The “Little Known” Muscle That May Be The Key To Fixing Your Back Pain….AND What You Can Do To Fix It!

If you have back pain😢, there's a good chance you need to work on strengthening your multifidus!

Anatomy

The multifidus muscle runs along your entire back (on each side of your spine), from your sacrum to your cervical spine. It originates at the transverse process of the vertebrae and attaches to the spinous process of the vertebrae 2-4 segments above. 

When the right and left multifidi contract together👐, they extend the spine. With an isolated contraction of the multifidus on just one side☝️, the muscle produces ipsilateral (same side) lateral spinal flexion and contralateral (opposite side) spinal rotation. For example, if the left multifidus contracts, it brings your left shoulder down and turns you to the right. 

The multifidus is a deep muscle of the spine and is extremely important in spinal stabilization🏋️ Research shows that people with low back pain often have significant atrophy of this muscle. Atrophy and weakness of the multifidus will lead to decreased stability of the spine, and can result in a vicious cycle of low back pain. Break the cycle and strengthen your multifidi to avoid low back pain👍

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Activation

If you want to strengthen your multifidus, you need to first learn how to properly activate it so you know which muscle should be firing when you're doing your core exercises.

  • Start standing with one foot in front of the other

  • To palpate the multifidus, place your thumb right next to the spine on the low back

  • Shift your weight forward and allow your heel to come off the ground

  • You should feel the multifidus pop into your thumb as it contracts

  • Try to maintain that contraction as you shift your weight back to the starting position

The Multifidus lift

Below is a great multifidus strengthening exercise. It also engages many of the other core muscles that need to be strong to stabilize the spine👍

  • Start with your left knee on a yoga block or foam pad and your right knee on the ground.

  • Engage your abdominals and activate your multifidus to pull your right knee parallel to your right so your pelvis is parallel to the floor.

With the right knee down as shown in the video, you will need the muscles that rotate your spine to the left to work. As you pull your right knee up to parallel, your right multifidus will be the one working.

  • Extend your right leg back and your left arm forward to further challenge the multifidus, transverse abdominals, obliques, glute max, and erector spinae.

Multifidus walk out

The multifidus walk out is a great way to strengthen the multifidus in a more functional standing position. Since many daily activities that require spinal stabilization are done in standing, it's important to train the multifidus in that same upright position.

  • Attach a band to a secure object about chest height level.

  • Grab on to the band with your arms straight

  • Take 3 large steps to the side

  • Keep your arms directly in front of your chest the whole time--don't let the band rotate your trunk as you step to the side.

As shown in the video, as you step out to the right, the band will be trying to rotate your spine to the left. Your left multifidus will be activated to perform relative right spinal rotation to prevent the band from rotating you to the left.

Do 10 reps on each side and feel your back pain melt away☺️

This Is What Happens To Our Spine As We Age

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 😬DEGENERATIVE DISC DISEASE😬 It sounds awful, right!?  Let’s talk about what that means, and why it’s important for you to fix how you are moving immediately.

As we all get older, our discs dry out and shrink.  This is a normal process that happens with aging.  Initially, as the disc height decreases, more movement will occur between the vertebrae of the spine.  The facet joints (not seen in the picture), which are now sitting right on top of each other, start rubbing against each other.  As bone rubs against each other, it will start to facilitate the growth of more bone ➡️➡️➡️ bone spurs ➡️ arthritis ➡️ a stiff spine.  Depending on how active an older adult you are, this may not affect you terribly.  BUT, you don’t want this process starting when you are young and active.  Now pay attention - herniated discs or disc bulges can also start this phenomenon.  Disc bulges lead to decreased disc height, and the same processes will occur ➡️ increased shear and torsional forces ➡️ increased facet loading ➡️ bone spurs ➡️ stiff spine ➡️ pain.


If you’re suffering from back pain, go see a physical therapist, who can teach you how to move better and get you out of pain. 


If you don’t have back pain, go see a physical therapist, and learn how to move better and stay out of pain😉

Prenatal Physical Therapy - You Don't Have To Be In Pain Anymore

 
 
 Prenatal Physical Therapy For Back, Hip, Ribcage, Neck, and Pelvis Pain

You're not alone if you believe that back and hip pain are just par for the course during pregnancy.  Fortunately, that's not the case!  Physical therapy can help to relieve some, if not all, the aches and pains of pregnancy and can literally be a life changing experience for a pregnant women experiencing pain. 

Many changes occur to a pregnant woman's body that will lead to low back and hip pain during, and sometimes after pregnancy. As a woman’s belly starts to get larger, the normal curvature of the spine changes and so does the distribution of body weight. Combine this with the normal weight gain, and the pressure and shear forces on the spine increase, causing pain in the low back and sacrum. 

A hormone known as relaxin is released by the body during pregnancy.  Relaxin softens the ligaments and loosens the joints of the pelvis to prepare for delivery. While these changes are necessary to allow for childbirth, the loose joints can cause pelvic instability.  The instability of the pelvic joints can cause misalignment of the pelvis and pain in the sacroiliac joints and/or separation of the symphysis pubis. Patients with sacroiliac joint dysfunction or symphysis pubis dysfunction often complain of back or pelvic pain with standing on one leg to put pants on, getting in and out of the car, going up and down stairs, or rolling in bed. The changes that occur in the pelvis often cause the muscles surrounding the area to spasm, which also contribute to low back and hip pain.

 

Because everything is connected in the body, pain in the low back and hips can cause a chain-reaction of pain in other parts of the body.   Many women experience upper back and rib pain from the ribcage expanding and the uterus and organs putting pressure on the diaphragm and ribcage. The muscles between the ribs and the muscles of the upper back become tight and can be painful with this ribcage expansion. Carpal tunnel syndrome is another common side effect in prenatal women. Increased fluid retention and swelling can increase the pressure placed on the median nerve in the wrist, which can cause numbness and tingling in the fingers, pain in the wrist and muscular tightness in the forearm.

So how can prenatal physical therapy help you with symptoms you may experience from all of these pregnancy associated physiological changes?  A prenatal physical therapist can educate you on posture and specific positions to diminish pressure on the joints, decrease muscle tightness, and help relieve pain. You can get tips on the best positions for pain-free sleeping, sitting, standing and other daily functional activities. A prenatal specialist can also perform kinesiotaping and strapping techniques and help you find the best brace or belt to give you a little extra back support. There are a variety of soft tissue mobilization, massage and joint mobilization techniques that can be performed to improve any pelvic misalignments, decrease muscle tightness, and provide pain relief.  A prenatal physical therapist will also provide you with specialized stretches and exercises focused on your specific impairments. Whether it’s stretches to relieve pain or specific therapeutic exercise to improve your strength and fitness level, physical therapy can help you have a pain-free and healthy pregnancy.

For additional questions or to book and appointment with our prenatal specialist, call 310-795-9800 or email amber@victoryperformancept.com.

 

The Butt The Wink

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Your pelvis is attached quite firmly to your spine. Whatever your pelvis does, your spine follows. What's happening when you see the dreaded "butt wink" during a squat or deadlift, is the pelvis rotating posteriorly. Your spine follows suit, going into flexion and putting compressive pressure onto the anterior part of the disc, vertebrae and facet joints. Now add whatever weight you are squatting/deadlifting and those forces grow exponentially. This is the most common mechanism for disc herniations. 

You can fix this by working on the flexibility and joint mobility in the hips and ankles as well as spending some time on the actual movement mechanics. 

Videos of some techniques to mobilize the hip and ankle coming soon. 

Ankle Sprains!

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The ATFL or anterior talofibular ligament is the most common ligament in the ankle that people tear/sprain/injure. 

It attaches the talus and the distal head of the fibula. 

The ATFL is typically torn or sprained when the ankle moves into inversion and plantar flexion (toes pointing in and down) at an extremely high velocity. 

Unfortunately, ligaments don't return back to their original shape.  Once they are sprained, or stretched, your ankle remains less stable and you are more likely to re-injure yourself. A physical therapist can give you targeted exercises to rebuild the muscles around your ankle and help improve your motor control and balance to decrease your risk of re-injury. 

Why You Pulled Your Hamstring and What You Need To Do To Prevent It

Hamstrings Complex

Biceps Femoris Long Head

Origin: Ischial tuberosity and sacrotuberous ligament

Insertion: Head of fibula

Action: Hip extension and knee flexion/external rotation

Innervation: Tibial nerve (L5-S2)

Biceps Femoris Short Head

Origin: Lateral lip of the linea aspera on the femur

Insertion: Head of the Fibula

Action: Knee flexion/ext

Innervation:  Common fibular nerve (L5-S2)

Semimembranosus

Origin:  Ischial Tuberosity

Insertion: Medial tibial condyle, oblique popliteal ligament, popliteus fascia

Action:  Hip extension and knee flexion/internal rotation

Innervation:  Tibial nerve (L5-S2)

Semitendinosus

Origin:  Ischial tuberosity and sacrotuberous ligament

Insertion: Medial to the tibial tuberosity in the pes anserinus

Action:  Hip extension and knee flexion and internal rotation

Innervation: Tibial nerve (L5-S2)

So?  If you have ever pulled your hamstring, you know that it sucks.  You can be sidelined for 2-8 weeks depending on the part of the hamstring you pulled.   You’re looking at 2-4 weeks if the pain is in the middle of your leg, and 6-8 weeks if the pain is higher up your leg, where it connects to the ischial tuberosity.  Hamstring strains usually occur when the hamstrings are trying to slow your femur down as it moves forward at a fast rate of speed, like in running, sprinting, or kicking.  Your hamstrings are primarily knee flexors, but three out of the four are also hip extensors.  When your glutes aren’t doing what they are supposed to be doing and slowing down hip flexion, your hamstrings are left to do more work than they can handle, and you end up being hamstrung.  Add “prevent hamstring strains” to the list of reasons why you should be working your glutes at the gym!  And also don’t forget to do this awesome eccentric hamstring exercise.  

 


Leg Day - If Your House Has Stairs, I’m Staying In The Car

 

QUADRICEPS FEMORIS

Rectus Femoris

Origin: Anterior inferior iliac spine and the acetabular roof of the hip joint

Insertion:  Tibial tuberosity via the patellar ligament

Innervation: Femoral nerve (L2 - L4)

Action: Hip - flexion
            Knee - extionsion

Vastus Medialis

Origin: Linea aspera (medial lip), and the distal intertrochanteric line

Insertion: Tibial tuberosity via the patellar ligament

Innervation: Femoral nerve (L2 - L4)

Action: Knee extension

Vastus Lateralis

Origin: Linea aspera (lateral lip) and the lateral surface of the greater trochanter

Insertion: Tibial tuberosity via the patellar ligament

Innervation: Femoral nerve (L2 - L4)

Action: Knee extension

Vastus Intermedius

Origin: Anterior side of femoral shaft

Insertion: Tibial tuberosity via the patellar ligament

Innervation: Femoral nerve (L2 - L4)

Action: Knee extension

So?  These four muscles make up the quadriceps femoris.  They all attach to your patella (knee cap) via your quadriceps tendon, and continue down to your tibia via the patellar ligament (tendon?).  The patella gives the quadriceps muscles a major mechanical advantage by increasing their leverage, which basically allows the quads to do approximately 30% more work with the same effort.  However, all of those forces created when extending (straightening) your knee are directed into the patellofemoral joint surfaces - where the patella and femur (thigh bone) meet.  With overuse, this joint breaks down and/or can cause osteoarthritis.  To help slow the breakdown of cartilage in your knee, don’t forget to use your glutes when doing things like going up/down stairs and anytime you sit down, stand up or squat. The more your glutes help out, the less your quads have to work.  The less your quads work, the happier your knee joint will be.