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'''Original Editor '''[[User:Andeela Hafeez|Andeela Hafeez]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
'''Original Editor '''-[[User:Lucindahampton|Lucinda hampton]]
== Description ==
[[File:Multifidus.png|thumb|Multifidus muscle|alt=Multifidus muscle|321x321px]]


The [[Multifidus Muscle|multifidusmuscle]] isfromthedeep[[Back Muscles|musclesof theback]] that together withthesemispinalisandrotatores formthe[[transversospinales]] muscles group.Multifidusi lies deep tothesemispinalisandsuperficial to the rotatores.
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
== Introduction ==
[[File:Muscles of the Back.png|thumb|364x364px|Multifidius, shown with back muscles ]]
TheMultifidus[[muscle]] isa series of small, triangular muscular and tendinous bundles located on either side ofthespinal column, where they fill the groove between the transverse and spinous processes of the vertebrae. Very well health[https://www.verywellhealth.com/multifidus-muscle-296470 Roleof theMultifidus Muscle]Available: https://www.verywellhealth.com/multifidus-muscle-296470 (accessed 29.1.2022)Darby S, Cramer G. [https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans Clinical anatomy ofthespine, spinal cord, and ANS.]St. Louis, Mo.: Elsevier. 2014.Available: https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans (accessed 29.1.2022)


The trasversospinales muscles group run laterally from the transverse process and attach medially in thespinous process, fillingthegroove on either side ofthespinous process.>Drake R, Vogl AW, Mitchell AW. Gray's Anatomy for Students E-Book. Elsevier Health Sciences; 2009 Apr 4.</ref>
These fasciculi ascend two to four (or sometimes five) vertebral segments before ending on aspinous process. Multifidi muscles insert onto allthevertebrae exceptthe[[atlas]].


The multifidus muscle spans the whole lengthof thevertebral column but is most developed inthe [[Lumbar Anatomy|lumbar area]].0" /> The multifidus muscle is a local[[Core Muscles|core stabilizers]] ,playing an important role in the staticanddynamic[[Spinal Stabilization|spinal stability]].Weaknessin themultifidus muscle is associated with low back pain.Zheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/核心稳定性训练监控盐土的效果abilitative Ultrasound Image and Surface Electromyogram in Local Core Muscles of Healthy People.] Pain Research and Management. 2019;2019.ref>">Kliziene I, Sipaviciene S, Klizas S, Imbrasiene D. Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain.Journal of back and musculoskeletal rehabilitation. 2015 Jan 1;28(4):841-7.
Multifidus is partofthedeep Intrinsic [[Back Muscles|back muscles]], known asthe[[transversospinales]], which consist of 3 major subgroups: [[Semispinalis]],Multifidus,和[[旋转器Muscles|旋转器]].They are the thickest musclesin thetransversospinal group, and are shorter than semispinalis, but longer than rotatoresname=":2">Ken Hub Mulrifidius Available:https://www.kenhub.com/en/library/anatomy/multifidus-muscle<nowiki/>(accessed 29.1.2022) < / ref >。
== Anatomy ==
[[File:Muscles of the Back.png|thumb|505x505px|Multifius, deep back muscles.]]


=== Origin===
== Origin, Insertion, Nerve Supply==
Thelumbarmultifidus muscle is a long muscle having several pointsoforigin:
[[File:Lumbar vertebra.jpg|thumb|Lx Vertebrae, processes etc.|alt=|310x310px]]
Origin: Posterior [[sacrum]], [[Pelvic Landmarks|posterior superior iliac spine]], [[aponeurosis]] of the [[Erector Spinae|erector spinae]], sacroiliac ligament, mammillary processes of the [[Lumbar Vertebrae|lumbarvertebrae]], transverse processes of [[Thoracic Vertebrae|T1-3]], articular processesof[[Cervical Vertebrae|C4-C7]].


*Theback surface ofthe[[Sacrum|sacrum.]]
Insertion:Themultifidus muscle fibers pass upwards and medially to insert ontothespinous processofeachvertebraeinthespinal column, except forthevery top cervicalvertebrae(C1)name=":3">Radiopedia TransversospinalisAvailable:https://radiopaedia.org/articles/transversospinalis-muscle-group?lang=us(accessed 29.1.2022).
* The [[Pelvic Landmarks|posterior superior iliac spine.]]
* The mammillary processesofthe lumbarvertebrae(bony prominences atthedorsal superior aspect ofthe[[Lumbar Vertebrae|lumbarvertebrae]]).
* The transverse processes of the [[Thoracic Vertebrae|thoracic vertebrae]].Study,com MultifidusAvailable:https://study.com/academy/lesson/multifidus-muscle-origin-insertion-action.html(accessed 29.1.2022)


=== Insertion ===
[[Neurone|Nerve]] Supply: The intrinsic/deep back primarily nerve supply arises from dorsal rami of the spinal nerves.. The medial branches of dorsal rami of spinal nerves specifically supply multifidus.=":2" />


Baseofspinous processofall vertebrae from L5 to T8,2-4 levels above origin.
== Actions ==
[[File:Multifidi.png|thumb|Muiltifidius muscle|alt=|300x300px]]Allofthe transversospinalis muscles, which multifidus is oneof,are extensors of the back and neck.


The multifidus isconnectedwith thetransversus abdominis viathethoracolumbar fascia.
#The multifidusand semispinalis muscle group has also been identified as rotators by some texts and refuted in others.
# Evidence points to the multifidus muscle being continuously active in upright [[Posture|postures]]. In fact, the multifidus is probably active in all anti-gravity activity.Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, Volume 2 E-Book: The Lower Body. Elsevier Health Sciences; 2011 Jul 5.Available:https://www.sciencedirect.com/book/9780443068157/clinical-application-of-neuromuscular-techniques (accessed 29.1.2022)
# The multifidus stabilizes the vertebrae as the spine moves. Itisthought that the unique design of the multifidus endows itwithextra strength.
# Whenthe[[External Abdominal Oblique|oblique abdominal muscles]] contract to produce trunk rotation, some flexion ofthetrunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.


===NerveandBlood Supply ===
==Physiotherapy==
[[File:Core activation 4point kneeling alternate legs.jpeg|thumb|Core activation exercise]]
The multifidus is one of the important [[Core Muscles|core muscles]] stabilizers, playing an important role in the staticanddynamic spinal stability.


*Medial ramusofthe dorsal rootofthe spinal nerve.name=":2"/>
*[[Core Stability|Core stabilization programs]] are suggested to increase multifidus cross section area and decrease low back pain, weakness in the multifidus muscle being associated with low back painZheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ EffectofCore Stability Training Monitored by Rehabilitative Ultrasound Image and Surface Electromyogram in Local Core MusclesofHealthy People]. Pain Research and Management. 2019;2019. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/ (accessed 29.1.2022)>Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain physician. 2016;19(7):E985-99.</ref>
*Branches of lumbarandsacral arteries.0" />
*Core muscles are noted for their contribution to [[Core Stability|spinal stability]]andare important in [[Adherence to Home Exercise Programs|home exercise programs]] given to people with [[Low Back Pain|low back pain]] in physical therapy.
[[File:Minna-hamalainen-Mgx1oe2vlVY-unsplash.jpeg|thumb|Plank core exercise]]
Investigators have categorized multifidus fiber types by layers:


=== Viewing ===
* The deepest layer appears to contributes more [[Strength Training|strength]] and [[Spinal Stabilization|stability]] tothespine than do superficial layers.Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). Theresulting shorter "excursion" of the deep layer of the multifidus means that when themusclecontracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.=":1"/>
This 1 minute video is a good watch rethemultifidus{{#ev:youtube|https://www.youtube.com/watch?v=c-_Y9q-kLdc|width}}J FitzgordonThemutifidusmuscleavailable from: https://www.youtube.com/watch?v=c-_Y9q-kLdc (last accessed 9.6.2019)</ref>
== Action ==


# [[File:Minna-hamalainen-Mgx1oe2vlVY-unsplash.jpeg|thumb|Multifidus hard a work]]Bilateral contraction extends the vertebral column.
== References ==
# Unilateral contraction contralaterally rotates the vertebral coloumn to the opposite side.=":0" />
# Evidence points to the multifidus muscle being continuously active in upright [[Posture|postures]]. In fact, the multifidus is probably active in all anti-gravity activity.
# The multifidus stabilizes the vertebrae as the spine moves. It is thought that the unique design of the multifidus endows it with extra strength.
# When the oblique abdominal muscles contract to produce trunk rotation, some flexion of the trunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.Physiopedia [[Multifidus Muscle]] Available:[[Multifidus Muscle]] (accessed 29.1.2022)


== Clinical Relevance ==
[[File:Core activation 4point kneeling alternate legs.jpeg|thumb|532x532px|Core activation 4point kneeling alternate legs]]
[[Category:Anatomy]]
multifidus肌肉是一个重要的稳定器of the lumbar spine. It functions together with [[Transversus Abdominis|transversus abdominis]] and [https://physio-pedia.com/Pelvic_Floor_Muscle_Function_and_Strength?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal pelvic floor muscles] for spine stability. Lynders C. [https://link.springer.com/article/10.1007/s11420-019-09717-8 The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain.] HSS Journal®. 2019 Oct 1;15(3):214-20.
Multifidus肌肉无力和萎缩是关联ed with chronic [[Low Back Pain|low back pain]]. [[Core Stability|Core stabilization programs]] are suggested to increase multifidus cross section area and decrease low back pain.Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain physician. 2016;19(7):E985-99.
[[三角ger Points|Trigger points]] in the multifidus decreases the contraction efficiency of the transversus abdominis due to decreased reciprocal inhibition. Dry needling of the multifidus trigger points increased the thickness of tansversus abdominus during contraction, suggesting that multifidus dry needling can be used for treatment of [[Low Back Pain|low back pain]].
Length Tension Relationship: The multifidus muscle has high cross section area so its force generating capacity is high and has a low fiber length so its muscle excursion is low.Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine StabilityfckLRSamuel R. Ward, PT, PhD,1 Choll W. Kim, MD, PhD,1 Carolyn M. Eng, BS,1 Lionel J. Gottschalk, IV, BS,1 Akihito Tomiya, MD, PhD,1 Steven R. Garfin, MD,1 and Richard L. Lieber, PhD1 Investigators have categorized multifidus fiber types by layers:
* The deepest layer appears to contributes more [[Strength Training|strength]] and [[Spinal Stabilization|stability]] to the spine than do superficial layers. Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). The resulting shorter "excursion" of the deep layer of the multifidus means that when the muscle contracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.Physiopedia [[Multifidus Muscle|Multifidus]] Available: [[Multifidus Muscle]] (accessed 29.1.2022)
== Physiotherapy==
[[File:Phy20.jpg|thumb|Side-lying body lift,]]
Treatment: Retraining the stabilising muscles of the core is done in a series of steps.The first step is to learn to isolate the muscle. The second step is to learn to co‐contract it in conjunction with the other muscles of the core. The final step is to co‐contract the entire core (connect simultaneously to the pelvic floor, transversus abdominis & multifidus) in coordination with the larger superficial muscle during functional activities.diane lee [https://dianelee.ca/article-training-deep-core-muscles.php Empower through Knowledge, Movement & Awareness] Available from: https://dianelee.ca/article-training-deep-core-muscles.php (last accessed 9.6.2019)
See [[Exercises for Lumbar Instability]]
'''Recruitment Training for the Deep Fibers of Lumbosacral Multifidus (dMF)'''[[File:Training-multifidus-1.jpg|alt=|right|200x200px]]
Lie on your back or side with your spine in a neutral posture, (gentle curve in your low back):'''  '''
*Try the following connect cues to produce a deep contraction of multifidus isolated from the long back extensors.
*For the part of multifidus that supports the SIJ - imagine a line that connects your left and right SIJ and think about connecting, or drawing together, along this line.
*Imagine a line connecting your groin (or back of your pubic bone) to the part of multifidus in your low back you are trying to train (wake up). Connect along this line and then gently think about suspending (lifting) the lumbar vertebra 1 mm above the one below.
*Breathe in and on the breath out contract the deep multifidus with the best connect cue (have your therapist help you determine which is your best connect cue).
*No movement of your hips, pelvis or spine should occur as you gently activate the dMF. If you compare how heavy your leg is to lift with and without this dMF contraction you should find that it is lighter with the proper contraction.
*Hold the contraction for 3- 5 seconds and then release and breathe throughout this exercise. Repeat the contraction and hold for 3 sets of 10 repetitions 3 – 4 times per day for 4 weeks.
'''Strength Training for Lumbosacral Multifidus'''[[File:Training-multifidus-2.jpg|alt=|right|200x200px]]
In side lying:
* Maintaining your connection to Transverse Abdominus (TrA), keep your ankles together and lift your top knee (only as high as you can control without breath holding), focus on turning your inner thigh outwards. Return your knee.
* Maintaining your connection to TrA, keep your ankles together, lift your top knee and then lift your ankle. Return your ankle and then your knee.
* Lying on your back with your knees and hips flexed:
* Slowly let your right knee move to the right, keep your low back and pelvis level. Return to the centre and repeat with the left.
* Lift the right foot off the floor keeping the knee bent. Don’t hold your breath and don’t bulge your lower abdomen. Return the foot to the floor and repeat with the left foot. There should be no clicking in your low back.
* Lift the right foot off the floor and then straighten the leg only as far as you can control your core with a proper strategy. Slowly bend the knee and return the foot to the floor. Repeat with the left leg.Lift the right foot off the floor and then the left foot off the floor. Alternate
* leg extensions, exert with exhalation, breathe in to rest or hold.
With all these exercises maintain the leg lift for 10 seconds, build to 3 sets of 10 repetitions before moving on
'''Incorporate into Other Activities
'''The final step is to remember to use the core during regular life activities. Each time you get out of the chair, lift, bend or reach, this local stabilising system should be working at a low level. The goal is to teach the body to resume its normal stabilisation strategy of connecting to the core before movement begins.
== Multifidus and back Pain ==
Have a look at this 2 min 30 sec. video for some good information of evidence regarding multifidus and low back problems.
{{#ev:youtube|https://www.youtube.com/watch?v=jjAWBiO7h4E|width}}Chris Centeno Multifidus Back Pain: Why Your Doctor Never Discussed It Available from: https://www.youtube.com/watch?v=jjAWBiO7h4E (last accessed 8.6.2019)
== Reference ==
[[Category:Anatomy]]
[[类别:肌肉]]
[[类别:肌肉]]
[[类别:腰椎Spine]]
[[类别:腰椎Spine - Anatomy]]
[[类别:腰椎Spine - Muscles]]
[[类别:腰椎Spine - Muscles]]

Revision as of 15:05, 13 July 2023

Original Editor-Lucinda hampton

Top Contributors-Lucinda hamptonandKim Jackson

Introduction[edit|edit source]

Multifidius, shown with back muscles

The Multifidusmuscleis a series of small, triangular muscular and tendinous bundles located on either side of the spinal column, where they fill the groove between the transverse and spinous processes of the vertebrae.[1]［２］

These fasciculi ascend two to four (or sometimes five) vertebral segments before ending on a spinous process. Multifidi muscles insert onto all the vertebrae except theatlas.［２］

Multifidus is part of the deep Intrinsicback muscles, known as thetransversospinales, which consist of 3 major subgroups:Semispinalis, Multifidus, and旋转器. They are the thickest muscles in the transversospinal group, and are shorter than semispinalis, but longer than rotatores[3].

Origin, Insertion, Nerve Supply[edit|edit source]

Lx Vertebrae, processes etc.

Origin: Posteriorsacrum,posterior superior iliac spine,aponeurosisof theerector spinae, sacroiliac ligament, mammillary processes of thelumbar vertebrae, transverse processes ofT1-3,关节的过程C4-C7.

Insertion: The multifidus muscle fibers pass upwards and medially to insert onto the spinous process of each vertebrae in the spinal column, except for the very top cervical vertebrae (C1)[4].

NerveSupply: The intrinsic/deep back primarily nerve supply arises from dorsal rami of the spinal nerves.. The medial branches of dorsal rami of spinal nerves specifically supply multifidus.[3]

Actions[edit|edit source]

Muiltifidius muscle

All of the transversospinalis muscles, which multifidus is one of, are extensors of the back and neck.

  1. The multifidus and semispinalis muscle group has also been identified as rotators by some texts and refuted in others.[4]
  2. Evidence points to the multifidus muscle being continuously active in uprightpostures. In fact, the multifidus is probably active in all anti-gravity activity.[5]
  3. The multifidus stabilizes the vertebrae as the spine moves. It is thought that the unique design of the multifidus endows it with extra strength.［２］
  4. When theoblique abdominal musclescontract to produce trunk rotation, some flexion of the trunk also occurs. The multifidus muscles oppose this trunk flexion maintaining a pure axial rotation, thus acting as stabilizers during trunk rotation.［２］

Physiotherapy[edit|edit source]

Core activation exercise

The multifidus is one of the importantcore musclesstabilizers, playing an important role in the static and dynamic spinal stability.

Plank core exercise

Investigators have categorized multifidus fiber types by layers:

  • The deepest layer appears to contributes morestrengthandstabilityto the spine than do superficial layers. Possibly because the deep layer only spans 2 vertebral segments (as opposed to up to 4 with the other layers). The resulting shorter "excursion" of the deep layer of the multifidus means that when the muscle contracts, it contributes to more compression type motion at the spinal joint it affects compared to other back extensor muscles and the more superficial layers of the multifidus.[1]

References[edit|edit source]

  1. ↑1.01.1Very well healthRole of the Multifidus MuscleAvailable:https://www.verywellhealth.com/multifidus-muscle-296470(accessed 29.1.2022)
  2. ↑2.02.12.22.3Darby S, Cramer G.Clinical anatomy of the spine, spinal cord, and ANS.St. Louis, Mo.: Elsevier. 2014.Available:https://www.sciencedirect.com/book/9780323079549/clinical-anatomy-of-the-spine-spinal-cord-and-ans(accessed 29.1.2022)
  3. ↑3.03.1Ken Hub Mulrifidius Available:https://www.kenhub.com/en/library/anatomy/multifidus-muscle(accessed 29.1.2022)
  4. ↑4.04.1Radiopedia Transversospinalis Available:https://radiopaedia.org/articles/transversospinalis-muscle-group?lang=us(accessed 29.1.2022)
  5. ↑Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, Volume 2 E-Book: The Lower Body. Elsevier Health Sciences; 2011 Jul 5.Available:https://www.sciencedirect.com/book/9780443068157/clinical-application-of-neuromuscular-techniques(accessed 29.1.2022)
  6. ↑Zheng Y, Ke S, Lin C, Li X, Liu C, Wu Y, Xin W, Ma C, Wu S.核心稳定性训练监控盐土的效果abilitative Ultrasound Image and Surface Electromyogram in Local Core Muscles of Healthy People. Pain Research and Management. 2019;2019. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612403/(accessed 29.1.2022)
  7. ↑Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain physician. 2016;19(7):E985-99.
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