6 minute read
MotoPT: IMPROVE YOUR MOVE
The Most Important Muscle You Have Never Heard Of!
Hello FTR Family,
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I hope your preseason training is going well and your goals are set for the 2022/2023 FTR season. We will be off and racing before you know it. Good luck to those racing the enduro series, which begins next month! Otherwise, I will see all the FTR hare scramble racers at Bartow, hosted by CFTR; it is going to be a great time. Thank you to those that have given me feedback about these articles I have been writing. I am taking some advice and will be a bit briefer this month, so the content is more digestible. I can continually expand on these topics at the races or via email, so feel free to reach out if you want more information. I know what it is like to be interested in reading an article but bookmarking it later because I don’t have the time to read it now.
This month’s article expands on the low back pain topic from last month since this is the most common musculoskeletal pain condition. When you think about your back and central low back pain, you can often reach back and feel the tight bands of muscles that run longitudinally adjacent to your spine. These are the erector spinae muscle group, composed of three muscles the iliocostalis, longissimus, and spinalis. These three muscles act like large exterior cables next to our spinal column and tend to get tight and tonic as we age, which can cause spinal column compression. We then rely too much on these muscles when we move our spine. The good part of using these muscles is they are the primary muscles in the spine that return you to upright from a forward bent position such as reaching for the floor in standing, as they are spine extensors, which is a needed action of these muscles. The bad part is that having tight and overfiring muscles exterior to the spinal column but acting on the spinal column can inhibit the deep segmental stabilizers of the spine.
These are the muscles that you want to fire and gain control over. Of the multiple muscles that act on the spine, the most important segmental stabilizer is the lumbar multifidus muscles. The lumbar multifidus, which I will call the multifidus from here on out, is the most important muscle in the lumbar spine. It is located deeper than the erector spinae and more centrally, connecting to each and every level of the spinal column in a segmentally specific way. There are several interesting facts about the multifidus.
One of those facts is in the presence of chronic low back pain, the multifidus tends to be inhibited, meaning it has difficulty contracting. What’s strange about this phenomenon is that every other muscle in the body spontaneously regenerates and fires as soon as possible.1 For example, if you have broken a bone and been in a cast, you have noticed the muscles not able to fire while you are wearing the cast tend to waste away or atrophy. When the cast is removed, simply moving the area will cause those muscles to fire, and they can regenerate little by little, almost automatically to a set point. For some reason, this does not happen in the case of the multifidus. Instead, with chronic low back pain, the multifidus continues not to fire. In contrast, the erector spinae and other muscles fire more to overcompensate, which is why your achy back is often in the center of your lumbar spine, directly over your erector spinae muscles. When you “throw your back out,” you are straining the overworked erector spinae muscle group. On and on the cycle goes, mainly when the core muscles are untrained unless the multifidus is forced to fire with any combination of tactics, including
palpation, deep electrical stimulation, manual therapy, manual resistive exercises, and other targeted multifidus exercises.
This leads us to the second most interesting fact about the multifidus. If it is left to its own devices, this muscle does not spontaneously regenerate. What happens to this unique muscle if left unattended? Well, the literature has finally caught up to what those fortunate enough to have access to cadavers have known for several decades, the body will use the multifidus as a fatty storage area, termed fat infiltrates.2,3 First, the muscle thins out by losing its thickness and then your body begins to deposit fat directly into the muscle.4 I have put a metal probe against a wasted multifidus on a cadaver with a history of low back pain and had the probe slide directly through the fatty deposit the size of a dime. Their multifidus was paper thin and marbled with fat where dense muscle fibers should be located. I have not seen any other skeletal muscle undergo such changes. I hope you can see that years of neglecting the multifidus can make the job of improving low back pain that much more difficult.
Are you convinced everyone needs to manage their multifidus to prevent and treat low back pain? Here’s a great exercise to get you started on feeling this muscle contract. Lie on your stomach on a stable surface such as the floor, with a thick pillow horizontally placed under your hips/pelvis. Gently draw your abdomen away from the floor without holding your breath. Once you can sustain this contraction, gently absorb the weight of one leg by lifting it one inch off the ground without losing any contraction or holding your breath. Make sure your hips/pelvis do not rock while you move your leg that short distance. Slowly return to the start position. Congratulations, whichever leg you lifted caused the opposite side multifidus to fire so that your spinal column could be stabilized. You are now on the road to great multifidus contractions!
Before you start any new exercise program, I highly recommend you consult a physical therapist or physician for a general health and physical activity readiness screening. If you are experiencing LBP, it is always beneficial to have a complete evaluation by a physical therapist or physician. If you have any questions or comments, please email me at contact@motopt.com. Let’s IMPROVE YOUR MOVE so you can ride better this season!
Sincerely, Dr. D
1. Gabel CP, Mokhtarinia HR, Melloh M, Mateo S. Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition. World J Orthop. 2021;12(4):178-196. doi:10.5312/ wjo.v12.i4.178
2. Zhong Y, Liu J, Zhou W, Yu D. Relationship between straight leg-raising test measurements and area of fat infiltration in multifidus muscles in patients with lumbar disc hernation. J Back Musculoskelet Rehabil. 2020;33(1):57-63. doi:10.3233/BMR-181304
3. James G, Chen X, Diwan A, Hodges PW. Fat infiltration in the multifidus muscle is related to inflammatory cytokine expression in the muscle and epidural adipose tissue in individuals undergoing surgery for intervertebral disc herniation. Eur Spine J. 2021;30(4):837-845. doi:10.1007/ s00586-020-06514-4
4. Catania B, Ross T, Sandella B, Bley B, Lobacz ADT. Clinical Assessment and Thickness Changes of the Oblique and Multifidus Muscles Using a Novel Screening Tool and Exercise Program: A Randomized Controlled Trial. J Sport Rehabil. 2021;30(3):384-394. doi:10.1123/JSR.2019-0156
