Do self-managed exercises and strength/fitness training affect multifidus muscle size in elite footballers?

Context: Low back pain (LBP) and lower limb injuries are common among Australian Football League (AFL) players. Smaller size of 1 key trunk muscle, the lumbar multifidus (MF), has been associated with LBP and injuries in footballers. The size of the MF muscle has been shown to be modifiable with supervised motor-control training programs. Among AFL players, supervised motor-control training has also been shown to reduce the incidence of lower limb injuries and was associated with increased player availability for games. However, the effectiveness of a self-managed MF exercise program is unknown. Objective: To investigate the effect of self-managed exercises and fitness and strength training on MF muscle size in AFL players with or without current LBP. Design: Cross-sectional study. Setting: Professional AFL context. Patients or Other Participants: Complete data were available for 242 players from 6 elite AFL clubs. Intervention(s): Information related to the presence of LBP and history of injury was collected at the start of the preseason. At the end of the preseason, data were collected regarding performance of MF exercises as well as fitness and strength training. Ultrasound imaging of the MF muscle was conducted at the start and end of the preseason. Main Outcome Measure(s): Size of the MF muscles. Results: An interaction effect was found between performance of MF exercises and time (F = 13.89, P ≤ .001). Retention of MF muscle size was greatest in players who practiced the MF exercises during the preseason (F = 4.77, P = .03). Increased adherence to fitness and strength training was associated with retained MF muscle size over the preseason (F = 5.35, P = .02). Conclusions: Increased adherence to a self-administered MF exercise program and to fitness and strength training was effective in maintaining the size of the MF muscle in the preseason.