multifidus atrophy, muscle wastage, lumbar disc injury
Multifidus atrophy after lumbar disc injury
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Previous research has suggested that the multifidus muscle - which has a key lumbar-stabilising function - can become inhibited during a lumbar disc injury. This inhibition leads to atrophy (muscle wastage).
The problem for the patient is that when the symptoms of the disc problem are relieved the weakened multifidus muscle cannot perform its stabilising role correctly and the risks of the injury recurring are greater. This is why training the multifidus muscle is an important component of any rehabilitation programme.
Current practice usually involves focusing on improving the endurance and static holding capacity of the multifidus during rehab training. One typical exercise involves holding a forward lean of 20o (from the hips) with the back aligned in neutral for 10 x 10 seconds. This kind of exercise will train the multifidus in a correct functional manner.
A new piece of research (Yoshihara at el. (2001). Spine, 26(6), 622-626) suggests that these static endurance-type exercises may not be enough to regain full multifidus function. Yoshihara et al found atrophy in both the type I and type II fibres following lumbar disc problems. The researchers suggest that, because of this, power and endurance training may be required in a rehab programme.
They also found that without exercises providing greater loads or greater rates of force development, multifidus may be unable to function correctly in more dynamic tasks.
While re-learning to hold correct posture with low load static exercises is undoubtedly important, patients and therapists may consider progressing on to more dynamic movements for the lower back musculature to complete the rehab picture.
Current practice usually involves focusing on improving the endurance and static holding capacity of the multifidus during rehab training. One typical exercise involves holding a forward lean of 20o (from the hips) with the back aligned in neutral for 10 x 10 seconds. This kind of exercise will train the multifidus in a correct functional manner.
A new piece of research (Yoshihara at el. (2001). Spine, 26(6), 622-626) suggests that these static endurance-type exercises may not be enough to regain full multifidus function. Yoshihara et al found atrophy in both the type I and type II fibres following lumbar disc problems. The researchers suggest that, because of this, power and endurance training may be required in a rehab programme.
They also found that without exercises providing greater loads or greater rates of force development, multifidus may be unable to function correctly in more dynamic tasks.
While re-learning to hold correct posture with low load static exercises is undoubtedly important, patients and therapists may consider progressing on to more dynamic movements for the lower back musculature to complete the rehab picture.
