The Multifidus Back Pain Solution


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The Multifidus Back Pain Solution, by Jim Johnson, P.T. offers an exercise program for chronic back pain sufferers. The program is based on evidence that one specific back muscle, the multifidus, plays a role in almost all non-neurological back pain. Because the book is written by a licensed allied health professional, it offers excellent background information as to why the program works, as well as how consumers can arm themselves with knowledge about back pain treatments.

Writing Style and Chapter Organization

Johnson's writing style is friendly, and he uses easily accessible analogies when explaining complex anatomical and scientific facts. Most chapters have a page of key points at the end.

The Approach of the Book

The approach taken by this book is in treating the function of the back, rather than the traditional labels such as herniated disk or spondylolisthesis. This may explain why there is an emphasis on background information and scientific studies. Supporting his approach is the research finding that there is no diagnosis for approximately 85% of low back pain cases.

Why a Book on One Muscle?

The author believes strongly that multifidus muscle is significant in almost all cases of back pain. He provides numbers comparing a:

  • strong link between an abnormal multifidus muscle and the presence of low back pain
  • normal multifidus muscle in conditions which are commonly associated with pain, but where there is none.
    He explains the anatomy of the spine and the multifidus muscle and discusses why it is so significant in the presence and absence of back pain.

    Specific Back Pain Conditions

    Johnson covers the specific conditions found to be affected by the multifidus muscle, for example, spondylolisthesis, back pain due to pregnancy, post back surgery back pain, and herniated disks.

    Among other things, the explanations address the activity of the multifidus muscle as revealed by EMG and/or ultrasound studies in each of these conditions. The conditions, themselves, are explained well, providing excellent background information.

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    Scientific Research on Exercise as a Treatment for Back Pain

    Chapter 3 provides a review the scientific research on the multifidus and its role in back pain, especially exercise as treatment. In this chapter, Johnson gives an overview of the process of scientific proof for medical treatments. How is one to really know what treatment will be effective? He discusses:

    • natural history studies
    • anecdotal evidence
    • randomized control trials.
    This is an excellent chapter, not only for understanding the rationale for the exercise program, but also for becoming an educated consumer of back pain treatments.

    The Exercise Program

    The exercises proposed by the author are geared for beginners -- those who either know little to nothing or don't really like to exercise. Johnson gives strength training guidelines, including definitions for reps and sets and a discussion of intensity and time, all for the purpose of implementing the program according to standard fitness protocol. He also talks about what you can expect once you have embarked upon the program, and how to progress and maintain the program.

    Comment on the Exercise Program

    Interestingly enough, Johnson's program consists of only 3 exercises (and variations meant to progress you as you become stronger). The exercises are excellent and can also be found in the Pilates repertorie, as well as other systems.

    The exercises have been adapted to target the multifidus muscle as it affects back pain. He instructs the reader to do the exercise in neutral position, but does not offer a lot of explanation has to how to establish, maintain and recognize that position.

    Further Resources in Back Pain Treatment

    Chapter 6 reviews other ways to address back pain including:

    • manipulation
    • stretching
    • the best way to sit
    • losing weight
    • back support belt
    • MacKensie exercises.
    In this chapter, Johnson also maps out the common treatments according to their effectiveness for specific types of low back pain. He also discusses stress and low back pain.

    Chapter 7 offers further reading for specific topics.

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