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1st Apr

2017

Poor Deep Back Muscle Strength Predicts Injuries to Hip, Knee and Ankle/Foot

Today, most people have heard the term “core muscle strength”, and how important it is to do well in a variety of sports, and to prevent injuries. Others prefer to call this “trunk control”, also suggesting sufficient activation and coordination of such core muscles.

When it comes to the back and trunk, as it connects to the pelvis, these core muscles include the main spinal stabilizer, the short and thick multifidus in the lower back, and its partners in action, the deep transverse and oblique abdominal muscles.The function of the quadratus lumborum in trunk stability, is more controversial and uncertain, with discrepancies found in research studies. It has shown weak biomechanical effects on the spine, and appears to work more as a back-up or compensatory mechanism when the multifidus fails.

When functioning properly, in people with good trunk and pelvic control, the multifidus and deep abdominal muscles contract together in synergy from different directions, one checking the other.

In recent years, there have been several studies which have all shown a clear relationship between having small multifidus muscles in the lower back, and a significantly increased rate of subsequent sports injuries affecting the hip, thigh, knee, and/or ankle and foot. Poor neuromuscular control of the low back-pelvic region has been tied to such small and weak low back multifidus.

Studies have revealed that the muscles of the low back-pelvic complex are essential for controlling hip motion, thigh rotation, and motion farther down the leg. Lack of such lumbo-pelvic control may then lead to altered function and force distribution down the leg.

A recent study out of Australia on Australian football players confirmed previous findings, that decreased size of the multifidus muscle in the lower back was related to prediction of football injuries.

These sports medicine findings can also be applied in rehabilitation to the less active general population, only with a different intensity and difficulty in training. A complete biomechanical analysis is important, to determine each person’s need for specific exercise. All too often, the trunk and low back-pelvis is disregarded when rehabilitating the hip, thigh, knee or ankle/foot. The leg is a kinetic chain, which can only function properly if its base in the pelvis and trunk, is stable.

Those of you who have seen me or my associates in the past, know that we typically gradually progress rehabilitation exercise from coordination and endurance exercise, favoring dynamic movements, to higher intensity strength and power training, and finally putting it together in more complex functional training. The recent research results discussed confirm that we must not neglect to include the trunk.

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