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Losing Control: A Huge Part of the Pain Puzzle

Losing Control: A Huge Part of the Pain Puzzle

You can do the plank for 3 minutes straight and those muscles on either side of your lower back feel rock hard, you have glutes of steel, and …your back still hurts. What the heck???

Strengthen your glutes, strengthen your abs – you’ve heard that – maybe ad nauseam- from us for years. Core, core and more core…. We’ve told you that core strength can help alleviate knee pain, hip pain, lower back pain and more. We’ve told you that core weakness is a huge part of the pain puzzle. In talking about the core, the abdominals and gluteal muscles keep coming up, but we’ve neglected the back muscles – the multifidus in particular. Here’s why it’s important: multifidi

The multifidus muscles take pressure off the vertebral discs and distribute body weight evenly throughout the spine. Those deep muscles make your spine more stable; they control the small movements from spinal segment to spinal segment. We call it local control. Studies have shown that the multifidus muscles are activated before any action happens. Before you bend, lift, or twist, your multifidus muscles start contracting to prepare your spine for the movement so you avoid injury.

Abdominal contractions normally cause a co-contraction of the spinal stabilizers. So many folks work on their abdominal muscles and call it good. There is a problem with this line of thinking, particularly if you’ve had a back injury. Multiple studies have shown that, despite patients returning to pain free function after a back injury or back surgery, the multifidus did not return to normal without specific retraining. In fact, following a back injury, CT scans show marked atrophy of the multifidus, even several weeks after the injury and even when the patient had returned to all his or her normal activities. So, once a person has a back injury, a weak multifidus can cause recurrent episodes of back pain with increasing severity and frequency. And it makes sense.

mutifidus video
Retraining the Multifidus Muscle

Retraining the multifidus requires a concerted effort. Awareness of how to activate the muscle is lost post injury, but there are ways to make them fire again. Your PT can easily check to see if you are using your back stabilizers and if not, develop a retraining program. It’s about reconnecting your brain to those small but powerful muscles deep in your spine. The hardest part of this training is creating awareness. We can’t see what’s happening, and we have to learn to feel them fire all over again.

If you have rock hard superficial muscles covering the deep stabilizers, it makes finding them even harder. And, when the superficial muscles are rock hard, it’s often because the multifidus is asleep. The good news is that once we have a sense of how to activate the muscles, there are great ways to challenge them. And then, using tranversus abdominus will actually make the co-contraction happen.


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