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The multifidus muscle is a deep spinal stabilizer that plays a crucial role in maintaining spinal stability and protecting the spine during movement. It runs along both sides of the lumbar spine, providing support and helping to control the position of the vertebrae. When the multifidus muscle becomes weak or atrophied, it can lead to low back pain and other spinal issues. Multifidus atrophy is a common condition, especially in women and individuals aged 55 and older, that can result in decreased strength, limited range of motion, and increased back pain. Treatment options include physical therapy, exercise programs, and in some cases, more interventional methods such as medial branch nerve stimulation.
| Characteristics | Values |
|---|---|
| Muscle structure | Consists of a number of fleshy and tendinous fasciculi |
| Muscle function | Stabilizes the joints within the spine |
| Muscle location | Runs along both sides of the spine |
| Muscle composition | Made of a series of small muscles |
| Muscle attachment | Attached to all vertebrae except C1 (the atlas) |
| Muscle action | Works with other core muscles to provide support during flexion, rotation, and extension |
| Muscle degeneration | Multifidus atrophy increases with age |
| Muscle atrophy causes | Disuse and denervation |
| Muscle atrophy treatment | Physical therapy, home exercise programs, medial branch nerve stimulation |
| Muscle pain | Low back pain |
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What You'll Learn
Multifidus muscle atrophy and back pain
The multifidus muscle is a deep spinal stabilizer that runs along both sides of the lumbar spine. It is responsible for controlling the position of the vertebrae, helping to maintain proper posture and stabilize the lumbar spine. It also works to extend the lower spine during reaching or stretching. The multifidus muscle is made up of several small muscles and is attached to all vertebrae except C1 (the atlas).
Multifidus atrophy is the shrinkage or loss of muscle cells in the multifidus muscle. It is seen at varying degrees in almost all people who experience low back pain. The atrophy can cause compression of the vertebra and a host of other back-related issues, including herniated discs, increased pressure on the spinal cord or peripheral nerves, and other spinal issues. This can lead to more unwanted and unsynchronized movement of the vertebral bodies, which can cause further pain.
Multifidus atrophy can be caused by a lack of regular use and strengthening of the muscle. This can lead to inhibition, where the muscle shuts down and becomes weak. This weakness can cause incorrect movements and injuries, with other muscles compensating for the weakness, leading to further pain.
Physiotherapy can help to treat multifidus atrophy through manual treatments, stretching, and exercise. Physicians may also suggest physical therapy and a home exercise program to engage the multifidus and promote strength. If the muscle has become too weak, there are more interventional methods, such as medial branch nerve stimulation, which can help strengthen and reactivate the muscle.
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Causes of multifidus atrophy
Multifidus atrophy is a condition that affects the multifidus muscle, which is a deep spinal stabilizer that runs along both sides of the lumbar spine. The multifidus muscle plays a crucial role in stabilizing the core and protecting the spine during movement. When the multifidus muscle becomes weak or atrophied, it can cause an array of spinal issues and lead to increased low back pain.
There are several causes of multifidus atrophy, including:
- Age: Multifidus atrophy is most common in individuals aged 55 years and older.
- Gender: It is also more prevalent in women.
- Inactivity: Not regularly using and strengthening the multifidus muscle can lead to weakness and atrophy.
- Trauma: Trauma or injury to the multifidus muscle can cause atrophy over time.
- Degeneration: Multifidus degeneration can lead to atrophy if not identified and treated promptly.
- Disc Degeneration: Studies have shown a correlation between lumbar disc degeneration and multifidus fatty atrophy, suggesting that disc degeneration may contribute to multifidus atrophy.
- Genetic and Environmental Factors: Multifidus atrophy can be influenced by a combination of genetic predispositions and environmental exposures.
It is important to note that multifidus atrophy often goes undetected or untreated, leading to chronic low back pain that is often misdiagnosed as "non-specific." Therefore, seeking medical advice and early intervention is crucial for proper diagnosis and treatment.
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Diagnosis of multifidus atrophy
The multifidus muscle is a deep spinal stabilizer that runs along both sides of the lumbar spine. It plays a crucial role in maintaining proper posture and stabilizing the core during movement. When the multifidus muscle becomes weak or atrophied, it can cause an array of spinal issues, leading to increased low back pain.
Magnetic Resonance Imaging (MRI) is a powerful diagnostic tool that can provide detailed images of the lumbar spine and surrounding structures. It is highly effective in visualizing muscle atrophy, detecting structural abnormalities, and ruling out other conditions that may be causing lower back pain. The MRI images can reveal significant changes in the size or composition of the multifidus muscle, helping to identify fatty atrophy and degeneration.
The Pfirrmann classification is used to assess the grade of lumbar intervertebral disc degeneration at the L4/L5 and L5/S1 levels. Fatty infiltration of the multifidus muscle is then graded as normal, mild, moderate, or severe. Axial T2-weighted MRI slices are also used to detect the cross-sectional area (CSA) of the right and left multifidus muscle at these intervertebral disc levels. High-intensity areas on the medial and depth of the multifidus myofascial sheath are identified to measure fatty atrophy compared to the total CSA.
Additionally, specific exercises and stretches can be recommended to help isolate and strengthen the multifidus muscle. Working with a physiotherapist or accredited exercise physiologist can be beneficial for maintaining and improving the strength of the multifidus muscle through manual treatments, stretching, and exercise routines.
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Treatment of multifidus atrophy
Multifidus atrophy is associated with chronic low back pain. It is caused by ongoing lower back pain and strain, which can cause the multifidus muscle to "shut off" or atrophy. This leads to spinal instability, which causes further low back pain as other muscles try to compensate. The longer the multifidus is inactive, the more weakness and atrophy develop in the muscle, making rehabilitation through physical therapy more difficult.
The best treatment for multifidus atrophy is prevention. An active lifestyle, a healthy diet, and regular exercise are some of the best ways to prevent atrophy. Working with a physiotherapist is a great way to maintain the strength of the multifidus muscle. Through manual treatments, stretching, and exercise, individuals can maintain and strengthen their multifidus and keep their lumbar spine healthy.
Some exercises that can be done at home to strengthen the multifidus muscle include:
- Dumbbell exercises: Lie on your side with your elbow directly beneath your shoulders and your legs stacked. Lift your hips off the ground, creating a straight line from your head to your feet. Hold for 20-30 seconds. Complete ten times. Switch sides and repeat.
- Using a weights bench or a table, place one leg back into a straightened position and lean forward from your waist until your upper body is parallel to the floor.
In addition to these exercises, it is important to start with low-impact exercises such as walking, swimming, or yoga and gradually increase the intensity over time.
For individuals who do not experience relief from physical therapy, medication, and other conservative pain management therapies, neurostimulation can be used to treat multifidus atrophy. ReActiv8 is an FDA-approved neurostimulation device that has been proven to be effective in reducing mechanical-related chronic low back pain. Neurosurgery One also offers an implantable neurostimulator that can help relieve mechanical chronic low back pain by reactivating the multifidus.
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Prevention of multifidus atrophy
Multifidus atrophy is a condition that affects the multifidus muscle, which is responsible for providing stabilisation during movement and helping to control the position of the vertebrae to maintain proper posture. This condition is often a result of muscle inhibition, where the muscle shuts down and becomes weak and atrophied. The atrophy of the multifidus muscle can lead to increased low back pain and other spinal issues.
To prevent multifidus atrophy, it is important to maintain an active lifestyle, a healthy diet, and engage in regular exercise. Here are some specific recommendations to help prevent multifidus atrophy:
- Engage in regular physical activity and exercise: Focus on exercises that promote core stability, such as yoga, pilates, or targeted core workouts. Additionally, incorporate full-body movement retraining and stretching to improve flexibility and maintain muscle health.
- Start with low-impact exercises: Begin with activities such as walking or swimming, and gradually increase the intensity and difficulty over time.
- Consult a specialist: Consider working with a physical therapist or personal trainer who can help devise a customised exercise plan tailored to your specific needs and goals. They can guide you through specific exercises to target the multifidus muscle and improve its function.
- Maintain a healthy diet: Ensure you are consuming a well-balanced diet that provides your body with the necessary nutrients for muscle health and recovery.
- Address posture issues: Be mindful of your posture during daily activities, such as sitting or standing for prolonged periods. Make sure to take breaks and adjust your posture to avoid muscle strain and imbalance.
- Treat pain and inflammation: If you are experiencing back pain or inflammation, seek appropriate treatment, such as medication or therapy, to alleviate discomfort and improve muscle function.
By following these preventative measures, you can help reduce the risk of multifidus atrophy and maintain the health and stability of your spine and surrounding muscles.
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Frequently asked questions
The multifidus muscle is a deep spinal stabilizer that runs along both sides of the lumbar spine. It plays a vital role in spinal health and mobility, helping to stabilize the lumbar spine and protect the spine during movement.
Multifidus atrophy is the shrinkage or loss of multifidus muscle cells. It is often associated with low back pain and is most common in women and those aged 55 and older.
Multifidus atrophy can be caused by a variety of factors, including inactivity, a poor diet, and a lack of exercise. The muscle is prone to inhibition, where it shuts down and becomes weak, often going undetected or untreated.
The best way to treat multifidus atrophy is through prevention. Maintaining an active lifestyle, a healthy diet, and regular exercise can help prevent atrophy. If atrophy is already present, physical therapy and a home exercise program can be recommended to engage and strengthen the multifidus muscle.
