Question

A client with chronic low back pain presents with difficulty activating the multifidus. What specific cue, focused on &#x27;precision&#x27; of movement, can help them connect to this deep spinal stabilizer during a supine pelvic curl?

Accepted Answer

The multifidus is a deep spinal stabilizer, a small muscle that runs along the spine, specifically responsible for providing segmental stability and controlling subtle movements between individual vertebrae. In clients with chronic low back pain, the multifidus often becomes inhibited or atrophied, leading to difficulty in activating it effectively for spinal support. A supine pelvic curl is an exercise where the client lies on their back with knees bent and feet flat, then gently lifts their pelvis off the floor, articulating the spine segment by segment. The goal is to promote controlled spinal movement and deep core engagement. Precision of movement in this context means isolating the desired muscle action without over-recruiting larger, more superficial muscles, ensuring the deep stabilizers like the multifidus engage correctly. A specific cue to help connect to the multifidus during a supine pelvic curl is: "As you begin to gently peel your tailbone off the mat, imagine a subtle, gentle upward expansion or firmness developing specifically in the small dimples just above your buttocks, as if these tiny areas are gently pressing into the floor first, initiating the lift from the very base of your spine." This cue focuses on the multifidus because those dimples are superficial landmarks that correlate with the sacral and lower lumbar spine, where the multifidus is prominent and contributes to subtle extension and stability. By asking for a "subtle, gentle upward expansion or firmness," the cue encourages a precise, isometric-like contraction of the deep spinal extensors rather than a gross, forceful movement that would primarily engage larger muscles like the gluteals or hamstrings. It directs the client&#x27;s proprioception to initiate the movement from the deep, segmental stabilizers at the lowest part of the spine, fostering a connection to the multifidus for controlled, precise spinal articulation.

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A client with chronic low back pain presents with difficulty activating the multifidus. What specific cue, focused on 'precision' of movement, can help them connect to this deep spinal stabilizer during a supine pelvic curl?