The Multifidus Muscle and Spine Pain – Cause and Effect

By Chris Centeno, MD /

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multifidus muscle and spine pain

The multifidus muscle is the most important stabilizer of your spine, but one that most patients and physicians have never studied. There are now hundreds of research studies confirming that when this little muscle goes south, all heck breaks loose in the neck and back. The multifidis is easy to spot on the average MRI and is now being looked at by NASA as an issue for long-term spaceflight, but to your average pain specialist, surgeon, or radiologist, it’s pretty much invisible.

The role of the multifidis in pain and spine degeneration

Normal Multifidis Function

First, the multifidus is an absolutely critical muscle that stabilizes your spine. To get a sense of what it does, take a look at the video to the right, which shows what happens to your lower back vertebrae (bones) when you walk. The vertebrae are under constant micro-motion feedback from the multifidus so that motion is allowed, but only a small amount in all of the right directions.

Multifidis Problem Causing Pain and Dysfunction

Now take a look at the vertebrae when the multifidus is off-line in the video to the left. The back bones are out of control and there’s too much sloppy motion. All of the extra movement can damage the disc spacer between the bones and the joints between them (facet joints), causing pinching of the spinal nerves.

The Multifidis on MRI

Multifidis Pain and How to Spot the Problem on MRI

+ Click to Enlarge – Multifidis on MRI

It’s not hard to spot an atrophied low back multifidus on MRI. In fact, it’s easy enough that anyone can do it with just a little training. If you click the thumbnail to the right you’ll see several examples, from a normal multifidus to one that’s severely atrophied. You can also read about how to grade the multifidus on your MRI here. So if you have an MRI of this area, take a few minutes to have another look and see what category you’re in. This alone may be one of the most important things on the film that was never read by the radiologist.

Why don’t radiologists and surgeons pay more attention to the multifidis?

Frankly, it has more to do with the business of medicine than anything else. There really is no surgery for this problem and surgeons are generally locked into a 1970s structural model of the spine, looking for discs and bones pressing on nerves that can be cut out. Radiologists tend to read what surgeons want to see, which is how they garner business. While surgeons may be oblivious to the multifidus, they do a great job of destroying the muscle with their procedures. In fact I just sat and looked at an MRI yesterday of a patient after a low back fusion where multiple levels of multifidus were fried.

Mutifidis Problems Creedt by Surgery

+ Click to Enlarge

While surgeons and radiologists generally ignore this stabilizer, NASA and the European Space Agency are paying attention. A recent study of an astronaut’s multifidus muscle after being on the International Space Station showed that despite special exercises, the muscle did atrophy. Thankfully it returned to normal size once the astronaut was back in earth’s gravity.

More research outside of space continues to be published on the critical muscle, such as a recent study of herniated low back discs. This new study shows that the multifidus goes south shortly after a herniated disc begins placing pressure on the spinal nerve. This makes sense, as the nerve innervates the multifidus, so the muscle shrinks and becomes weaker as it’s nerve supply is disrupted.

The upshot? The multifidus is literally the most important muscle that your physicians never mentioned. It needs to be looked at in every low back pain patient. In our clinical experience, damage and pain related to the multifidus can often be reversed through regenerative injection treatments and special exercises, without resorting to surgery (which generally destroys the muscle). Regenexx Advanced Platelet Lysate and Super Concentrated Platelet Rich Plasma for Spine utilize the growth factors from your own blood platelets to reduce nerve irritation and help clean up the disc herniation. Combining that with special exercises should get this critical stabilizer back on track!.

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7 thoughts on “The Multifidus Muscle and Spine Pain – Cause and Effect

  1. Charlie McCartan

    I’m gathering what info I need to see if I’m a candidate for treatment of lower back spinal stenosis resulting in interfering with walking without pain, or at all. Seems to come from the L5/S1 area. My hang up is my age, 85, and how that might apply, and the estimated cost of a procedure. If it’s a waste of time, even $200 for discussion is questionable. Can you give me an idea?

    Charlie

    1. Regenexx Team

      Charlie,
      L5/SI and resulting nerve and instability issues causing spinal stenosis are not uncommon and are treatable. While we’ve found that older age does not negatively affect outcome in general, I’d be glad to run your situation by one of our doctors to see if anything jumps out at them with this limited information. In the meantime, this was a spinal stenosis situation treated with Regenexx DDD: http://www.regenexx.com/blog/spinal-stenosis-surgery-alternatives/

    2. Regenexx Team

      Charlie,
      Unfortunately, there isn’t a way to give you more of an idea than we treat those situations regularly. The purpose of the discussion is we carefully look at everyone’s MRI, history, and symptoms to grade a candidate as good, fair, or poor, so you will need to go through that process.

  2. Valerie

    On June 6 I went in to have them cells and platelets none in my lower back and Dr Patel also treated the Multifidus muscle. Shortly before I schedule for surgery, But my mother looked into another option for me knowing I had a six-year-old to take care of. My life before going to see Dr. Patel was a struggle every day putting shoes on my daughter giving her a bath and taking care of her. today I feel wonderful I’m able to do so many things I can do before I fill my back is much stronger, the sciatica’s are gone the pinching is gone and I am a happy mother who can now raise a happy daughter. Doctors there and the staff are wonderful and so caring, I would recommend anyone to try this before surgery.
    Thank you!
    Your happy patient,
    Valerie

    1. Regenexx Team

      Valerie,
      Thank you for sharing your story, it is wonderful to hear that you are doing so well! Dr. Patel is a talented physician, and your case demonstrates clearly the potential of Regenerative Interventional Orthopedics.

  3. Lynn Howe

    Good Morning! I am 4 days post Regenexx Platelet Lysate injections for L4, L5, SI and surrounding muscles,etc. I am ready to start the special exercises but can not find a specific list of those exercises for the multifiis muscle, isometrics, etc. Where can I find this list so I may start them? Also, should I be concerned that I’ve had little injection pain but my sciatica is returning? Thank you very much!

    1. Regenexx Team

      Hi Lynne,
      No, you should not be concerned. Where were you treated?

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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