The multifidus muscle group, located along the back of the spine, is an important muscle to train if you are healing pelvic pain and incontinence. The multifidus extends your back when both the right and left column contract, or rotates your spine when one side is contracted.
So, what do your back muscles have to do with your pelvic floor?
Think of your midsection, or core, as a canister of support—a soda can, if you will.1
Imagine the “soda can” as the transverse abdominals in the front, multifidus in the back, pelvic floor muscles at the bottom and diaphragm and vocal cords at the top.
If I toss an unopened soda can across the room, it will not leak. If I create “weakness” by opening the top of the can, or piercing the front/back/bottom, it will leak.
This is why we consider core stability when someone is experiencing pelvic floor dysfunction.
Reasons to add multifidus exercises
If you are working on optimizing your pelvic girdle you may have already been practicing strengthening your pelvic floor muscles for urinary incontinence or lengthening them to mitigate pain.
You may have also started training the abdominal wall with special attention to the transverse abdominals to support lengthening or strengthening your pelvic floor muscles. To round out your program, and support your spinal health, consider adding an exercise to strengthen the multifidus.
Why would you be looking for a multifidus exercise?
- You are working with a pelvic health physical therapist or occupational therapist on recovering from a pelvic pain diagnosis like vulvodynia, interstitial cystitis, or constipation. You are looking to strengthen other aspects of your core so your pelvic floor muscles don’t need to hold on for stability as much.
- You just had a baby, concerned about a diastasis recti abdominis, urinary incontinence, or pelvic organ prolapse.
- You have hip, back, or sacroiliac joint pain and want to optimize your core.
Bird-dog exercise for strengthening multifidus
One of my favorite multifidus exercises is alternate arm leg extension, or bird-dog. It’s a great way to work on hip stability, shoulder stability, and abdominal wall control, all of which assist optimal pelvic function.
Very often, especially when I see postpartum women, they have a difficult time stabilizing through their pelvis, abdominal wall, and ribcage. Makes sense! They have had to deal with internal pressure changes, muscles that have been elongated, and scar tissue…not to mention lack of sleep, nutrition and sheer exhaustion!
I find creating modifications so that my patient can transfer weight optimally is ideal. Sure, someone can throw their arm and leg up and count to ten, but if we can exercise specifically and mindfully, the work can go even deeper.
Here is how I like to progress people. This may take place over the course of a few or many visits…however long it takes to gain strength, motor control, and stability.
Start in tabletop position. Be sure that your hips are right under your pelvis and your hands are right under your shoulders.