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Effects of core stabilisation training on multifidus muscle and lower back pain.

Reports by Andrew Hamilton BSc Hons MRSC ACSM Despite high fitness levels and intensive strength training programmes, many athletes still suffer from lower back pain. Over recent years, core-strengthening work has become very popular among athletes, both as a general conditioning technique and do avoid or reduce the risk of this injury. However, despite this popularity, the evidence that core stabilisation work actually reduces the risk of injury remains patchy at best. But a new study on Australian cricketers indicates that core training may indeed strengthen key stabilisation muscles in the torso and so reduce the incidence of lower back pain.

In the study, researchers studied 21 cricketers (with and without low back pain) using ultrasound imaging to determine the cross-sectional area (CSA) of the lumbar multifidus muscle at four vertebral levels (L2, L3, L4, L5). The incidence of lower back pain amoung Australian cricketers is 8% and as high as 14% amoung fast bowlers. Previsous researchers have found that the multifidus muscle contributes to segmental stability of the lumbopelvic region; smaller cross sectional areas (indicating lower multifidus strength) therefore may be associated with an increased indidence of lower back pain.

The CASs of the multifidus muscles were assessed at rest on the left and right sides at the start and completion of a 13-week cricket training camp. Seven subjects who reported current or previous LBP were placed in a rehabilitation group and were given stabilisation exercices. The stabilisation programme involved voluntary contraction of the multifidus, transversus adbominis, and pelvic floor muscles, with real-time feedback from rehabilitative ultrasound imaging. The programme was structured to progress from non-weight-bearing to weight-bearing positions and finally movement training. The pain scores were also collected from those subjects reporting lower back pain. The remaining 14 (pain free) subjects ere assessed for multifidus cross-sectional area, but dit not undergo any stabilisation training. The results were as follows:

1. The CSAs of the multifidus muscles at the L5 vertebral level increased for the seven cricketers with lower back pain who received the stabilisation training, compared with the 14 cricketers without pain and who did not receive rehabilitation;
2. The amount of muscle asysmmetry amoung those with lower back pain significantly decreased, and became comparable to cricketers without pain;
3. There was a 50% decrease in the mean report pain level among the cricketers with lower back pain. The researchers concluded that multifidus muscle atrophy can exist in highly active, elite athletes with lower back pain, that specific retraining resulted in an improvement in multifidus muscle CSA and this was concomitant with a decrease in pain.

J. Orthop Sports Phys Ther 2008; 38(3):101-8)