• Journal of The Korean Society of Integrative Medicine
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• v.7 no.2
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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.

• PNF and Movement
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• v.12 no.4
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• pp.243-248
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• 2014

Purpose: The transverse abdominis and themultifidus muscle are located in the core. They surround one's trunk and help in body stabilization. Specifically, they control spine articulation to maintain posture and balance. Therefore, weakened deep muscle in the trunk may cause spinal malalignment. This study aims to compare the correlation between the thickness of the transverse abdominis and the multifidus muscle and the spine alignment among college students in their 20s. Methods: This study measured the thickness of the transverse abdominis and the multifidus muscle of 42 healthy college students in their 20s using ultrasonic waves. The thickness of the muscle was measured for the length of the cross-section except for fascia. The thickness of the left and right muscles was measured, and the mean value was calculated. As the thickness of the transverse abdominis can increase because of pressure during exhalation, it was measured at the last moment of exhalation. Spinal alignment was measured by the kyphosis angle, lordosis angle, pelvic tilt, trunk inclination, lateral deviation, trunk imbalance, and surface rotation using Formetric III, which is a three-dimensional imaging equipment. They were measured for three times, and the mean values were calculated. The general characteristics of the subjects were analyzed using descriptive statistics. The correlations between each factor were analyzed using Pearson's correlation analysis. Results: The transverse abdominis showed asignificant correlation with trunk inclination (p<.05). The multifidus muscle showed a significant positive correlation with pelvic tilt and a negative correlation with surface rotation (p<.05). Conclusion: The thickness of transverse abdominis and the multifidus muscle appears to influence spinal alignment. Specifically, the multifidus muscle, which plays an important role on the sagittal plane, influences surface rotation, thus making it an important muscle for scoliosis patients. Therefore, a strengthening training program for the transverse abdominis and the multifidus muscle is necessary according to specific purposes among adults with spinal malalignment.

• Journal of the Korean Society of Physical Medicine
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• v.5 no.4
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• pp.615-621
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• 2010

Purpose : The purpose of this study was to compare chronic LBP patients and asymptomatic subjects on measures of multifidus size (cross-sectional area;CSA, thickness) and symmetry (proportional difference of relatively larger side to smaller side). Methods : Data were obtained from 12 asymptomatic subjects without a prior history of LBP (8 females, 4 males), and a retrospective audit was undertaken of records from 12 chronic low back pain patients (8 females, 4 males). CSA and Thickness of the lumbar multifidus muscles was measured from axial T1-weighted magnetic resonance images(MRI). Results : The results of the analysis showed that chronic LBP patients had significantly smaller multifidus CSA and thickness than asymptomatic subjects at L4-5 vertebral levels(p<.05). The asymmetry between sides was seen at L4- L5 vertebral level in patients with chronic low back pain presentations(p<.05). Conclusions : MRI provided a quantitative measure of change between asymptomatic subjects and chronic low back pain patients of multifidus muscle. MRI identified significant differences in cross-sectional area and thickness and helps to evaluate clinically and plan the treatment modalities of LBP.

• Physical Therapy Rehabilitation Science
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• v.5 no.1
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• pp.40-46
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• 2016

Objective: The purpose of this study was to examine the effect on multifidus and external oblique abdominis muscle activation during hip contraction of three types (concentric, isometric, eccentric) in standing position. Design: Cross-sectional study. Methods: Twenty healthy adult men volunteered to participate in this study. Muscle activation was recorded from gluteus maximus, both multifidus, and both external oblique abdominis by surface electromyography (EMG) while holding position in the type of gluteus maximus contraction. EMG values were normalized by maximum muscle contractions (% maximum voluntary isometric contraction). All subjects performed hip extension with three contraction methods. The type of gluteus maximus contraction using Thera-band was composed of concentric contraction (type 1), isometric contraction (type 2), and eccentric contraction (type 3). To measure muscle activation on the gluteus maximus contraction type, each position were maintained for 5 seconds with data collection taken place during middle three seconds. Muscle activation was measured in each position three times. Results: For the results of this study, there was no significant difference within three contraction patterns of the gluteus maximus (concentric, isometric, and eccentric) each both multifidus, both external oblique abdominis, and gluteus maximus. And there was no significant difference among both multifidus, both external oblique abdominis, and gluteus maximus each hip extension contraction type. Conclusions: These findings suggest that specific contraction types of the gluteus maximus does not lead to a more effective activation of the multifidus, external oblique abdominis, and gluteus maximus.

• The Journal of Korean Physical Therapy
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• v.30 no.5
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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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.16 no.1
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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 Korea Society of Industrial Information Systems
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• v.5 no.2
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• pp.1-8
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• 2000

Manual material handling(MMH)is major factor which causing physical injuries of worker at working area and frequency of low back pain(LBP) is increasing industrial accidents. Especially, working in bad circumstance such as farm, orchard, harbor loading and unloading, logging place and mining place which located in inclined slope can cause much possibility of hazard and absence of working balance can cause injuries of musculoskeletal system such as joint, bone, ligament. So, this study used EMG system to measure and evaluate muscle force information and fatigue of worker when lifting on slope. The result of measuring averaged integrated EMG(AEMG) shows multifidus muscle be used more than anything else in force. neck extensors are used at 15°, 20°frequently. generally the AEMG result shows multifidus muscle be used in force. Commonly, muscle fatigue of multifidus is higher than other muscle by analysis mean power frequency(MPF). The result of load sharing rate shows multifidus and erectorspinae which are deep spinal muscles is relatively high and neck extensor is low.

• Physical Therapy Korea
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• v.18 no.3
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• pp.59-66
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• 2011

The purpose of this study is to examine the activity ratios of global trunk muscles and local trunk muscles in relation to adjustments in the level of task difficulty while performing stability exercises in easily applied bridging lumbar stabilization exercise. Twenty healthy subjects performed bridging lumbar stabilization exercise while the level of task difficulty was plate was used in the same posture for all the exercises. EMG was used to examine the activity ratios of the global muscles and multifidus in relation to the level of task difficulty. Moreover, the activity ratios of the multifidus muscle, the erector spinae and the gluteus maximus muscle were measured. A one-way ANOVA with repeated measures was used, and a Bonferroni correction was conducted (${\alpha}$=.05). When the bridging lumbar stabilization exercise were performed at different difficulty levels, the activity of the multifidus muscle, which is a local muscle, was high in all three exercises. Also, compared to low intensity and intermediate intensity exercises, high intensity exercises showed more significant differences (${\alpha}$=.05). Among all the muscles, the multifidus showed the highest activity at intermediate intensity. Based on these results, we suggest that in the case of bridging lumbar stabilization exercise, low intensity or intermediate intensity exercises are more suitable and efficient for local muscle stabilization.

• The Journal of Korean Physical Therapy
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• v.22 no.3
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• pp.9-15
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• 2010

Purpose: To evaluate, in patients with degenerative disc disease (DDD), the efficacy of using spinal stabilizing exercises for the reversal? of atrophy of the multifidus and psoas major, reductions in pain and disability, and for increases in paraspinal muscle strength. Methods: Nineteen patients diagnosed with DDD participated for 10 weeks in a spinal stabilization exercise program. Pain and disability were measured before and after exercise using, respectively, a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Paraspinal muscular strength in four directions was evaluated using CENTAUR. Both before and after exercise we used computed tomography (CT) too measure cross-sectional areas (CSAs) of both the left and right multifidus and the psoas major at the upper & lower endplate of L4. Results: After 10 weeks of a spinal stabilization exercise program, pain was significantly decreased from $5.7{\pm}0.9$ to $2.5{\pm}0.9$ (p<0.01); the ODI score decreased from $16.7{\pm}4.9$ to $7.3{\pm}3.1$. Paraspinal muscle strength was significantly increased (p<0.01) and the CSAs of the left and right multifidus and psoas major muscles were significantly increased (p<0.01). Conclusion: Spinal stabilization exercise is effective in reversing atrophy in DDD patients, in reducing pain and disability, and in increasing paraspinal muscle strength. It is an effective treatment foro aiding rehabilitation in these cases.

• Physical Therapy Korea
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• v.22 no.4
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• pp.79-86
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• 2015

This study examined the effects of trunk stabilization exercise on balance and trunk control in children with spastic diplegia. Four children with ambulatory spastic diplegia participated in the trunk stabilization exercise program using a Both Sides Utilized (BOSU) ball, 30 minutes a day, two times a week for eight weeks. Outcome variables included the pediatric balance scale, trunk control movement scale and multifidus thickness using ultrasound image. After trunk stabilization exercise, there was statistically no significant improvement in pediatric balance scale, trunk control movement scale and multifidus thickness. However, individual outcomes were observed with some positive changes. Balance, trunk control movement, and thickness of multifidus were found to be improved. Trunk stabilization exercise using a BOSU ball could improve trunk control and increase the thickness of multifidus in children with spastic diplegia. Further investigation is needed to evaluate subjects according to type of cerebral palsy and to understand the relationship between postural control and gait.