Archive for September, 2009

29 September

Multifidus Muscle – The Core: Part 3 – Week 4 of Pilates

Multifidus_drawing

The multifidus muscle group is the posterior aspect of the core.  The transversus abdominis could be thought of as the corset and the mustifidi as the laces in the back.  The two work together to support the core.  The multifidus group is relatively new to the scientific community as  muscles worthy of interest or research.  Over the last few years though, there has been an abundance of research done on the multifidus group that is quite interesting to those interested in movement or rehabilitation from back injury.

The multifidus muscles are an intermediate to deep group of spinal muscles that are located on both sides of your spine, and run from your pelvis and low back all the way to your neck.  Each muscle spans 2-4 vertebrae. The multifidus muscles are thicker at the bottom toward the sacrum and thinner toward the neck or cervical spine.  It looks like a scalloped design from the top to the bottom.  The multifidus group is know to co-contract with the transversus abdominis.

Besides working with the transversus abdominis to help stabilize the low back, the multifidus group attaches to the deep laminae of the posterior thoracodorsal  fascia, separating from the gluteus maximus muscle and below the posterior sacroiliac ligaments to blend with the sacrotuberous ligament (Lee, p 34).  So, the multifidus group helps to stabilize the pelvis and sacrum.  Basically, these muscles help to stabilize the sacrum, illium and lumbar.

Multifidi is the plural form of these muscles and in latin it means many to cleave.  Most anatomical texts use the muscles in the singular form or multifidus.  When these muscles contract on opposite sides of the spine, it extends the spine.  When the muscles contract on the same side of the spine, it side bends the spine in that direction and rotates the spine in the opposite direction.

The multifidus muscle group has become very well known in the last few years because of new research linking it to back pain.  “ Researchers are now finding out that in some people with low back pain, it’s not always the whole multifidus muscle  group that is the problem.  In many cases, it’s just a single multifidus muscle at only one level of the spine that’s not working (Johnson p. 8).”  Due to the fact that there are many multifidi muscles that span the vertebrae from the sacrum to the cervical spine, it makes it possible that a single multifidus muscle can act upon and articulate one vertebrae at a time.  Although this amount of control helps gain a greater range of motion in the spine, it can also lead to possible problems in the spine.  For example, if one of the multifidi muscles are not participating in movement then that level of the spine is held victim to movement from above and below the area.  Thus, that part of the back can become stiff or suffer the consequences of being pushed and pulled without support.

So, a well trained multifidus group is active in all levels of the spine.  You know your multifidus group is working well if you can articulate every vertebrae of your spine and have a well connected core while moving.

Exercises for the Multifidus

1. Multifidus Awareness. The multifidus group is more challenging to find than the transversus abdominis muscle.  The easiest place to feel the multifidus group is to lie on your side with your legs bent and place your hand on your low back.  When you exhale, connect your transversus to your multifidus muscles.  You may feel a slight plumping under your hand.  It will feel like a ripe avocado, or a sponge being filled with water.  Yes, it is that subtle.  If you are unable to feel this, have someone pull on your top leg slightly.  Again, connect the transversus to multifidus group on the exhale, have your friend pull your leg as you resist.  That will increase the pull on the multifidus group and help  you feel that muscle under your hand.  If you still cannot feel this muscle you may need to stretch is out by lying over a physio ball, or doing a few cat backs.  Remember, visualizing the muscle working is always important for neural improvement even if you cannot feel the muscle.

Multifidus_1

2. Clam, or Multifidus Awareness with Leg Lift. Same position as above.  Exhale and connect the transversus abdominis to the multifidus group.  Pull the knee slightly in toward you while thinking about someone pulling it in the other direction, and lift the knee toward the ceiling.  Lower the knee and repeat.

Multifidus_2

References

Johnson, Jim PT. The Back Pain Solution. New Harbinger Publications, Inc. Oakland, CA. 2002.

Lee, Diane.  The Pelvic Girdle. Harcourt Publishers Limitied. Edinburgh, UK. 2000.

 

21 September

Transversus Abdominis – The Core: Part 2 – Week 3 of Pilates

 

 

 

TA pic

 

This is a picture of your Transverse Abdominal.  Notice the length of the muscle from the pubic bone to the xiphoid process on the rib cage and horizontal fibers around to the back.

 

The Transverse Abdominal is the deepest layer of abdominal muscle that runs from the pubic bone to the upper rib cage and attaches to the spine via the lumbar fascia.  It creates a cylinder of stability around the torso to support the low back and pelvis.  The muscles fibers are static on the bottom and phasic on the top.  That means that the lower fibers are meant to be stabilizers and the upper fibers are more movable.  Think of a tree with the trunk being more stable than the upper branches.  This allows for the low back and pelvis to be more supported, and still allow for the movement in the ribs for breathing. 

This muscle is one of the main muscles of the core.  If this muscles does not engage, then the multifidi or back stabilizers will also not engage. “Contraction of this muscle increases the tension laterally in the thoracodorsal fascia and helps to increase the intra-abdominal pressure(Hodges and Richardson 1996, Vleeming et al 1997).”  The thoracodorsal fascia has superficial, intermediate and deep layers that connect every muscle, including back stabilizers, like a sling between the shoulder and opposite hip.  For simplicity sake, I like to think mainly of the transversus and the multifidi relating to each other like a sandwich around your spine, hugging you all day long.  This sandwich feeling is the intra-abdominal pressure that stabilizes the low back. 

Of all the muscles of the core, I find that the transversus abdominis is one of  the easiest of the core to locate and to feel engage.  Therefore, it is always the best place to start when educating yourself about the core.  Below are some exercises to start noticing your transversus abdominis muscle.

Abdominal Sensation – Lying with your back on the floor(supine), with your knees bent and feet firmly on the floor.  Feet in line with your hips or sit bones.  Place a little more weight between the big toe and second toe.  If possible, put a rolled up towel between your upper inner thighs.  Make sure your pelvis and spine are neutral.  Place your hand below your belly button on your abdominal wall.  Take an inhale, and as you exhale feel your abdominal sink below your hand.  Repeat.  Try breathing out like you are fogging up a mirror if you would like more of an abdominal sensation.

Abdom sensation

 

Modified Curl Up –  Same position as before.  Interlace your fingers and place them behind your neck, or grab the corners of your mat if you have neck problems.  Take and inhale to prepare, as you exhale feel your transversus abdoninis sink and then curl up. Use the fogging up a mirror breath if you would like. Check that when you curl up, you don’t lose the connection to your transverse abdominal.  If you do lose the connection, you will see a slight bulge in the abdominal area.

Mod curl 1

 

Mod curl 2

 

Modified Curl Up for Upper Transversus Abdominis – Same position as before.  Place you hand on the lower ribs.  As you exhale, you will feel the ribs lower toward the floor.  Use that movement to begin your curl up.  Maintain the rib connection as you lower down to the floor.

Upper thoracic 1

 

Upper thoracic 2

 

Standing Abdominal Sensation –   Standing, place one had below your belly button in front and one at your mid back.  As you exhale, feel how the two hands come together.  As you inhale, your hands will move slightly away from each other.  It is like giving yourself a little hug all day long.

Standing abdom sensation

18 September

The Core, Part 1 – Week Two of Pilates


core_1

Picture taken from Diane Lee’s Pelvic Girdle Text

The Core is a very popular word these days if you read fitness magazines or have a personal trainer.  Some people may have a different definition of the word core, so it is always important to ask your trainer or fitness instructor what they mean by using your core.

In our work, we use the term core to mean the relationship between the transverse abdominal, pelvic floor, multifidi and diaphragm.  How these four things work together and coordinate creates what is called intra-abdominal pressure.  It is that pressurized system that stabilizes the pelvic, lumbar and sacral regions.  To go a little further in the area of biomechanics, the core acts as part of the inner muscular system that supports the joints.

Now it may begin to make sense to you why we started with the alignment of the bones.  The way the bones fit together, their size, shape and way they relate to each other through cartilage and ligaments is called form closure.  How those bones stay together is called force closure.  Force closure is your core.  The force the core uses to support the bones needs to be complete and consistent.  “Adequate compression through the joint must be the result of all forces acting across the joint if stability is to be insured and load transferred efficiently and safely (Lee, p. 53).”  If your core is not acting in a balanced and consistent way around joints that are in a neutral position, you body will not be able to organized itself efficiently and that may lead to injury.

It is important to note for our purpose of functional fitness and movement in general, that these muscles are not held or clenched when performing movement.  These muscles work together in a well organized synchronization to provide support and strength for the joints and hence the rest of your body.  Gravity produces both vertical and horizontal shear forces that must be transferred through the system. Stability is not only about the quantity of muscular contraction or end point of your range of motion, but the quality and control of the systems that allow the load to be transferred and movement to be smooth and effortless (Lee p. 54).  The core is a perfect example of a group of muscles that works best in relation to each other.  Their relationship allows for your brain to determine how much force is needed when and for what activity.  A lack of this relationship would result in possibly too much or too little force over the joint system and that would not allow for smooth and effortless movement transfers or coordination.

Coordination or motor control is referring to your ability to engage muscles with sufficient timing or synchronozation and correct amount of force for the task.  There was a study done that found a timing delay in the transversus abdominis.  The muscle failed to contract prior to the initiation of arm or leg movement in the in people with chronic low back pain.  Isn’t interesting that the people who need their core support the most are probably the ones that don’t use it?

A significant motor control deficit is present in people with chronic low back pain which is primarily associated with the control of contraction of the transversus abdominis.  The failure of the stabilization mechanism with subject in the low back pain group indicates that the normal strategy used by the body to control intervertebral motion and stiffness is inefficient(Hodges and Richardson, 1996).

This means that if the core is not organized and firing seconds before movement occurs, then the body has to find another, less efficient way to accomplish what you want to happen.  This might not be a problem the first few times you do the task, but over time this compensatory pattern can wear on the system and can lead to a chronic injury.  It would be the same as trying to push your car around the corner rather than getting in the car to drive it around the corner.  Using compensatory patterns means you work harder for worse results.

How do you connect into the core so that you can reduce the risk of a compensatory pattern? Here are a few things you can do that we have gone over in class, and in this short discussion.

  1. Check that your joints are in a neutral position.  It doesn’t mean that you have to be scared and only stay in neutral.  Of course you need to belly dance, bike ride, play tennis and surf.  What is does mean is that for the majority of the time that you are dealing with gravity, stay in neutral.  Think of it as your home base.
  2. Start getting really familiar with the muscles that make up your core.  Read these blogs so you can get information on all the pieces of the core and how they interact. Get out an anatomy book and notice where these muscles are located on your body.
  3. Think quality rather than quantity.  As stated earlier, the core muscles work to create a pressurized system across the joints of the pelvis, lumbar and sacrum.  That does not mean that you clench your muscles to the extent that they interfere with your movement.  On a scale of 1-10(one being lowest and ten being greatest), the core maintains an consistent and steady 5-7 of muscular contraction.
  4. The core works in relationship to itself and the whole of your body.  Although you may learn about the core one muscle at a time, in the end they all work together to give you strength and stability.
  5. Slow down and work less.   You have to slow down and recreate a neural pathway to the brain informing it that you want the core to connect before you move.  Remember the study about people that suffered from chronic back pain.  It may sound silly, but the brain does not work as fast as you think.  Any new movement takes time for the brain to coordinate.  Let it have that time, do not fight this process by becoming impatient.  You will have these concepts intellectually before your body gets them physically.  Do not give up.
  6. Take this information into your daily routine.   Another part of movement learning is to take it out of the classroom and incorporate it into your daily life.  Periodically check during the day if your pelvis and spine are neutral.  I used to check every time the phone rang, or someone called my name.  Connect with you core before you turn over the car ignition, before you answer the phone, before you pick up a bag of groceries.  This all helps you wire this pattern more quickly in the brain.

Hopefully now you have a better understanding of the core muscle group and why it is so important to the rest of the body.  The core is not just necessary for the aesthetic look of a bathing suit model, but for the function of how the body transfers load placed on it through movement and gravity.  In the coming weeks, I will be writing about each one of the muscles in the core.  If you have any comments, please let me know and I will attempt to fulfill your desires.  For example, maybe you would like more anatomical detail?  Or maybe more exercises? I will do my best to accommodate you.

Contact me at:  stephanie@stephanie-spencer.com

Looking  forward to talking to you soon!

References

Hodges, P W, Richardson, C A. 1996. Inefficient muscular stabilization of the lumbar spine associated with low back pain.  A motor control evaluation of transversus abdominis. Spine 21(22): 2640-2650.

Lee, Diane. 2000. The Pelvic Girdle. Harcourt Publishers Ltd. Edinburgh, UK.