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

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.