Although chronic LBP patients demonstrate a variety of apparently dysfunctional neuromuscular control strategies, (38-49) many stabilization exercise programs focus primarily on the training of the deep (local) muscles, particularly multifidus
and transversus abdominis.
Muscle spindles in the lumbar multifidus
and longissimus muscle also act thixotropically wherein the fidelity of their proprioceptive signaling is influenced by very small, maintained changes in the position of a vertebra.
Most of the multifidus
muscle remained attached to the [L.
13) Another study showed that activation of the cervical multifidus
muscles occurred between 105 and 194ms following impact or auditory startle; however, there was a large amount of individual variability (range 34 to 571ms).
2,6,16) These recommendations include spinal stabilization exercises to activate the transversus abdominus and multifidus
muscles, transitioning to a more classic swing (by shortening their backswing to decrease low back strain without affecting performance or moving to a two-plane swing to minimize hip and trunk separation), aerobic endurance training to reduce fatigue, balance training, resistance exercises, as well as a good warm-up of at least 10 minutes, and flexibility/stretching of affected musculature (which has been shown to decrease injury by up to 60%).
Post-partum rehabilitation exercise prescription recommendations include: restoring hip stability, lumbo-pelvic stability and motor control by training the transverse abdominis and multifidus
muscles, activating the related muscle-fascia-tendon slings and pelvic floor muscles, with slow progressions within patient tolerance.
These authors found no significant differences in the cross-sectional area of the psoas major or paraspinals but they did find significant differences existed in the cross-sectional area of the multifidus
at the L4 spinal level.
10 Core stability exercises are advocated for strengthening lumbar multifidus
muscles and adequate strength of these muscles affords segmental stability.
They observed that the surface EMG activities of the longissimus and multifidus
muscles during a maximal isometric lumbar extension together with shoulder isometric horizontal abduction were greater by 69% to 84% compared with the maximal isometric lumbar extension alone.
However, no significant differences were observed in the AIS group between the directions of scoliosis, which does not support a possible theory of a specific (associated with the direction of the scoliosis) type of abdominal muscle asymmetry, as in case of the multifidus
Different studies have reported delayed activation of TrA with respect to erector spinae with significant atrophy of multifidus
in subjects with chronic low back pain.
16) Some authors suggest that the entrapment may be due to spasms of the paraspinal musculature, mainly the multifidus
, the scapular stabilizers including the rhomboid and trapezius, or impingement due to degenerative changes in the thoracic spine and/or thoracic herniated discs.