Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain

J Orthop Sports Phys Ther. 2008 Mar;38(3):101-8. doi: 10.2519/jospt.2008.2658. Epub 2007 Dec 7.


Study design: A single-blinded, pretreatment-posttreatment assessment.

Objectives: To investigate, using ultrasound imaging, the cross-sectional area (CSA) of the lumbar multifidus muscle at 4 vertebral levels (L2, L3, L4, L5) in elite cricketers with and without low back pain (LBP) and (2) to document the effect of a staged stabilization training program on multifidus muscle CSA.

Background: Despite high fitness levels and often intensive strength training programs, athletes still suffer LBP. The incidence of LBP among Australian cricketers is 8% and as high as 14% among fast bowlers. Previous researchers have found that the multifidus muscle contributes to segmental stability of the lumbopelvic region; however, the CSA of this muscle has not been previously assessed in elite cricketers.

Methods and measures: CSAs of the multifidus muscles were assessed at rest on the left and right sides for 4 vertebral levels at the start and completion of a 13-week cricket training camp. Participants who reported current or previous LBP were placed in a rehabilitation group. The stabilization program involved voluntary contraction of the multifidus, transversus abdominis, and pelvic floor muscles, with real-time feedback from rehabilitative ultrasound imaging (RUSI), progressed from non-weight-bearing to weight-bearing positions and movement training. Pain scores (using a visual analogue scale) were also collected from those with LBP.

Results: The CSAs of the multifidus muscles at the L5 vertebral level increased for the 7 cricketers with LBP who received the stabilization training, compared with the 14 cricketers without LBP who did not receive rehabilitation (P = .004). In addition, the amount of muscle asymmetry among those with LBP significantly decreased (P = .029) and became comparable to cricketers without LBP. These effects were not evident for the L2, L3, and L4 vertebral levels. There was also a 50% decrease in the mean reported pain level among the cricketers with LBP.

Conclusion: Multifidus muscle atrophy can exist in highly active, elite athletes with LBP. Specific retraining resulted in an improvement in multifidus muscle CSA and this was concomitant with a decrease in pain.

Level of evidence: Therapy, level 2b.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Athletic Injuries / diagnostic imaging*
  • Athletic Injuries / epidemiology
  • Athletic Injuries / physiopathology
  • Athletic Injuries / rehabilitation*
  • Australia / epidemiology
  • Case-Control Studies
  • Humans
  • Incidence
  • Low Back Pain / diagnostic imaging*
  • Low Back Pain / epidemiology
  • Low Back Pain / physiopathology
  • Low Back Pain / rehabilitation*
  • Male
  • Muscle, Skeletal / anatomy & histology
  • Muscle, Skeletal / diagnostic imaging*
  • Muscle, Skeletal / physiopathology
  • Muscular Atrophy
  • Pain Measurement
  • Physical Therapy Modalities*
  • Treatment Outcome
  • Ultrasonography