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The most important structure for spinal stabilization and support is likely one you’ve never heard about: the multifidus muscle. Study after study has shown that when this muscle’s not happy, the entire neck and back suffer. However, despite the fact that the multifidus is easy to see on an MRI, most physicians or surgeons haven’t studied it and don’t pay much attention to it. So today we’re going to explain the multifidus muscle as it relates to spinal function and discuss ways it can be treated when it’s damaged.

What Is the Multifidus Muscle?

Deep in the back, there are small muscles that live between the spinous processes at the back of the spinal column that are collectively known as the multifidus muscle. The multifidus muscle serves the entire spine, from the neck to the pelvis, running the entire length of both sides of the spine, and focuses specifically on spinal stability. Watch the brief video below on multifidus back pain to see images and MRI comparisons and learn more.

The Multifidus Muscle as It Relates to Function

The multifidus muscle, like most muscles, can shrink (the medical term for this is atrophy) over time, especially when it is not exercised regularly. This can cause not only pain in the back but also functional issues with movement. Take a look at the two four-second videos below that show a spinal stability comparison between a normal and abnormal multifidus muscle when walking.

With a normally functioning multifidus muscle, as the video below shows, the vertebrae (the bones that make up the spine) are allowed to move, but the multifidus muscle is in constant control of the movements, and the movements are small with only micromotions allowed in precise directions.

With an abnormally functioning multifidus muscle, as the video below shows, the muscles have gone off-line, the vertebrae are uncontrolled, and the motion of the spine is very sloppy. These uncontrolled motions can cause pain and damage discs, joints, and nerves along the spinal column.

So when your multifidus has atrophied or weakened, is there any way to strengthen or treat it? Yes!

Strengthening and Treating the Multifidus Muscle

Multifidus muscle atrophy is very apparent on MRI, but despite this, radiologists rarely include this issue in their reports as most physicians don’t pay attention to it and there is no surgery for it. Regardless, back pain from multifidus atrophy is a real issue, and there have been over a hundred studies on multifidus pain and MRI findings alone that confirm this. So what can be done to help the multifidus?

First, exercise can strengthen the multifidus muscle. If you want to minimize your risk of developing multifidus atrophy to begin with, regular exercise before any damage is done is ideal; however, it’s never too late to start, even if your muscles have already weakened. As we mentioned in a post last week, multifidus muscle inflammation due to damage and other spinal issues, can be reduced with exercise.

You can also see your interventional orthopedic physician who can check your MRI and offer regenerative medicine options depending on the cause of the multifidus atrophy. If it is due to damaged facet joints (the joints at the back of the spine where the vertebrae meet), injections of platelet-rich plasma or stem cells may help. If the nerves that supply the multifidus muscle have become pinched, platelet lysate injections may be a good solution. Stretched and unstable ligaments can also be addressed with orthobiologics to tighten them up.

There are also some what not to dos when it comes to keeping your multifidus muscle healthy and properly functioning. Steer clear of spinal fusions as these can heavily damage the multifidus muscle.  Another common procedure is radiofrequency ablation (RFA) that, as its name implies, is intended to destroy (ablate) the nerves that supply the multifidus muscle. The idea here is that if there is no longer a nerve to feel the pain, there’s no longer a problem, but as you can understand, this only leads to further problems down the road.

The upshot? The multifidus muscle is critical for proper spinal function and support, and it’s easy to see on an MRI if the muscle has atrophied. Multifidus atrophy and pain, in our experience, can often benefit from exercise and/or orthobiologic treatments. Surgeries, such as fusions for damaged discs or vertebrae or RFA for damaged nerves only serve to further damage the multifidus muscle and should be avoided whenever possible.