The multifidi are a part of the deep paraspinals group. They lie beneath the semispinalis directly next to the spine and are usually not addressed during massage, as these muscles are deep and a bit too lax to palpate in the face-down position without using a body support cusion. They can be palpated in a sidelying position with the knees bent. Typically there will be tenderness when the area is tapped, for example, by a practitioner.
The multifidi are responsible for spinal flexion and very fine rotational adjustments. They are also responsible for stabilizing contracture; for example, when the body is positioned in a sustained forward bend, such as when giving a light-pressure massage (with no counterbalance) , or when sitting still for long periods in a chair without lumbar support. EMG imaging has shown that this muscle is initially relaxed in an standard chair without support, but becomes increasingly active after about 30 minutes. When already in a state of dysfunction, this muscle is shown to be constantly active.
How does it feel?
Often a nagging and persistent steady ache or "bone pain" is felt on one side of the spine that is not relieved by changing positions, often in the the sacral area (see S1 and S4 in the illustration above). This discomfort can be relieved momentarily by extending the spine (bending slightly backwards). After a period of dysfunction on one side, the other side usually becomes involved. Fortunately pain from the multifidus is local, so trigger points can be easily addressed by the client.
Perpetuating factors:
sustained forward bending
sitting in an improperly designed chair for long periods
sleeping on a soft, hammock-like bed
Self-care:
Multifidus trigger points can be released by applying pressure to the area of discomfort directly next to the spine in the with a back knobber. While applying pressure, circle the upper body and for the lower back and SI area, circle the upper body and hips while applying pressure; my favorite tool to use for this the Big Bend by Pressure Positive.
Alternately, you can lie face-up while applying pressure with a tennis ball to the affected area. In cases where there may also be facet joint dysfunction (or stiffness and inflammation in the spine) a frozen tennis ball may be preferrable.
The In-bathtub Stretch Exersize can be particularly effective.
Once these trigger points are relased (and possibly related trigger points in the superficial paraspinals), you will want to correct perpetuating factors. If sitting for a prolonged period is a perpetuating factor, a support cushion is a good first step: place a support cusion just below (caudal to) the sholder blades and adjust according to comfort in order to support natural lumbar lordosis while sitting. You may like to position the cusion a bit lower on the back than just below the shoulder blades, so experiment.
If you are working from home, there are many factors to consider, including finding a chair with adjustable armrests (especially, if like many of us, you have short upper arms) but this study mostly focuses on supporting the paraspinal group:
In an extensive study to determine what chair design causes minimum muscular stress, as measured electromyographically when typing, Lundervold found that the chair should have a backrest with a backward slope, a seat wihich is slightly hollowed out, no casters, and firm upholstery. Seat height should be low enough so that the feet rest flat on the floor without compression of the thigh by the front edge of the seat. A footrest may be used to avoid underthigh compression. The lower edge of the backrest is positioned to support that part of the lumbar spine which flexes the most when bending forward. The upper edge of the backrest should reach high enough to cover and support at least the inferior angels of the scapulae.
-Travell and Simons' Myofascial Pain and Dysfunction: A Trigger Point Manual, Volume 1
For practitioners: Palpate this muscle with the spine flexed. Tap in the area of the transverse process to find areas of sensitivity. There may be a slight hollow or "flatness" over the area affected by trigger points, usually 1-3 spinal segments. Skin may not pull up from the spine in this area. Deep finger pressure is directed along the side of the spinous process. These muscles can be worked on while the client is lying on the unaffected side with knees drawn to chest in order to bring the muscles in to flexion or face-down with a body support cusion.
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