[進階肌動學] 多裂肌的深層分析 Deeper into Multifidus

多裂肌是人體背側重要的核心肌群
由薦骨開始一路向上到頸椎
每一個單位向上2-4節脊椎連結到棘突上
是重要的脊椎穩定肌群
Multifidus is the important core muscle on the back
From sacrum all the way up to neck
Every unit goes 2-4 segment above toward the spinous process.
Play an important role as a lumbar stablizer

由於多裂肌本身的組織排列

在身體向前彎曲時多裂肌可以產生最大的肌力

這也間接證實了多裂肌在矢狀面上身為穩定肌群的能力

Due the the sacromere length change,

Multifidus generates max strength output during trunk flexion.

That somehow implies the ability as a trunk stabilizer on saggital plane.

許多的研究顯示在慢性下背痛的患者身上

會發現多裂肌失能的狀況

也會在影像學上觀察到

明顯腰部多裂肌受到脂肪組織取代萎縮的現象

Many researches showed that multifidus dysfunction occur among chronic low back pain population.

Also form image studies,

the fat will infiltrate multifidus tissue, A.K.A multifidus atrophy.

因此如何正確的評估與誘發多裂肌的活動

對於下背痛的患者來說非常重要

Thus, its important to assess and activate multifidus for low back pain population.

臨床上有兩個適合評估多裂肌的動作

多裂肌抬高測試(MLT)以及後彎測試

There are two excellent movements can be used to assess multifidus.

Multifidus Lifting Test (MLT) and multi-segmental extension test

多裂肌抬高測試是在四足跪姿下進行

受試者需先維持脊椎中立

然後將腳或手抬起

如果腰椎無法維持姿勢就是陽性

MLT is performed under quadruped position

The subject need to get the neutral spine first,

then raising arm or leg or both.

Belly dropping or can not maintain neutral spine are consider positive

後彎動作是另一個非常簡單可以快速執行的理學測試

主要評估要點有兩個

1. 腰椎是否過度前凸

2. 脊椎是否有折點出現

這兩個現象都表示多裂肌的失能導致無法有效的分散後彎壓力

Multi-segmental extension is another easy PE.

There are two signs we need to watch out

1. Hyperlordorsis of the lumbar

2. Any hinge point on the spine

Both signs tell you that multifidus is dysfuntion that cannot distribute the pressure properly.

當我們處理完結構上或肌肉控制的問題之後

我們必須要指導個案如何正確使用多裂肌

下面介紹兩個我常用的多裂肌啟動與訓練的方式

After dealing with the structural issue and motor control issue,

we need to teach them how to use their multifidus.

Below are two exercises I use a lot to activate multifidus.

改良多裂肌超人式

傳統超人式在執行上容易過度使用脖子與豎脊肌群

反而可能造成更多的症狀產生

而在將手腳抬起前

先讓上肢往身體收進來

可以徵召核心穩定肋骨

Mofified Superman by Dr. Kathy Dooley

Original superman may over recruit neck and erector spinae during practice,

which might make the symptom worse.

Instead, you can add a pulling movement of the arms before raising limbs.

That can help you recruit core muscles to stabilize ribs during movement.

側躺多裂肌啟動

想像你的胯下與背後有一條線連接在一起

將這條線縮短並把腰椎向上略為抬高

從屁股的位置給予一個輕輕向前推的力量

另一隻手可以去感受多裂肌是否收縮或式產生過度豎脊肌活化

Sidelying Mf activation

Think about there's a ling connecting your groin and lumbar spine

Contracting this line gently and lifting lumbar vertebra up slightly

Then you can give light resistance to push pelvis forward

Another hand can touch their back to feel if the Mf is contracting or erector is over activating.

多裂肌是背後的核心

協助我們抵抗重力與旋轉

下背的穩定除了腹肌核心以外

多裂肌的訓練是一個不可忽略的重要因素

Multifidus is core of the back.

It assists us against gravity and rotation.

In order to stabilize low back spine, 

multifidus is one muscle you can not neglect.

參考文獻

1. Freeman, M. D., Woodham, M. A., & Woodham, A. W. (2010). The role of the lumbar multifidus in chronic low back pain: a review. PM&R, 2(2), 142-146.

2.Ward, S. R., Kim, C. W., Eng, C. M., Gottschalk IV, L. J., Tomiya, A., Garfin, S. R., & Lieber, R. L. (2009). Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. The Journal of Bone and Joint Surgery. American volume., 91(1), 176.

3. Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873-888.

4. Kjaer, P., Bendix, T., Sorensen, J. S., Korsholm, L., & Leboeuf-Yde, C. (2007). Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?. BMC medicine, 5(1), 2.

本著作由I-Chen Liu, PT, MS, DPT, OCS製作，以創用CC 姓名標示-非商業性-相同方式分享 4.0 國際 授權條款釋出。