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The multifidus muscle is a deep back muscle that runs along the entire length of the spine, from the pelvis to the neck. It is an important contributor to lumbar spine stability, and its atrophy or weakness can lead to low back pain. As a result, the restoration of lumbar multifidus function is a common goal of rehabilitation. To assess lumbar multifidus function, the multifidus lift test (MLT) can be performed, which involves palpating the muscle at the L4/L5 and L5/S1 spinal levels. Palpation of the multifidus muscle can be done by placing the thumb next to the spine on the low back and shifting the weight forward. This article will provide an introduction to the multifidus muscle and explain how to palpate it.
| Characteristics | Values |
|---|---|
| Muscle location | Runs along the entire back, on each side of the spine, from the sacrum to the cervical spine |
| Muscle function | Provides an important contribution to lumbar spine stability |
| Muscle palpation location | At the base of the lumbar spine, where it is only covered by a thin layer of fascia |
| Muscle palpation procedure | Patient is asked to flex the arms to approximately 120° and the elbows to approximately 90°, then the patient is instructed to raise their contralateral arm toward the ceiling approximately 5 cm |
| Normal contraction | Robust and obvious muscle contraction during the arm lift |
| Abnormal contraction | Little or no palpable contraction of the muscle during the arm lift |
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What You'll Learn
The multifidus muscle's role in spinal stabilisation
The multifidus muscle is a series of long, narrow muscles that run along the entire length of the spinal column on both sides. It is a deep muscle of the spine and is responsible for spinal stabilisation. It provides three types of support: segmental, intersegmental, and global stabilisation. Segmental stabilisation refers to the control of individual vertebral segments, intersegmental stabilisation is the coordination of adjacent segments, and global stabilisation refers to the overall control of the spine as a whole.
The multifidus muscle works alongside two other deep muscle groups to stabilise and move the spine in complex ways. The rotatores muscles, which are situated on each side of the spine, enable unilateral rotation and bilateral extension. The semispinalis muscle, which is also situated on each side of the spine above the multifidus muscle, allows for the extension and rotation of the head, neck, and upper back. The multifidus muscle also works synchronously with other back muscles, such as the erector spinae, to extend the spine and maintain an upright posture.
The multifidus muscle has numerous attachment points to the spine, which helps protect against spinal deterioration and the onset of arthritis. It also provides a protective mechanism against spinal injury, as individuals with reduced multifidus muscle activation are more likely to experience low back pain and injuries. Weak or atrophied multifidus muscles can lead to spinal instability, vertebral compression, and back pain. Therefore, proper activation and strengthening of the multifidus muscle through exercises and physical therapy can play a crucial role in maintaining spinal stability and preventing back pain and injuries.
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The Multifidus Lift Test (MLT)
To perform the MLT, the patient is positioned prone with their arms flexed to approximately 120 degrees and elbows flexed to approximately 90 degrees. The examiner palpates the multifidus muscle lateral to the interspinous space of L4/L5 and L5/S1. The patient is then instructed to raise their contralateral arm towards the ceiling by approximately 5 cm.
During the arm lift, the examiner assesses the quality of multifidus muscle contraction through palpation. A normal contraction is characterised by a robust and obvious muscle contraction during the arm lift, while an abnormal contraction is indicated by little to no palpable contraction. The test result is considered positive when an abnormal contraction is identified and negative when a normal contraction is observed.
The MLT provides valuable information about lumbar multifidus function, particularly in individuals with low back pain. It offers a simple and reliable method to evaluate multifidus dysfunction without the need for expensive technology. However, it is important to note that the validity of the MLT depends on the spinal level assessed, and it may have less interrater reliability compared to other tests such as the Prone Instability Test (PIT).
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Palpating the multifidus muscle at the base of the lumbar spine
The multifidus muscle is a long, narrow muscle that runs down both sides of the spine, providing stability and strength to the lower back. It is the innermost layer of three layers of muscles of the back, known as the deep layer. The multifidus muscle is situated on both sides of the lumbar spine and helps with back extension and spinal stability.
To palpate the multifidus muscle at the base of the lumbar spine, follow these steps:
- Lie on your back or side with your spine in a neutral posture, maintaining a gentle curve in your lower back.
- Identify the L4/L5 and L5/S1 spinal levels by first palpating the iliac crests bilaterally and proceeding posteriomedially along the intercristal line to the intersection of the lumbar spine. The level of intersection is considered the L3/L4 interspace.
- Palpate caudally to identify the L4/L5 and L5/S1 interspaces, which will help you locate the L4/L5 and L5/S1 spinal levels.
- With your arms flexed at 120 degrees and elbows flexed at 90 degrees, slowly raise your arm that is opposite to the side of the interspinous space you are palpating towards the ceiling. For example, if you are palpating the interspinous space on the right side, raise your left arm.
- During this arm lift, the examiner will determine the quality of multifidus muscle contraction through palpation. A normal contraction will be palpable and robust, while an abnormal contraction will result in little to no palpable muscle contraction.
It is important to note that the anatomical landmarks for the spinal levels may vary between individuals, making the correct identification of spinal levels through palpation a challenging task.
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The relationship between the multifidus muscle and low back pain
The multifidus muscle is a deep spinal stabilizer that runs along the entire back, on each side of the spine, from the sacrum to the cervical spine. It is responsible for controlling the position of the vertebrae, which helps maintain proper posture and spinal stability. When the left and right multifidi contract together, they extend the spine. When the multifidus on only one side contracts, it produces ipsilateral (same-side) lateral spinal flexion and contralateral (opposite side) spinal rotation.
The multifidus is a crucial muscle for spinal stabilization and plays an important role in protecting the spine during movement. Weakness, atrophy, and inhibition of the multifidus muscle are associated with low back pain. Research shows that people with low back pain often have significant atrophy of this muscle, which leads to decreased spinal stability and can result in a cycle of persistent back pain.
To examine the function of the multifidus muscle in patients with low back pain, a clinical test called the Multifidus Lift Test (MLT) can be performed. During this test, the patient is asked to lie in a prone position and relax. The examiner then palpates the multifidus muscle lateral to the interspinous space of L4/L5 and L5/S1. The patient is then instructed to flex their arms to approximately 120 degrees and elbows to 90 degrees before raising their contralateral arm towards the ceiling. The examiner assesses the quality of multifidus muscle contraction by palpation, determining whether it is normal or abnormal.
There are also exercises to strengthen the multifidus muscle and reduce low back pain. One such exercise is the multifidus walkout, which involves using a band attached to a secure object at chest height. By stepping to the side, the band creates resistance that works the multifidus and other core muscles. Another exercise is to kneel on the left knee and engage the abdominals and multifidus to pull the right knee parallel to the left so that the pelvis is parallel to the floor. This exercise also engages other core muscles that stabilize the spine.
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The challenges of palpating the multifidus muscle
Palpating the multifidus muscle is a challenging task due to its location and the potential for individual variations in anatomy. Here are some of the key challenges:
Firstly, the multifidus muscle is a deep muscle that runs along the entire back, on both sides of the spine, making it difficult to access and palpate effectively. It originates at the transverse process of the vertebrae and attaches to the spinous process of the vertebrae a few segments above. This position means that accurately locating and isolating the multifidus muscle through palpation can be tricky.
Secondly, individual variations in spinal anatomy can further complicate the palpation process. The specific spinal levels and landmarks used for reference during palpation, such as the L4/L5 and L5/S1 interspaces, can vary between individuals. As a result, correctly identifying the appropriate spinal level through palpation alone may prove challenging and requires a good understanding of spinal anatomy.
Additionally, the multifidus muscle is often associated with low back pain. However, there are currently no widely accepted physical examination procedures to assess multifidus function in patients experiencing this issue. While the multifidus lift test (MLT) has been proposed as a method to identify lumbar multifidus dysfunction, its validity depends on the spinal level being assessed. This limitation means that MLT may not consistently provide accurate information about multifidus function, especially at certain spinal levels.
Furthermore, the multifidus muscle is a key contributor to spinal stability, and its atrophy or weakness can lead to decreased spine stability and a cycle of low back pain. This dynamic nature of the muscle, where its function directly impacts spinal health, adds another layer of complexity when attempting to palpate and assess the multifidus accurately.
Overall, palpating the multifidus muscle presents several challenges due to its location, individual variations in anatomy, the dynamic nature of the muscle, and the lack of standardized assessment procedures, especially in the context of low back pain.
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Frequently asked questions
The multifidus muscle is a deep back muscle that runs along your entire back, on each side of the spine, from the pelvis to the neck. It is made up of many small, segmental muscles and is important for lumbar spine stability.
The best place to palpate the multifidus muscle is at the base of the lumbar spine, where it is covered only by a thin layer of fascia. To palpate the multifidus, place your thumb right next to the spine on the low back.
The multifidus lift test (MLT) is used to identify lumbar multifidus dysfunction among patients with low back pain. The patient is asked to lie in a prone position and relax. The examiner then palpates the multifidus muscle lateral to the interspinous space of L4/L5 and L5/S1. The patient is then asked to flex their arms to approximately 120 degrees and their elbows to 90 degrees before raising their contralateral arm towards the ceiling. The examiner can then judge the quality of the multifidus muscle contraction.
