rehab

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☺️

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. 

Back Pain And What It's Trying To Tell You

 

An interesting article by Deepak Chopra. 

I firmly believe that regular "physical therapy check-ups" would put a huge dent in the incidence of low back pain.  

In California, you no longer need a physicians referral to see your physical therapist.  Whether you have a long standing injury, or want to prevent one, do yourself a favor and go get yourself assessed by a physical therapist.

back pain

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.  

 


Infraspinatus and Teres Minor

 

Infraspinatus & Teres Minor

Infraspinatus

Origin:  Infraspinous fossa (immediately below spine of scapula)

Insertion: Greater tuberosity of the humerus

Innervation: Suprascapular nerve (C4 - C6)

Action:  External rotation

Teres Minor

Origin: Lateral border of the scapula (lateral and inferior to infraspinatus origin)

Insertion: Greater tuberosity of the humerus

Innervation:  Axillary nerve (C5, C6)

Action:  External rotation and weak adduction

Why do I care:  These two external rotators are an integral part of the rotator cuff.  They have the best lever arm to externally rotate the shoulder, allowing the greater tuberosity to rotate away from the coracoid process of the scapula.  This ultimately allows us to reach or push objects over our heads without jamming our rotator cuff tendons between the greater tuberosity and acromion process.  Chronic computer and phone use can cause these muscles to become stretched out.  A stretched out muscle is a weak muscle in most cases.  To prevent this, make sure that you regularly stretch your pecs, subscapularis and anterior shoulders.

Subscapularis - The Armpit Muscle

Subscapularis

Origin:  Subscapular fossa (costal or anterior component of the scapula)

Insertion:  Lesser tuberosity of the humerus

Innervation:  Subscapular nerve (C5, C6)

Action:  Internal rotation of the humerus

Why do I care:  Subscapularis is one of the four rotator cuff muscles of your shoulder.  You can touch it if you stick your hand in the opposite arm pit and push on the front of your scapula, or shoulder blade.  This muscle can become shortened with chronic computer use or if placed in a sling for any length of time.  

So? So, if your internal rotators are shortened, you will lack appropriate external rotation of the humerus, which is necessary to get your arm completely overhead without pinching your other rotator cuff tendons in the shoulder joint, which will lead to bursitis, tendonitis and/or rotator cuff tears.