What if I told you there is a little muscle in your low back (and neck) that you and your doctor have never heard of, that will probably determine if you ever recover or will have a lifetime of problems. It’s the same muscle that causes a lower back popping sound when it’s offline. Would you be surprised?
One of the weirdest quirks in medicine that’s invisible to patients is that medical care is often not about the science that keeps churning along and advancing, but often more about the business plans that are the most profitable and have inertia. A great example of this phenomenon is multifidus atrophy and low back pain. This is a problem that’s well researched, but rarely read by radiologists. Why? In the case of a lower back popping sound and many others, what the research says and what physicians practice are often two very different things.
The multifidus is the most important back and spine muscle you’ve likely never heard of. It’s the main stabilizer for the spine bones as you move. We know that it’s atrophied (weak and small) in back and neck pain patients and that these changes are associated with pain and disability. We also know that multifidus muscle damage is likely a more reliable predictor of who has back or neck pain and who will or won’t recover than bulging or degenerated discs. However, radiologists all but ignore the multifidus and perseverate on the status of the disc. Before this most recent study, we had 191 research articles listed in the US National Library of Medicine on lumbar multififus and MRI, now with this most recent study, we have 192.
The new study looked at the MRIs of 72 adults who were randomly chosen. The radiologists paid attention to the status of the muscles of the low back including the errector spinae (the main muscles that extend the low back) and the multifidus. They noted again (like many other studies), that the patients who had fatty infiltration of the multifidus had more disability and low back pain. The more the multifidus and errector muscles were trashed, the more degenerative spine changes were present. This all makes sense, as the multifidus is the major stabilizer of the back bones and when it’s “off-line” the bones, joints, and discs crash into one another and get more wear and tear damage (hence the popping).
The upshot? Medicine is funny, and sometimes not in a good way. Given the amount of research that we have on multifidus and back and neck pain, every radiologist and physician who sees spine patients in America and elsewhere should be paying attention to this little muscle. However, finding new and innovative ways to treat mutifidus and protect people’s backs isn’t nearly as profitable as operating on discs! In the meantime, that lower back popping sound you hear could mean that your multifidus needs help!