In order to know how to strengthen specific muscle groups, it is important to know the muscles origin, insertion, its isolated function and its integrated function. I hope you find the following information of help:
Origin: Posterior aspect of the sacrum; processes of the lumbar, thoracic, and cervical spine
Insertion: Spinous processes one to four segments above the origin
Isolated function: Concentrically accelerates spinal extension and contralateral rotation
Integrated function: Eccentrically decelerates spinal flexion and rotation; isometrically stabilizes the spine.
Hopefully the above information will assist you in determining appropriate exercises for your clients to “reduce, eliminate and prevent low back pain.”
Starte with simple Drawing in of the TVA in a supine position, then progress to holding the drawn in TVA in a supine position while marching in place (do not let the hips move and keep back pressed into the floor)
Glute bridge while maintaining a drawn in TVA.(don’t allow the movement to happen throught the lumbar)
Single leg Glute bridge while maintaining level hips(don’t let one side drop) while maintaining an active TVA.
Opposite arm and leg raise while maintaining a rigid LPHC (no movement in the core). These can be done on the floor prone, on a bosu supported with a little instability, in a quadraped position, and on a ball. The starting body position is determined by the ability to control the core.
Plank raises, get in a ready position (prone on elbows) draw in TVA then lift hips into a plank position hold for 3-5 seconds then lower, reset, and repeat for programed reps.
Side plank, get in ready position placing elbow directly below the shoulder while lying on side. Draw in TVA, then raise hip off of the floor hold the same as the plank raise.
Start with stability, then mobility of limiting muscles that are creating autogenic inhibition, then start with movement while controlling the core. The multifidus are segmental local stabilizers of the spine, don’t start moving till you can stabilize the segments.
As stated in the other post, knowing the functional anatomy of the multifidus is half of the battle. Once you know what they do and how they are activated just plug in some exercises that activate that function.
Something that is worth mentioning is that most back pain is a combination of limited hip mobility causing instability of the Lumbo Pelvic Hip Complex. If we look at the moving and stabilizing segments of the body we see a stabilize, mobility, stabilize, mobility, combination of segements. The ankels need mobility, the knees need stability, the hips need mobility, the lumbar/pelvis need stability, the thoracic spine needs mobilty, and so on. So in most cases the inability to stabilize the LPHC is due to limited hip mobilty.
Attempting to isolate particular intrinsic muscle groups like the multifidus in an effort to mitigate pain can be a very frustrating and losing effort.
According to Dr. Michael Clark of NASM and others, localized “dysfunction” or overuse pain is the result of an imbalance in musculature and muscle signaling – not simply a matter of one particular weak muscle.
In addition, according to work by Michol Dalcourt, Ian O’Dwyer and others with PTA GLobal, skeletal support and muscle structure is as much a function of fascial strength, flexibility, and cohesion as it is muscle strength and endurance.
For this reason, I would suggest changing your focus away from isolating multifidus action, and rather carefully manipulate the entire CORE structure (TVA, multifidus, RA, obliques, ES, TS, QL … arguably this list goes on and on) in a safe, directed environment such as within a pool.
Water’s buoyancy will allow you to concentrate on trunk movement without the full weight of gravity on sensitive joints:
1) In shoulder high water, stand with your feet slightly wider than hip width and brace your feet to the ground ensuring that your heel, big toe, and little toe all touch the ground and lean your weight slightly into your forefoot.
2) Activate CORE stabilizers by considering yourself in the restroom and actively stopping the action that normally takes place there – this signals the pelvic floor and lumbar support structures that movement will occur.
3) With hands separated, sweep the water from side to side slowly and up and down slowly and alternately at first You should feel good tension in the middle and lower half of your body, but your legs should not move. As you become more comfortable with the sweep exercise, you may add more force and/or speed to your movements.
4) Once you are comfortable with the movement, you may try the same action on land with a resistance band tied to a vertical post or other hip – shoulder level point of resistance.
Do 2-3 set of 15-20 repetitions up to 5 times per week to integrate the movement of the multifidus with other CORE group actions. Be sure to apply ice to the point of pain for up to 20 minutes immediately following completion of exercise, and if pain persists, or worsens, seek professional assistance.
great answers. All of them are good. Improving core function is the key. Stabilisation function is often used than rotation and flexion extension. So activating core muscles in non weight bearing to partial and then to fully weight bearing exercises static to dynamic unloaded to loaded will help restore it’s function.
Great answers here. Thanks for the information.
Mac Dodds M.A., CSCS
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