From the Guidelines
To treat multifidus muscle atrophy, strength training is particularly indicated, and a combination of endurance and strength training is recommended, as it has multiple beneficial effects and is well tolerated. When designing a treatment plan, consider the principles outlined in the American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation 1, which, although focused on pulmonary rehabilitation, provides valuable insights into exercise intensity and frequency. For multifidus muscle atrophy, the goal is to enhance spinal stability and reduce back pain.
Key Considerations
- Begin with gentle exercises that target the multifidus muscles, such as pelvic tilts and bird dog exercises, to activate these deep spinal stabilizers.
- Progress to more challenging exercises like bridges, side planks, and quadruped arm/leg raises as strength improves, aiming for 3-4 times weekly, with 2-3 sets of 8-12 repetitions, and gradually increase the intensity.
- Incorporate functional movements that engage the core, such as walking, swimming, or Pilates, to complement specific exercises and enhance overall spinal stability.
- Consistency is key, with significant improvement typically requiring 6-12 weeks of dedicated exercise.
- Proper form is essential; thus, focusing on quality over quantity and considering initial guidance from a physical therapist to ensure correct technique is advisable.
Exercise and Rehabilitation
Given the importance of strength training for muscle atrophy, as highlighted in the pulmonary rehabilitation guidelines 1, applying similar principles to multifidus muscle atrophy treatment can be beneficial. High-intensity exercise produces greater physiologic benefits but may not be suitable for all patients; therefore, a tailored approach based on the individual's capability and progress is necessary. Interval training and the combination of endurance and strength training can offer multiple beneficial effects and are generally well-tolerated, making them valuable components of a rehabilitation program for multifidus muscle atrophy.
From the Research
Treatment of Multifidus Muscle Atrophy
To treat multifidus muscle atrophy, several approaches can be considered based on the available evidence:
- Exercise therapy: Specific, localized exercise therapy has been shown to promote multifidus muscle recovery and reduce muscle atrophy in patients with low back pain 2, 3, 4.
- Stabilization training: A staged stabilization training program involving voluntary contraction of the multifidus, transversus abdominis, and pelvic floor muscles can improve multifidus muscle cross-sectional area and reduce pain in elite cricketers with low back pain 3.
- Multifidus-focused low back exercises: Performing exercises that target the multifidus muscle can lead to a decrease in muscle atrophy and fatty replacement, as well as functional improvements in patients with chronic low back pain 4.
- Spinal manipulative therapy: While spinal manipulative therapy alone may not be sufficient to reduce multifidus muscle atrophy, it can be used in conjunction with exercise therapy to promote recovery 4.
Key Findings
Some key findings from the available evidence include:
- Multifidus muscle atrophy can exist in highly active, elite athletes with low back pain 3.
- Muscle atrophy is not always characterized by a decrease in muscle size, but rather by structural remodeling of muscle, adipose, and connective tissue 5.
- Exercise therapy and stabilization training can promote multifidus muscle recovery and reduce muscle atrophy 2, 3, 4.
- Magnetic resonance imaging (MRI) can be used to quantify changes in multifidus muscle atrophy over time 6, 4.