Chronic low back pain can be so frustrating and despite trying to avoid motions or positions that are known to increase pain, it can flare up for no reason whatsoever! ARGGGGHHHH!!!! It can put huge limitations on people’s activities and therefore, on their quality of life – so not cool! If you have ever dealt with this kind of pain, you understand how it can literally change your life. It can make even the simplest tasks seem like giant feats – lifting your toddler, picking your kid’s toys up off of the ground, putting on your shoes and socks, sitting at the table to eat….the list goes on. It will interrupt every aspect of your life, including the most important thing that is needed for healing – SLEEP! Some people use more than 5 pillows every night just to try to find some position that will allow them to get some respite from the pain. Everyone talks about how important “core strength” is, but does everyone know what is meant by “core strength?” I didn’t know until I went to PT school, but even then, I didn’t really know until I worked with many people over the years who felt like they had tried everything. They’d done “core exercises” and worked their abs and glutes but it didn’t help their pain as much as they would have expected, or in some cases, it made it worse.
Over the years, I’ve really noticed that most “core” exercises concentrate on the larger muscle groups or are much more global exercises, meaning that they are big exercises that utilize many different muscles. These can be great exercises, but I often find that when people have chronic low back pain, their body develops compensation patterns and some muscles will overwork while others get weaker. A good example of this is with the multifudi muscle group. Multifudi is plural for multifudus, which is a very deep spinal stabilizer muscle. It’s small but mighty! It connects between the vertebrae, so it is truly controlling the motion of the vertebral segments, and therefore is very important in spinal stability. This muscle is one of the first to shut down after an injury to the back – the inflammation, muscle spasms and pain inhibit this muscle from contracting well. Over time, if this muscle hasn’t “turned back on” it will atrophy and then other larger muscle groups will try to take over and compensate. This may work for a while, but none of the larger muscle groups can stabilize in the same way that the little multifudi do. The body will start to have less and less spinal stability and control which will lead to continued pain and breakdown of the entire system.
What can be done once you have developed multifudi weakness, you ask? Lots of things! It completely depends on each individual person and what the reasons are behind their dysfunction. Some people have had spinal surgery, a c-section or other abdominal surgery, an injury directly to the back, or some may have had an injury or holding pattern in some other area of their body that has affected the low back. Due to each person being so different, there is no way to just give out a couple of exercises to help engage the multifudi. I often do a lot of hands-on work to resolve the main restrictions and tightness that are preventing the multifudi from activating correctly. Then, depending on the extent of the damage, I utilize dry needling with electrical stimulation to essentially “wake up” the muscles, and/or I use very specific exercises. There are many exercises that we can use to engage the multifudi, but in order to have the best outcomes, I have found that they must be individualized and taught with very specific form that can change based on the person’s issues.
No body is the same and each person should be treated based on their exact needs. This is often the problem with traditional in-network physical therapy – there is not near enough time to evaluate each patient at each visit (things change constantly, so bodies need to be re-evaluated consistently), do a significant amount of hands-on work, and work with them on very specific exercises and form from an experienced physical therapist. Many in-network clinics have to utilize PT aides to help patients with exercises, as the PTs don’t have enough time to be able to do this themselves. Most PT aides are awesome, but are usually just starting their journey into the physical therapy world and do not have much of the knowledge that is required to teach proper form for each individual patient – this comes from years of experience working with a lot of bodies and a lot of education!
So, if you experience chronic low back pain, there can be a myriad of things contributing to this. The multifudi are not the only thing to look at, but that’s another post for another day. =) The reason that I chose to write about the multifudi is because I feel like they are often a big contributor to low back pain and are often overlooked. I want people with chronic low back pain to know that they don’t have to “just deal with it!” Find a physical therapist that will spend time with you, treat you as the unique individual that you are, and really hone in on the source of the pain. If they are a great PT, they will also recognize when you might need more of a team effort and will be able to refer you to other practitioners that can help you get back to living your best life!
If you are in the Denver Metro area, please contact Solstice Physical Therapy to help you with your chronic low back pain or any other pains or discomforts that you may have. We specialize in treating people that have tried many other therapies in the past but have not had the results that they are looking for. Don’t ever think that you just have to live with it – keep searching for answers and there will be someone out there that has the solution to your puzzle!
Contact Dr. Lisa Wilcox at drlisa@solsticephysicaltherapy.com, www.solsticephysicaltherapy.com, or (720) 369-7738.
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