(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

Pediatric Incontinence - Duluth, MN (Postponed)

Oct 23, 2020 - Oct 25, 2020
Location: Polinsky Medical Rehabilitation Center

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Oct 23, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Parkinson Disease and Pelvic Rehabilitation - Remote Course

Oct 23, 2020 - Oct 24, 2020
Location: Short Form Remote Course

Pelvic Floor Level 2A - Braintree, MA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Peak Physical Therapy

Pelvic Floor Level 2A - New York, NY Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: 5 Point Physical Therapy

Pregnant and Postpartum Rehabilitation Special Topics - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC (POSTPONED)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Troy, NY Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: The Green Room Physical Therapy

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - Greenville, SC Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Peripartum Advanced Topics - Somerset, NJ (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 2A - Minnetonka, MN Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Viverant

Pelvic Floor Level 2A -Decatur GA Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - East Norriton, PA Satellite Course

Oct 24, 2020 - Oct 25, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH Satellite Location (Sold Out)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Pelvic Floor Level 2A - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Athens, GA Satellite Course (Rescheduled)

Oct 24, 2020 - Oct 25, 2020
Location: Thrive Integrative Medicine

Pelvic Floor Level 2A - Tampa, FL Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Optimal Performance and Physical Therapies

Pelvic Floor Level 2A - Monroe, LA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Ouachita Physical Therapy

Manual Therapy Techniques for the Pelvic Rehab Therapist - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Goodyear, AZ Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: STI Physical Therapy & Rehab

Breastfeeding Conditions - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Manual Therapy for the Abdominal Wall - Remote Course (Postponed)

Oct 25, 2020
Location: Short Form Remote Course

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center