds. Repeat.
Key here: IMPORTANT to keep the upper torso totally straight. You can feel the difference if you bend the torso by curving forward vs. bending at the hips with the upper body erect (the correct movement). You want to learn this difference, and you can easily feel it with just a little practice.
By the way, #1 and #3 can be performed in a sitting position if standing is not possible, thus providing even more possible moments to take advantage of the moves during our day.
I am designating these two quick exercises as ‘strengthening’ because they are more advanced and do strengthen, but they also continue to stabilize the multifidus. While it is doubtful that either of these movements would cause pain, it is helpful to do the beginning 3 at least for a week before progressing on if you are ALREADY in pain. Both of these are in a routine I have developed over many years; simple and beneficial.
When: while watching TV, during a computer video, or while doing other stretching or exercise routines. [These require just a tad more time than the other three.]
- Angry Cat. [Hopefully many of you are familiar with this one.]
On all fours (hands and knees), arch back, relax, let back sway. Hold both the arch and the sway for 5 seconds. Repeat up to 10x.
- Bird Dog.
On all fours, extend one arm and opposing leg in a pointing fashion (keeping both in line with torso and not widening out). The position may remind you of a bird dog. Hold 5 seconds. Repeat up to 10x.
Alternative. If you feel awkward or too unstable and weak to perform this movement, simplify it by raising the arm/hand and opposing leg/knee just slightly off the floor without extending either.
NMS Rehab at Home
These simple movements and exercises may not afford the expertise (nor the price tag) of a Neuro-Musculo-Skeletal (NMS) rehab specialist. But they offer you a significant avenue for self-care. And you aren’t on someone else’s schedule – not for appointments, referrals or dismissal when insurance runs out. Additionally, your NMS specialist would more than likely condone these at-home exercises.
The ‘secret’ or little-mentioned multifidus muscle can not only stabilize our spine and prevent certain conditions from happening, but exercising it can reduce bouts of pain – even low-back pain. And remember that often pain in one area affects or exacerbates dysfunction of muscle/joint problems in another area. “The back bone’s connected to the hip bone”….and all that. Further, multifidus exercises can expedite recovery for those who find themselves experiencing current back problems.
I wish I had remembered this on my little trip. One of my favorite sayings is “Knowing the Way is not Going the Way.” Still, next time (if there is one) I will remember to “go the way.”
drb note: It is possible that some of the motions above may also activate the muscle known as the erector spinae – thus an added bonus. Many muscles are activated together with others.
Bello, Bahir, Dr. Bayer University Kano, Nigeria. Multifidus Activation, Pain and Functional Disability in Individuals With Chronic Low Back Pain (CMLBP). 2016 From: Clinical Trials.gov. https://clinicaltrials.gov/ct2/show/NCT02901327. Full Study results not yet released.
Note: Preliminary results from above show treadmill walking helpful for activating Multifidus.
Danneels L, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. European Spine Journal, 2002 Feb; 11)1):13-19.
Ng, Joseph and Richardson, Carolyn. EMG study of erector spinae and multifidus in two isometric back extension exercises. Australian Journal of Physiotherapy, 1994 June 2(40); 115-121
Paolo Pillastrini, Silvano Ferrari, et al. Exercise and tropism of the multifidus muscle in low back pain: A short review. Journal of Physical Therapy Science 2015, March 27 (3); 943-945
Woodham M, et al. Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series. Journal of Radiological Case Reports, 2014 May: 8(5); 27-34
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