(646) 355-8777

Herman & Wallace Blog

Multifidus size and prevalence of concussion

A couple of years ago, I wrote a blog about an interesting article by Hides and Stanton that related size and strength of the multifidus to the risk for lower extremity injury in Australian professional football players.

Now some of the same researchers are looking above. A prospective cohort study has recently been published that examined factors and their effects on concussions. Physical measurements of risk factors were taken in pre-season among Australian football players. These measurements included balance, vestibular function, and spinal control. To measure these outcomes the following tests were included: for balance the amount of sway across six test conditions were performed; vestibular function was tested with assessments of ocular-motor and vestibular ocular reflex; and for spinal control cervical joint position error, multifidus size, and contraction ability was tested. The objective measure was concussion injury obtained during the season diagnosed by the medical staff.

The findings were so interesting! Age, height, weight, and number of years playing football were not associated with concussion. Cross-sectional area of the multifidus at L5 was 10% smaller in players who went on to sustain a concussion compared to players that did not receive a concussion. There were no significant differences observed between the players that received concussion and those who did not with respect to the other physical measures that were obtained.

With all the recent evidence about the harmful effects of concussions amongst our athletes, I find this information amazing and am excited to see where the researchers take this in the future. The next question for the physical therapist is how do we train the multifidus? The multifidus can be difficult to retrain in some individuals. It is a hard muscle for some patients to learn to recruit. Biofeedback using ultrasound imaging can make this daunting task easier for many patients. With the cost of ultrasound units coming down, it is also a very reasonable tool for clinics to look at investing in.

Join me to learn more about the multifidus and how to use ultrasound imaging in the retraining process. Future course offerings include August in New Jersey, and November in San Diego. I look forward to seeing you there!


Hides, Stanton. Can motor control training lower the risk of injury for professional football players? Med Sci Sports Exerc. 2014; 46(4): 762-8.
Leung, Hides, Franettovich Smith, et al. Spinal control is related to concussion in professional footballers. Brit J of Sports Med. 2017; 51(11).

Regaining sexual function after a cancer diagnosis
Using Yoga for Post-traumatic Stress Disorder

Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

May 22, 2020 - May 31, 2020
Location: Replacement Remote Course

Oncology of the Pelvic Floor Level 1 - Remote Course

May 26, 2020 - Jun 4, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 Part 1 - Remote Course (SOLD OUT)

May 28, 2020 - May 29, 2020
Location: Short Form Remote Course

Pelvic Floor Level 1 - Chicago, IL (RESCHEDULED)

May 29, 2020 - May 31, 2020
Location: Advocate Illinois Masonic Medical Center

Boundaries, Self-Care, and Meditation - Columbus, OH (RESCHEDULED)

May 29, 2020 - May 31, 2020
Location: The Ohio State University Wexner Medical Center

Pelvic Floor Level 2A - Syracuse, NY (RESCHEDULED)

May 29, 2020 - May 31, 2020
Location: SUNY Upstate Medical University

Gender Diversity and Pelvic Health - Livingston, NJ (RESCHEDULED)

May 29, 2020 - May 31, 2020
Location: Ambulatory Care Center- RWJ Barnabas Health

Pelvic Floor Level 2B - Maywood, IL (Rescheduled)

May 29, 2020 - May 31, 2020
Location: Loyola University Health System

Sexual Medicine in Pelvic Rehab - Remote Course (SOLD OUT)

May 30, 2020 - May 31, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

May 30, 2020 - May 31, 2020
Location: Replacement Remote Course

Sacroiliac Joint Evaluation and Treatment - Nashua, NH (RESCHEDULED)

May 30, 2020 - May 31, 2020
Location: St. Joseph Hospital Rehabilitative Services

Postpartum Rehabilitation - Foothill Ranch, CA (Rescheduled)

May 30, 2020 - May 31, 2020
Location: Intercore Physical Therapy

Pilates for the Pelvic Floor - Valencia, CA (Rescheduled)

May 30, 2020 - May 31, 2020
Location: Henry Mayo Newhall Memorial Hospital

Building Resilience Through Nourishment

Jun 2, 2020
Location: Short Form Remote Course

Pelvic Floor Series Capstone - Salt Lake City, UT (SOLD OUT)

Jun 5, 2020 - Jun 7, 2020
Location: Rocky Mountain University of Health Professions

Pelvic Floor Capstone - Remote Course

Jun 5, 2020 - Jun 7, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Jun 5, 2020 - Jun 6, 2020
Location: Replacement Remote Course

Pediatric Incontinence - Grand Rapids, MI (RESCHEDULED)

Jun 5, 2020 - Jun 7, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 2A - Kansas City, MO (Rescheduled)

Jun 5, 2020 - Jun 7, 2020
Location: Centerpoint Medical Center

Pelvic Floor Level 1 - Atlanta, GA (RESCHEDULED)

Jun 5, 2020 - Jun 7, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Washington, DC (Rescheduled)

Jun 5, 2020 - Jun 7, 2020
Location: The George Washington University

Pelvic Floor Level 1- Canton, OH (Rescheduled))

Jun 5, 2020 - Jun 7, 2020
Location: Aultman Hospital

Restorative Yoga for Physical Therapists - Remote Course

Jun 6, 2020 - Jun 7, 2020
Location: Short Form Remote Course

Pelvic Floor Level 1 Part 1 - Remote Course (SOLD OUT)

Jun 6, 2020 - Jun 7, 2020
Location: Short Form Remote Course

Trauma Informed Care - Remote Course

Jun 6, 2020
Location: Short Form Remote Course

Pelvic Floor Level 1 - Berrien Springs, MI (Rescheduled)

Jun 7, 2020 - Jun 9, 2020
Location: Andrews University

Pelvic Floor Level 2B - Bay Shore, NY (Rescheduled)

Jun 7, 2020 - Jun 9, 2020
Location: Touro College: Bayshore

Pelvic Floor Level 1 Part 1 - Remote Course

Jun 11, 2020 - Jun 12, 2020
Location: Short Form Remote Course