Motriz, Rio Claro, v.20 n.1, p.58-64, Jan./Mar. 2014 DOI: http://dx.doi.org/10.

1590/S1980-65742014000100009

Original article
Evaluation of the lumbar multifidus in rowers
during spinal stabilization exercise

Joseani Ceccato
Federal University of Health Sciences of Porto Alegre, Brazil

Jeam Marcel Geremia
Alexandre Mayer
Raquel de Oliveira Lupion
Marco Aurélio Vaz
Federal University of Rio Grande do Sul, Porto Alegre, Brazil

Abstract—Lumbar stabilization is important in high performance rowing due to the high incidence of low back pain.
The purpose of this study was to evaluate the lumbar stabilizers muscles performance during an exercise of spinal seg-
mental stabilization and in lumbar multifidus muscle thickness in rowing athletes trained and untrained for this exercise.
Nine rowers trained with lumbar stabilization (TLS) and eight rowers without training (CON) participated in the study.
Lumbar stabilization performance and multifidus muscle thickness were measured during a maximal voluntary isometric
contraction. Lumbar stabilization performance was higher (p=0.015) in the TLS (mean 18.38 ± 8.00 mmHg) compared
to the CON (9.31 ± 4.91 mmHg) group. Muscle thickness variation was higher (p=0.023) in the TLS (6.92% ± 3.98)
compared to the CON (2.81% ± 1.40) group. Lumbar stabilization training is an efficient clinical tool to strengthen
lumbar muscles and may help to prevent low back pain in rowers.
Keywords: spinal stabilization, multifidus, rowing, prevention

Resumo—“Avaliação dos multífidos lombares em atletas do remo durante exercício de estabilização vertebral.” A esta-
bilização lombar é fundamental em esportes de alto rendimento como o remo, devido a elevada incidência de lombalgia.
O objetivo do presente estudo foi avaliar o desempenho dos músculos estabilizadores lombares e a espessura do músculo
multífido lombar durante um exercício de estabilização segmentar vertebral em remadores. Nove remadores treinados
com exercícios de estabilização lombar (TLS) e oito remadores destreinados (CON) foram avaliados. O desempenho
dos músculos estabilizadores lombares e a espessura dos músculos multífidos foram mensurados durante uma contração
voluntária isométrica máxima. O desempenho foi maior (p=0,015) no grupo TLS (18,38±8,00 mmHg) quando comparado
ao grupo CON (9,31±4,91 mmHg). A variação da espessura muscular foi maior (p=0,023) no grupo TLS (6,92%±3.98)
quando comparado com o grupo CON (2,81%±1,40). Treinamento de estabilização lombar é uma ferramenta clínica
eficiente para fortalecimento da musculatura lombar e pode auxiliar na prevenção de lombalgia em remadores.
Palavras-chave: estabilização vertebral, multífidos, remo, prevenção

Resumen—“Evaluación del multifidus lumbar en los atletas de remo durante el ejercicio en la estabilización de la columna
vertebral.” La estabilización lumbar es fundamental en la práctica de deportes como el remo de alto rendimiento, donde la
lumbalgia aparece con frecuencia. El objetivo de este estudio fue evaluar el rendimiento de los músculos estabilizadores
lumbares, así como el espesor del músculo multifido lumbar, durante un ejercicio de estabilización espinal segmentaria
lumbar (una contracción isométrica voluntaria máxima) en atletas de remo. Fueron evaluados nueve remadores sometidos
a entrenamiento con ejercicios de estabilización lumbar (TLS) y ocho sin este adiestramiento (CON). El rendimiento
fue mayor (p=0,015) en el grupo TLS (18,38±8,00 mmHg) e comparación con el grupo CON (9,31±4,91 mmHg). Va-
riación del espesor muscular fue mayor (p=0,023) en el grupo TLS (6,92%±3,98) en comparación con el grupo CON
(2,81%±1,40). El entrenamiento lumbar es una herramienta clínica eficiente para el fortalecimiento de la musculatura
lumbar e puede auxiliar en la prevención de lumbalgias en remadores.
Palabras clave: estabilización espinal; multifidos, remo y prevención.

58

in lumbar stabilization. psoas major. The athletes presen. Richardson. & Fritz. between strengthening of transversus abdominis and multifidus Several factors can contribute to overload and low back pain muscles (Lehman. & High performance rowing is a sport with a high level of overload Sexton. spondylolisthesis. lumbar portion of the lumbar iliocostalis. Richardson. Coppieters. in competitive rower athletes (Caldwell. 2005). In 70% of the training the following reasons: (1) the possibility of simultaneous measu- cycle. & Williams. Methods external obliques and the thoracic part of iliocostalis lumbar) when activated. Therefore. Hodges. The multifidus muscle group was chosen due to nitude at the lumbar spine is substantial. 2005). Parent. The PBU test is a reliable and valid clinical instrument The study included only rowing athletes with a minimum of to assess deep abdominal muscle function and/or performance two years of training. 2010. Mcgregor. especially in The population of the present studied included 80% of the athletes with overload at the spine. v. & Shirley. The athletes were divided into two groups: the group 2006. Hides. & Mabee. 2009. Latimer. The sessions began with stabili- & Byng-Maddick. or control group (CON) consisted of eight untrained athletes ted improvements on the lumbo-pelvic stability after training. 2011). The combination of rements of ultrasound and abdominal pressure with subjects in the this flexed position with compressive forces at the vertebrae has prone position. Spine extensors muscle fatigue. 1989. 2010. & Jull. the force mag. Segmental spinal stabilization training Tsao. usually muscle thickness during the maximal voluntary contraction in associated with large volume and training intensity. 2009. (2005) used the PBU test to evaluate the deep abdominal and back muscles (transversus abdominis and effect of a 10-week training program on lumbo-pelvic stability multifidus) for more than two years. Fulton. & Orlando. The study included only athletes who showing evidence that the PBU test is an important and effective were enrolled on daily training (3 to 4 hours of rowing a day) tool in the evaluation of lumbo-pelvic stability. Hall. Oh. & Jahn.. Lumbar multifidus evaluation Introduction Assuming that low back pain arises from a poor spinal seg- mental stabilization (Dickx et al. Hebert. abdominal pressure or pressure biofe./Mar. rowers remain with the trunk flexed. Story. athletes undergoing weekly training sessions to strengthen sen. & Yi. The global muscular system (consisting of the rectus abdominal. Macdonald. during an abdominal wall contraction (Cynn.1. trained in lumbar stabilization (TLS) consisted of eight Toppenberg. longissimus.20 n. 2008) showed evidence of hypo. posterior fibers of the dia- phragm and internal oblique) acts directly on the lumbar spine and is responsible for providing segmental stability and directly Participants control the lumbar segments (Bergmark. These stabilizing muscles should be very fit. & William’s. which can lead to an excessive synergistic muscles responsible for spinal stabilization compa- lumbar flexion and increased stress on spinal structures. (2) the ease of access to these muscles (posterior been identified as one of the likely mechanisms for lumbar spine region) (Hides.58-64. bar stabilization (TLS) would have a larger change in multifidus ne. Bull evolution of preventive training. Thus. the aim of this study was to evaluate the changes to the trunk. & Comerford. 2002). Taunton. 1989). 2010. red to the untrained (CON) group. emphasi. lumbar disc herniations or edback unit (PBU) (Garnier et al. spondylolysis. McEvoy. 1992. lumbar via functional tests such as. reduces the the PBU test as an adaptation to the strength training of these contractility of muscle fibers. Maher. Sessions lasted 45 minutes and were held once muscles on the side of low back pain. and were standardized according to the (Koppenhaver. All athletes belonging to the TLS group performed the same trophy or atrophy of the transversus abdominis and multifidus training program. leads to an overall stability of the trunk. p. transversus abdominis. our expectation was that subjects trained in lum- 2003. & Hodges. spinal stability is necessary to reduce stress and de- pends on integrating two muscle systems: local and global. 2005. whereas the non-trained in volleyball and basketball female athletes. co-contraction of synergistic muscle groups (trans. Storheim. & Lind. 2014 59 . Lebrun. or any previous surgical treatment) were evaluated. & Mills. Mcnair. Within this population. 2009. (3) the synergism found injury (Rumball. 2005). 2005. 2002). In clinical practice of sports population of rowing athletes in junior and youth categories physiotherapy. but Study design is not able to directly influence specific spinal segments. 1998). Cowling. of Rio Grande do Sul State.. exercises for the stabilizing muscles of the spine were taught by zing the importance of strengthening of deep abdominal muscles the same physiotherapist. rowing athletes. Reid & Mcnair. Cagnie. Garnier et al. & Danneels. 2009. zation exercises in the prone position. Rumball et al. sixteen versus abdominis and multifidus) can be evaluated and followed healthy male rower athletes (with no history of injury. Parlevliet. Stanton. Kwon. Pederstad. 2005). Rio Claro. 2000. Mills et al. Mills et al. Jull. The The present study is an ex post facto and correlational study. Mills et al. Studies (Costa.. local muscle system (comprised of the multifidus.. All procedures were approved by the ethics committee and par- quadratus lumborum. and the cause of lower back pain that frequently in PBU and the lumbar multifidus muscle thickness during a appears as the second most frequent injury complaint by rowers segmental spinal stabilization exercise in trained and untrained (Comerford & Mottram. These studies report a a week. before starting physical training. Mendis. progressing to sitting and Motriz. Dickx. 2004. 2001). Lavens. Panjabi. and participating in competitions. ticipants signed an informed consent to participate in the study.. protrusions. During rowing. Di Ciacca. Jan. Teitz. The strengthening decrease in contractile performance of these muscles. Mills. O’Ka.

the probe was Lumbar stabilizer muscles performance positioned in the approximate direction of the muscle fibers and laterally to the spinous processes.A. Rio Claro. Geremia. athletes the second exercise subjects laid on their back. with knees flexed were asked to: (1) empty their bladder before they started the and upper limbs resting besides the trunk. with 10 each athlete. knees flexed and (3) not perform any abdominal strengthening exercise on the day feet plants facing each other. The sessions began with stabilization athlete to produce spinal segmental stabilization (Garnier et al. in the region located emphasis on the expiratory phase of the respiratory cycle.58-64. exercises in the prone position. O. the reduction in abdominal pressure exercise. The between the anterior superior iliac spines and centered rela- athlete was asked to inspire by inflating the abdomen and during tive to the navel (Figure 1B). Hides and Richardson extended) and extending the contralateral hip and the knee. In voluntary contraction of the abdominal wall muscles. one-minute intervals between trials and five-minute over the Stabilizer was registered during four seconds within intervals between exercises. Chattanooga Group. v. aiming at the formation of a pelvic belt (Richardson and. Tokyo. contact support positions (see below). Stabilizer equipment (A) used during the Pressure Biofeedback Unit (PBU) test used to assess lumbar spine stabilization (B). The athletes were positioned prone described above. Vaz Figure 1. same physiotherapist. measurement. In the first exercise sub. sampling frequency = 45 Hz)./Mar. The Stabilizer was inflated to a the exhale. 2009). Ceccato. 1992. 10-second period (Garnier et al. Next. The larger the reduction sized to be performed with emphasis on the expiratory phase in pressure on the Stabilizer was considered the capacity of the of the respiratory cycle. to tighten the abdomen. p.1. J. standing positions. 60 Motriz. Figure 1A). The measures were The lumbar stabilizer muscles performance was obtained made at rest and during maximal voluntary contraction of by means of the PBU test (Stabilizer. the spinous processes of L4 and L5 were exercises were observed and corrected. The thickness was measured on the dominant side of Subjects performed these movements alternating sides. In the third exercise test. 1995). This methodology was similar to that of a previous trial consisted of a maximal voluntary isometric contraction study (Storheim et al. Jan. at the L4-L5 level. subjects sat on the floor with hips abducted.. 2002). J. (2006). the abdominal wall muscles during the stabilization exercise Australia.M. 2014 .. In the fourth exercise subjects flexed their Muscle thickness variation shoulders and hips. In order to avoid any interference on the results during the jects laid prone in the same position depicted in Figure 1B.5 MHz) was position). with 20 repetitions from each back.. were asked to contract the abdomen as et al. Muscle contractions were performed with with the Stabilizer under the abdomen. During the exercise. The athlete was positioned prone with the head relaxed to one side (left or right). progressing to sitting and four 2009. For the first three exercises each of the test. (2) not consuming food at least two hours before testing. while maintaining the elbows extended and Simultaneously with the variation in abdominal pressure wrists hyper-extended and knees flexed in the prone position.. The exercise consisted to contract the abdominal wall positioned longitudinally and unilaterally (Figure 1B) following muscles while simultaneously flexing the shoulder (with elbow the parameters of the study by Van. Lupion & M. 1995). Japan. Richardson & Jull. with an ultrasound machine repetitions for each side. Mayer. All sessions were supervised by the (Aloka SSD 4000. the multifidus muscle thickness was assessed. supported in their hand palms and knees (four contacts prone The linear array probe (sampling frequency = 7. during expiration.  Athletes performed four much as possible as if they were pulling the navel towards the different exercises per session. of the abdominal wall muscles lasting about ten seconds with four seconds in the inhalation phase and six seconds for the expiratory phase.20 n. and the unwanted movements during the After palpation. pulling the navel towards pressure of 70mmHg and the athletes were instructed to inhale the back. Richardson & Jull. A. marked on the skin. Muscle contractions were empha. R.

313). A= aponeurosis. height (p=0. The PBU the rigidity in the L4-L5 segment. and is similar to the results from a previous study the CON group compared to TLS group.20 n. there is a combination of normal the values on the Stabilizer display.98 0. Costa et al. The higher variation (6.50 ± 2. 2006). 1995) which reported Table 1 shows the PBU and the variation in lumbar mul. Claes. Data A decrease in contractile performance of the multifidus mus- were analyzed using the Sigma Plot Program (version 11) with cle has been reported in patients with low back pain (Barker et a significance level set to α=0. respectively.6 m.31%) No difference was found in age (p=0..372). Ultrasound image of the multifidus muscle thickness.91 18. Figure 2.00 0.023 values were higher in the TLS group compared to CON group (p=0. thickness from rest to full effort.79 ± 1. & Wiesend.40 6. The greatest variation in Motriz.32 kg and A similar reasoning could be used when comparing trained body mass index (BMI) of 23. Lumbar multifidus evaluation Table 1. that the lumbar multifidus promoted more than two thirds of tifidus muscle thickness values of both groups.35 kg/m2. Although global mus- / thickness at rest x 100%]. Age. Results (mean ± SD) for the Pressure Biofeedback Unit (PBU) test and for the variation in multifidus muscle thickness (ΔMT) in the control (CON) and trained in lumbar stabilization (TLS) groups. Wolf. aponeurosis (superior border of the multifidus muscle).. and training the spinal stabilizing muscles might help was as follows: [(thickness in contraction .010) in this idea. The multifidus to maintain proper alignment of the spine and to establish thickness (Figure 2) was measured from the tip of the L4-5 a stable base of support for body movement (Comerford & zigapophyseal joint to the superior border of the superficial Mottram.83 ± 0. 1989). MT: multifidus muscle thickness. body mass of 75. 2014 61 . The BMI was higher (p=0. Z= L4-5 zygapophyseal joint.44 ± 1. 2006)./Mar. a strong pelvic belt should be The Shapiro-Wilk test was used to test the normality of the emphasized in rowing athletes to protect their spine during data.58-64.015 ΔMT (%) 2.023) in the TLS compared to the CON group. 2009. Lee et al. changes in muscle thickness) when going from the resting state Athletes of the CON group had a mean age of 18.38 ± 8. height. (Wilke. as it may help to avoid spinal pain multifidus muscle thickness were compared between the groups and/or injury.88 ± 8. Untrained had a mean age of 16. Training of the local stabilizing muscles is necessary logy described elsewhere (Van et al. there is a high demand of the equation used to calculate the variation in muscle thickness trunk..76 kg/m2.thickness at rest) in decreasing the risk for spinal injury.. years. Arand. height of 1.05. cle strengthening is important.00 kg and BMI of 21. The In sports such as rowing.139) of lumbar multifidus muscle thickness in TLS agrees with and body mass (p=0. 2001). subjects with low back pain should have more difficulty in contracting this muscle. The TLS group showed a mean variation exceeding 50% of that of the CON group’s average.38 ± 5.31 ± 4. Jan. If so.e.89 ± 7. height of 1.78 ± 0. Figure 3 illustrates the multifidus thickness obtained at rest (Figures 3A and 3C) and during the maximal abdominal volun- tary isometric contraction during the PBU test of an individual from the CON group (with small variations in thickness) and from an athlete of TLS group (with high thickness variation. To obtain the values of movement restriction and compensations to maintain spinal muscle thickness.92 ± 3.62 m. body mass. and therefore should present a smaller muscle thickness Results and also a smaller capacity to produce structural changes (i. (trained and untrained) using an independent Student t-test. the evaluation followed the same methodo. The TLS group and untrained subjects in spinal functional stability. p. 1989.1. CON TLS p (n=8) (n=8) value PBU (mmHg) 9. The variation in lumbar multifidus muscle thickness was higher (p=0.67 years.10 to a maximal effort condition. Discussion Spinal functional stability is dependent of both the local and Data analysis global muscle integration systems (Bergmark. When The abdominal pressure was obtained directly by reading spinal dysfunctions are present. v. al.015). abdominal pressure and changes in high performance training. Figures 3B and 3D). subjects should present a smaller capacity to change muscle body mass of 71.81 ± 1. stability. Rio Claro.

D) of a representative athlete from the CON (A. Conclusion These results may help in the understanding of spinal functional stabilization. protecting the lumbar region thereby reducing the incidence of low back pain in rowers. Z = zygapophyseal joint.A. Mayer. Lupion & M. due to the few studies that we were higher compared to the CON group).20 n. in abdominal pressure and a greater variation in multifidus thickness during spinal stabilization exercise compared to untrained athletes. observed in TLS group (more than 50% from injury. improving the lumbar stabilization (Van et multifidus thickness during maximal effort. A. abdominal pressure. 2006). the exercises used in our strengthening that stabilization exercises for low back pain in young rowing program may help to avoid the incidence of excessive loads athletes may help to decrease the injury risk due to sports training on skeletal tissues in this region. respectively. Vaz Figure 3.1.M. MT = multifidus muscle thickness. Geremia. J. p. is also evidence that able to find in this area with a population of rowing athletes.B) and from the TLS (C. Ultrasound images of the multifidus muscle at rest (A. 2014 ./Mar. Ceccato. Rio Claro. v. O. J.D) groups. The above results confirmed evaluate if strengthening training programs of abdominal our initial hypothesis that rowers participating on a low back muscles may really act effectively in the prevention of back pain prevention program would show a greater variation injury in rowing athletes. the strengthening of Rowing athletes trained on segmental spinal stabilization the transversus abdominis and multifidus muscles increases the exercises showed great variation in abdominal pressure and in muscular thickness.58-64. R. Jan. In addition. trained athletes in lumbar stabilization have a greater capacity further longitudinal studies are necessary in order to better of lumbar spine stabilization. However. These results suggest al. In other words.C) and during the PBU test (B. 62 Motriz..

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D. Brazil. is researcher at the Exercise Research Labo- ratory. Porto Alegre. Alexandre Mayer. O. p. J.20 n.1. Raquel de Oliveira Lupion. n°500. Federal University of Rio Grande do Sul. Federal University of Rio Grande do Sul. Rio Claro. R. Brazil. Vaz Jeam Marcel Geremia. Federal University of Rio Grande do Sul. Jan. Brazil.Sc. Porto Alegre 90440-050 RS. Porto Alegre. J. professor.Sc. Manuscript received on May 10. is affiliated with the Exercise Research Laboratory. The authors would like to acknowledge the Clube Grêmio Náutico União and the athletes for their cooperation. Porto Alegre. Brazil. Porto Alegre./Mar. student. Lupion & M. Corresponding author Joseani Ceccato Clube Grêmio Náutico União. Mayer. Marco Aurélio Vaz.Sc. M.58-64.D. 2014 64 Motriz. Exercise Research La- boratory. is a Ph. Brazil. 2014 ..M. B. v. is a master’s student. A. M. Rua Quintino Bocaiúva.com.A. 2013 Manuscript accepted on January 28. Exercise Research Laboratory. Phone: 55-51-3025 3929 E-mail: joseanic@ig. Federal University of Rio Grande do Sul.br Acknowledgements This study was supported by CNPq grant awarded to Marco A Vaz. Geremia. Ph.. Ceccato.