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One of the most common disorders we see in the clinic is low back pain. In fact, we
know that it affects over 80 percent of the population at some point. Chances are,
you have experienced it at some time in your adventures. The U.S. spends billions of
dollars on low back pain each year, and we know this problem is here to stay. But
how has it become so prevalent? This is the million-dollar question! One part of back
pain relates to muscles called multifidi.
Multifidi are muscles that run deep in the troughs along each side of your spine.
They act as stabilizers between segments (vertebrae) of your spine and help to
insure smooth movement when you are bending over to pick up the groceries. The
multifidi are part of a group of muscles called local stabilizers. These small muscles
are the foundation to pain-free movement in regard to back pain.
So how do we know that the multifidi are impacted when someone has low back
pain? Well, many studies have examined this relationship – and one such research
team found that in those with long-term, chronic, low back pain the multifidi are
atrophied significantly.[1] What does this mean? It means that if you have had low
back pain for some time, then your multifidi have wasted away and are no longer
able to perform their job correctly. Why the muscles atrophy has to do with a pain
inhibition cycle. As you can imagine, this further perpetuates the problem since you
cannot adequately stabilize.
Several other studies have examined the effects of low back pain on the composition
of multifidi. What was discovered was that the multifidi actually begin to store fat
within the muscle as back pain progresses.[2] One does not need a degree in
physiology to understand that muscle should not be storing fat!
Lastly, we need to understand what happens when back pain resolves. If your back
pain suddenly goes away after several months, what happens to the multifidi? Well,
we now know that the muscles do not automatically get stronger, bigger or with less
fat storage. [3] So what does this mean for you? It means that even though the pain
may be gone, your muscles are not back to normal. We need to train them back to
normal!
So let’s review:
- The multifidi muscles are deep stabilizers that help your spine move
smoothly and in a controlled fashion.
- In an episode of low back pain, these multifidi muscles waste away and are
no longer able to perform their job adequately.
- The multifidi will also begin to store fat since they are not being used.
- Even after low back pain ends, the multifidi still don’t return to normal
without adequate training.
Think your back pain may be coming from your multifidi? Email me, and let’s set up
an appointment to fix them!
Thanks for reading,
Ryan
1. Beneck, George J., and Kornelia Kulig. "Multifidus atrophy is localized and bilateral in active
persons with chronic unilateral low back pain." Archives of physical medicine and
rehabilitation 93.2 (2012): 300-306.
2. Kjaer, Per, et al. "Are MRI-defined fat infiltrations in the multifidus muscles associated with low
back pain?" BMC medicine 5.1 (2007): 2.
3. Freeman, Michael D., Mark A. Woodham, and Andrew W. Woodham. "The role of the lumbar
multifidus in chronic low back pain: a review." PM&R 2.2 (2010): 142-146.