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The Multifidus Muscle Group: Why It Matters and a Simple Yoga Pose for Strengthening It
The deep muscles of the back are important muscles to train if you are having pelvic pain, incontinence, or looking to strengthen your core. One of the most powerful of these muscles, the multifidus, is actually a group of small, thin muscles that runs the length of the spine. Its function is to stabilize the indidivual spinal segments and joints. It also extends your back when both the right and left columns contract at the same time. When one side contracts, your trunk rotates.
Image Courtesy of Pelvic Guru, LLC www.pelvicguru.com
What relationship do your back muscles have with your pelvic floor? Your core is your canister of support—an analogy Mary Massery created is a soda can. (1) Imagine the “soda can” with the transverse abdominals in the front, multifidus lining the back, pelvic floor muscles at the bottom, and vocal cords and diaphragm at the top. If I throw an unopened soda can across the room, it will not leak liquid. If I create “weakness” by popping the tab open or piercing the front/back/bottom of the can, it will leak. This is why core stability training is important for folks experiencing pelvic floor dysfunction.
Why Add Multifidus Exercises?
If your goal is optimizing your pelvic health, you may have already been doing Kegels to decrease urinary incontinence or lengthening your pelvic floor muscles to decrease pelvic pain. You may have also started strengthening your abdominal wall with special attention to the transverse abdominals to support lengthening or strengthening your pelvic floor muscles. To round out your program, and support your spinal health, consider adding an exercise to strengthen the multifidus.
Why strengthen the multifidus?
You are experiencing pelvic pain and are being treated by a pelvic health physical therapist or occupational therapist.
You are looking to strengthen other aspects of your core so your pelvic floor doesn’t need to grip for stability.
You are postpartum and want to decrease a diastasis recti abdominis, eliminate urinary incontinence, and/or pelvic organ prolapse.
You want to optimize your core strength to support your hip, back, or sacroiliac joint.
Practice Parsva Balasana (Bird Dog Pose)
One of my favorite multifidus exercises is Parsva Balasana or Bird Dog Pose. It’s a great way to work on hip stability, shoulder stability, and abdominal strength.
When I evaluate postpartum women in the clinic, they have a difficult time coordinating and stabilizing through their pelvis and trunk. They have experienced pressure changes, an elongated abdominal wall, and scar tissue in the abdomen and /or pelvic floor.
Modifications allow my patients to transfer weight optimally. Exercising specifically and mindfully allows a deeper connection to the core and can help retrain the brain to fire the optimal muscles.
Here is an example of a progression. This may take place over the course of a few visits—however long it takes to gain coordination, strength, and stability.
How to Practice Bird Dog Pose (images courtesy of Your Pace Yoga)
1. Start in Bharmanasana (Tabletop Pose). Check that your knees are right under your hips, and your hands are right under your shoulders.
2. Hug your lower belly in and have a soft bend to your elbows.
3. Lift your left palm, but keep your fingertips in contact with the floor. If you shifted your ribs or pelvis, try again.
4. Reach your left arm forward, with your thumb to the ceiling, drawing your shoulder blade down your back. If you shifted your ribs or pelvis, try again. If you are unable to keep your abdominal wall compressed, stay with the tenting of fingers option until you can control your trunk and pelvis, especially if you are rehabbing a diastasis recti abdominis (DRA).
5. Draw your right leg back so your toes are touching the floor. If you shifted your pelvis to the left, bring it back to the center.
6. Keeping your lower belly compressed and spine neutral (no arching the back), lift up your right leg. If you shifted your pelvis to the left, bring it back to the center.
If you can’t avoid the shift, stick with the first option.
7. Bring your left arm forward and right leg back. Create as much length as possible between the top of your head and your tailbone. Be careful that you aren’t shifting your weight, sinking between the shoulder blades, or hyperextending your elbows.
8. Want to increase the intensity of the pose? Drift your leg out to the side a few inches and back. This activates your outer hip muscles (hip abductors) and increases the lever arm of your leg, asking your abdominals to work harder.
9. While you are in Tabletop Pose, try Phalakasana (Plank Pose) prep. Take a breath in, then exhale as you compress your lower belly, Lift and hover your knees. If you find that your abdomen is bulging, try activating the muscles by pressing the palms of your hands into the floor and imagine you are lifting your knees.
1. The soda can model was first proposed by Mary Massery, a world-renowned pediatric physical therapist, who discovered that postural control is heavily influenced by the diaphragm and vocal cords. She encouraged physical therapists to think beyond the traditional thoughts of what “the core” is.
Reprinted with permission from yourpaceyoga.com
Dustienne Miller is the creator of the pelvic health video series Your Pace Yoga. She is the contributing author of two books about the integration of pelvic health and yoga, Yoga Mama: The Practioner's Guide to Prenatal Yoga (Shambhala Publications, 2016) and Healing in Urology (World Scientific). Dustienne regularly speaks at conferences and workshops and is on the faculty at the Herman and Wallace Pelvic Rehabilitation Institute. Her clinical practice, Flourish Physical Therapy, is located in Boston's Back Bay.