Deep Multifidus Stiffness In Athletes | Fixing Chronic Low Back Pain With Physiotherapy

 Chronic low back pain (CLBP) is a common problem among athletes, often leading to reduced performance, missed training sessions, and even prolonged time away from competition. One of the lesser-known but critical contributors to CLBP is increased stiffness in the deep lumbar multifidus (LM) muscle. This deep stabilizer of the spine is essential for segmental control, and when it becomes excessively stiff, it can perpetuate pain and dysfunction.

      Physiotherapy plays a central role in both preventing and treating LM stiffness, ensuring athletes can perform at their best while minimizing the risk of recurrent back injuries.

 

What is the Deep Lumbar Multifidus Muscle and Why is it Important?

The lumbar multifidus muscle is a series of small but powerful stabilizers located on either side of the vertebral column. It has two primary layers:

1. Superficial fibers: Span multiple vertebral levels and assist with gross trunk extension and posture.
2. Deep fibers: Attach segmentally from one vertebra to the next, providing precise control of intersegmental movement.

For athletes, especially those involved in sports requiring dynamic trunk control (e.g., cricket, football, gymnastics, weightlifting), the deep LM muscle is critical for absorbing load, maintaining spinal alignment, and preventing excessive motion that could lead to injury.

 

What Does Increased Stiffness Mean?

Muscle stiffness refers to the resistance a muscle offers when being stretched. While some stiffness is necessary for stability, excessive stiffness in the deep LM muscle can be problematic.

1. Structural stiffness: Chronic low back pain can lead to changes in muscle tissue, including fibrosis, fatty infiltration, and altered muscle fiber composition.
2. Neuromuscular stiffness: Ongoing pain can cause the nervous system to increase muscle tone as a protective mechanism, leading to prolonged tension.

In athletes, this maladaptive stiffness can reduce the LM’s ability to respond dynamically during training and competition, causing further discomfort and performance deficits.

 

Why Does LM Stiffness Develop in Athletes with CLBP?

Several mechanisms contribute to increased stiffness in athletes:

1. Pain-induced muscle guarding – Pain triggers the nervous system to keep the muscle contracted to “protect” the spine. Over time, this becomes habitual, leading to chronic stiffness.
2. Altered motor control – Chronic pain often disrupts the normal activation timing of the LM, causing it to remain engaged even when it shouldn’t.
3. Repetitive microtrauma – High training volumes, poor technique, or repetitive trunk extension/rotation can create micro-injuries, resulting in scar tissue and increased stiffness.
4. Deconditioning – Athletes who avoid certain movements due to pain may lose LM strength and endurance, with stiffness arising as a compensatory mechanism.

 

Consequences of Increased LM Stiffness

Excessive stiffness in the deep LM muscle can have multiple effects on spinal function and athletic performance:

1. Reduced spinal segmental mobility, limiting natural movement patterns.
2. Abnormal load transfer, increasing stress on discs, joints, and ligaments.
3. Persistent pain cycle, where pain leads to stiffness and stiffness perpetuates pain.

4. Compensatory movement patterns, leading to secondary injuries in the hips, pelvis, or thoracic spine.

 

How Physiotherapy Helps: Prevention and Treatment

Physiotherapists play a pivotal role in addressing increased LM stiffness through early detection, targeted interventions, and long-term prevention strategies.

1. Accurate Assessment

a. Palpation and manual testing: Skilled physiotherapists can identify increased tone and tenderness in the LM.

b. Motor control assessments: Identify poor LM activation patterns that contribute to stiffness and pain.

 

2. Pain Relief and Muscle Relaxation

Before retraining the LM, physiotherapists aim to reduce pain and muscle guarding:

a. Manual therapy: Soft tissue release, joint mobilizations, and trigger point therapy can reduce stiffness.

b. Modalities: Techniques such as dry needling, tens, Laser, Shockwave, Cret therapy, therapeutic ultrasound, and heat therapy help decrease tone.

c. Education: Teaching athletes to avoid maladaptive postures and movements that perpetuate stiffness.

 

3. Restoring LM Activation

Once pain is managed, physiotherapists guide athletes through specific activation exercises:

a. Prone abdominal draw-in maneuver: Teaches isolated activation of the deep LM fibers.

b. Quadruped and functional stabilization exercises: Progressively challenge the LM while ensuring proper motor control.

c. Biofeedback: Real-time ultrasound or tactile feedback ensures correct muscle recruitment.

 

4. Improving Mobility and Motor Control

Segmental mobility drills help restore flexibility in the lumbar spine.

a. Dynamic stability training integrates LM activation with global core muscles (e.g., transversus abdominis, obliques) to optimize trunk control.

b. Functional retraining ensures improved spinal stability during sport-specific movements such as jumping, twisting, and sprinting.

 

5. Load Management and Long-Term Prevention

Physiotherapists also focus on reducing re-injury risk by:

a. Educating athletes on optimal training loads and recovery strategies.

b. Correcting biomechanical issues that place undue stress on the lumbar spine.

c. Incorporating regular core stabilization and flexibility programs into training routines.

 

Why Early Physiotherapy Intervention Matters?

Early intervention by a physiotherapist can break the pain-stiffness cycle before it becomes chronic. By addressing both the pain and the underlying dysfunction, physiotherapy not only reduces stiffness in the LM but also improves spinal mechanics, allowing athletes to return to sport stronger and more resilient.