• 척추신경추나의학회지
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• 제3권2호
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• pp.61-68
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• 2008

Objectives : Lumbar multifidus muscle stabilize lumbar spine. Atrophy of multifidus muscle follows disfunction of low back pain patient's activity and increase the reoccurency of herniation of nucleus purposus surgery. Lumbar herniation of nucleus purposus if common cause of low back pain. We have evaluated the atrophy of multifidus of nucleus purposus. Methods : Five patients were diagnosed as Lumbar herniation of nucleus purposus through the CT imaging. CT imaging were visually analysed to know lumbar multifidus muscle atrophy. Results and Conclusions : Examination of multifidus muscle atrophy should be considered with assessing CT imaging of lumbar spine. It may help for further evaluation and planning the treatment of Lumbar herniation of nucleus purposus patient.

• 한방재활의학과학회지
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• 제19권4호
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• pp.151-163
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• 2009

Objectives : In the assessment of the lumbar spine by magnetic resonance imaging (hereinafter, "MRI"), changes in the paraspinal muscles are overlooked. The purpose of our study is to examine the correlation between the multifidus muscle atrophy on MRI findings and the clinical findings in low back pain (hereinafter, "LBP") patients. Methods : The retrospective study on 38 LBP patients, presenting either with or without associated leg pains, was undertaken. The MRI findings on the patients were visually analysed to find out a lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compressions. The clinical history in each case was obtained from their case notes and pain drawing charts. Results : The lumbar multifidus muscle atrophy has occurred from more than 80% of the patients with LBP. Most of lumbar multifidus muscle atrophies have increased from lower level of lumbar spine. It was bilateral in the majority of the cases. In addition, multifidus muscle atrophy was correlated to the patient's age, disc degenerations and spinal stenosis. On the contrary, gender, the duration of LBP, referred leg pain, disc herniation and nerve root compressions had no relevance to multifidus muscle atrophies. Therefore, when assessing the MRIs of the lumbar spine, we should have more attetion on multifidus muscle, because it has lot's of information about spinal neuropathy problems. Conclusions : Therefore, the examination of multifidus muscle atrophies should be considered when assessing the MRIs of the lumbar spine. In addition, it helps to evaluate and plan the treatment modalities of LBP. Moreover, it prevents from LBP by discovering the importance between the multifidus muscle and the spine stabilization exercise.

• The Journal of Korean Physical Therapy
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• 제30권5호
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• pp.173-180
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• 2018

Purpose: This study examined the effects of sling exercise therapy on vertebral alignment, VAS, muscle activity, and multifidus of patients with chronic low back pain. Methods: Simple random sampling was used to divide the patients (n=116) into the sling exercise therapy group (SETG) and conservative physical therapy group (CPTG), with each group provided a intervention program in 3 sessions a week for 12 weeks. The lumbar lordosis angle (LLA), lumbar intervertebral disc angle (LIVDA) for vertebral alignment, lumbar muscle activity, and multifidus atrophy were measured before and after the intervention. Results: SETG showed significant changes in LLA, LIVDA of rate of change (delta score), and in relieving pain. The right-left balance gap for the lumbar dynamic muscle activity decreased after the intervention. The SETG showed significant changes in the grade of lumbar multifidus atrophy. Conclusion: The sling exercise therapy program is an effective exercise therapy method on vertebral alignment, muscle activity, recovery from multifidus atrophy, and pain relief for patients with chronic low back pain.

• 대한정형도수물리치료학회지
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• 제16권1호
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• pp.9-19
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• 2010

Purpose : To identify whether isometric shoulder horizontal extension (ISHE) exercise could sufficiently activate the lumbar multifidus muscle, and to determine appropriate exercise intensity to increase muscle strength. Methods : Twenty healthy volunteers (10 males and 10 females) participated in this study. ISHE exercises on the dominant side were performed with $90^{\circ}$ shoulder abduction held in $90^{\circ}$ elbow flexion so that their arms were in the horizontal plane. Electromyographic (EMG) measurements of multifidus activation were performed in standing and supine positions, and were taken under four strength conditions: 75%, 50% and 25% of maximum shoulder horizontal extension strength, and maximum strength. Results : The EMG activations of both lumbar multifidus increased significantly with ISHE exercises of larger % strength (p<.05). In their multifidus EMG data measured in standing and supine positions, men differed significantly in their 75%, 50% and 25% strength for both sides (p<.05), and women differed significantly in their 75%, 50% and 25% strength on their 5th lumbar vertebrae's left side, but 75% only for their 5th lumbar vertebrae's right side (p<.05). The EMG data of 5th lumbar vertebrae's left and 5th lumbar vertebrae's right sides appeared to differ significantly at all strength levels for men while standing, but only at the 25% level for women in the supine position (p<.05). These findings indicate that ISHE exercises can be considered a beneficial method to enhance the multifidus strength. Conclusion : This study provides useful information for further study in this field.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.201-204
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• 2011

Objective : To quantitatively evaluate the asymmetry of the multifidus and psoas muscles in unilateral sciatica caused by lumbar disc herniation using magnetic resonance imaging (MRI). Methods : Seventy-six patients who underwent open microdiscectomy for unilateral L5 radiculopathy caused by disc herniation at the L4-5 level were enrolled, of which 39 patients (51.3%) had a symptom duration of 1 month or less (group A), and 37 (48.7%) had a symptom duration of 3 months or more (group B). The cross-sectional areas (CSAs) of the multifidus and psoas muscles were measured at the mid-portion of the L4-5 disc level on axial MRI, and compared between the diseased and normal sides in each group. Results : The mean symptom duration was $0.6{\pm}0.4$ months and $5.4{\pm}2.7$ months for groups A and B, respectively (p<0.001). There were no differences in the demographics between the 2 groups. There was a significant difference in the CSA of the multifidus muscle between the diseased and normal sides (p<0.01) in group B. In contrast, no significant multifidus muscle asymmetry was found in group A. The CSA of the psoas muscle was not affected by disc herniation in either group. Conclusion : The CSA of the multifidus muscle was reduced by lumbar disc herniation when symptom duration was 3 months or more.

• Physical Therapy Rehabilitation Science
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• 제11권1호
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• pp.88-96
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• 2022

Objective: Purpose of this study was to compare muscle activity ratio of multifidus to erector spinalis according to various cueing including tactile stimulation to provide an effective strategy to provide verbal and tactile feedback during exercise to provoke multifidus muscle activation. Design: Cross-sectional study. Methods: Participants of this study included 28 healthy adults. Muscle activities of the multifidus and erector spinalis were measured while the participants performed tasks according to the three different methods of verbal cueing and three different tactile stimulation. Surface EMG was used to measure the muscular activity of the muscles during all the tasks. Results: Tactile stimulation to abdomen and lumbar vertebrae showed no significant difference in the muscle activity ratio (p>0.05). However, muscle activity ratio of the multifidus in relation to the erector spinalis was increased when subjects were given verbal instructions to make lumbar curvature with little force and to make lumbar curvature while pulling navel (p<0.05). However, it was decreased when they were provided with verbal instruction to make lumbar curvature with strong force (p<0.05). Conclusions: According to the results, proper verbal instruction was an effective tool to increase the muscular activity of multifidus. This study aimed to find and provide the most appropriate verbal cueing while doing exercises to activate multifidus.

• 대한통합의학회지
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• 제7권2호
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• pp.121-131
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• 2019

Purpose : Lower back pain is a common disorder experienced by approximately 90-% of the population at least once in a lifetime. This study examines changes in the thicknesses and ratios of the deep and superficial fibers of the multifidus according to the lumbar stabilization exercise used for spinal stabilization. Methods : Ten different lumbar stabilization exercises were implemented by 20 healthy men in random order, and the thickness of multifidus muscle was measured ultrasound image during each exercise. Results : The surface muscle fibers of the multifidus muscles significantly increased in the exercise method in which the arms and legs were lifted (p<.05), while the deep muscle fibers of the multifidus muscles increased significantly in the exercise in which the arms and legs were not lifted (p<.05). The ratio of the thickness of surface muscle fibers to the total thickness of muscle fibers was higher in the exercise method in which the arms and legs were lifted (p<.05), while the ratio of the thickness of deep muscle fibers to the total thickness of muscle fibers was higher in the hollowing and bracing exercise method in which the arms and legs were not lifted (p<.05). Conclusion : When lumbar stabilization exercise should be performed at clinics to strengthen the deep muscle fibers of the multifidus muscles that have larger effects on the stability of spinal segments, taking the stability of the spine into consideration indicates that, hollowing and bracing exercise methods that do not that cause isotonic extension to the spine are appropriate.

• Journal of Veterinary Science
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• 제22권1호
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• pp.3.1-3.13
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• 2021

Background: Multifidus muscle stiffness decreases in patients with lumbar intervertebral disk herniation; however, age-related changes in humans have not been reported. Objectives: The reliability of ultrasound shear wave elastography in dogs, and changes in the shear elastic modulus of the thoracolumbar multifidus muscle with aging in dogs, were investigated. Methods: Twelve beagle dogs were divided into 2 groups based on the age of onset of intervertebral disk herniation: young (aged not exceeding 2 years; 1.3 ± 0.6 years old, n = 5) and adult (4.9 ± 1.2 years old, n = 7). The shear elastic modulus of the multifidus muscle, from the thirteenth thoracic spine to the fourth lumbar spine, was measured using ultrasound shear wave elastography. The length, cross-sectional area and muscle to fat ratio of the multifidus muscle, and the grade of intervertebral disk degeneration, were assessed using radiographic and magnetic resonance imaging examinations. Results: The length and cross-sectional area of the multifidus muscle increased caudally. In the young group, the shear elastic modulus of the multifidus muscle of the thirteenth thoracic spine was less than that of the third lumbar spine. In the adult group, the shear elastic modulus of the multifidus muscle of first and third lumbar spine was lower than that of the same site in the young group. Conclusions: Ultrasound can be used to measure shear wave elastography of the thoracolumbar multifidus in dogs. If the multifidus muscle stiffness decreases, we should consider age-related change.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.174-179
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• 2013

Objective : Many studies have investigated paraspinal muscle changes after posterior lumbar surgery, including lumbar fusion. However, no study has been performed to investigate back muscle changes after pedicle based dynamic stabilization in patients with degenerative lumbar spinal diseases. In this study, the authors compared back muscle cross sectional area (MCSA) changes after non-fusion pedicle based dynamic stabilization. Methods : Thirty-two consecutive patients who underwent non-fusion pedicle based dynamic stabilization (PDS) at the L4-L5 level between February 2005 and January 2008 were included in this retrospective study. In addition, 11 patients who underwent traditional lumbar fusion (LF) during the same period were enrolled for comparative purposes. Preoperative and postoperative MCSAs of the paraspinal (multifidus+longissimus), psoas, and multifidus muscles were measured using computed tomographic axial sections taken at the L4 lower vertebral body level, which best visualize the paraspinal and psoas muscles. Measurements were made preoperatively and at more than 6 months after surgery. Results : Overall, back muscles showed decreases in MCSAs in the PDS and LF groups, and the multifidus was most affected in both groups, but more so in the LF group. The PDS group showed better back muscle preservation than the LF group for all measured muscles. The multifidus MCSA was significantly more preserved when the PDS-paraspinal-Wiltse approach was used. Conclusion : Pedicle based dynamic stabilization shows better preservation of paraspinal muscles than posterior lumbar fusion. Furthermore, the minimally invasive paraspinal Wiltse approach was found to preserve multifidus muscles better than the conventional posterior midline approach in PDS group.

• 대한물리의학회지
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• 제3권3호
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• pp.185-192
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• 2008

Purpose : The purpose of this study is to examine the effect of the electro-acupuncture stimulation into the multifidus for the lumbar flexibility improvement and pain reduction. The subjects were consisted of 20 women patients with chronic low back pain. Methods : 20 women patients with chronic low back pain voluntary participated for the research. 15 minute electro-acupuncture stimulation(frequency: 4Hz, Intensity: below threshold of pain) with Infra-red therapy, 3 times a week during 6 weeks period. Acupuncture application given to the patients' trigger point of the multifidus. The Application of multifidus was L3, L4, L5 spinal vertebra levels Short form McGill pain questionnaire (SFMPQ) was used to measure patient's pain level. Lumbar flexibility measurement was trunk flexion and trunk extension. Global Perceived Effect Scale(GPES) was used to measure recovery or worse of patient's condition. Results : SFMPQ was after treatment showed significantly decreased more than before stimulation treatment (P<.05). Lumbar flexibility was after treatment showed significantly increase more than before treatment(P<.05). GPES was after treatment showed significantly increased more than before treatment(p<.05). Conclusion : This study will be used as treatment method of patient with chronic LBP. The multifidus muscle in chronic LBP patients clinical significance. Most of chronic LBP patients have multifidus contraction pattern. So chronic LBP patients necessary multifidus muscle release treatment.