The Multifidus Muscle, So Small Yet So Very Important

Marbling may be good for a juicy steak or hamburger but not so much for your back muscles!!!

So, if you have been keeping up with my blog posts you know I try my best to be a bit tongue-and-cheek and at least attempt to inject some humor in what can be considered some dry topics of conversation. So, this post will be no different in that regard.

We will be discussing the importance of having fully functioning spinal stability musculature and the consequences of dysfunction and also how to help fix this dysfunction.

We humans are vertebrates, if you remember back to elementary school biology class that means that we have a skeleton or more specifically a backbone / spinal column supporting our bodies on the inside. This skeleton is inherently unstable without the proper structures in place to provide not only static but dynamic stability as we go about our busy lives. Unfortunately, these supporting structures do not get much attention from us or the press… and when they do not function properly we can have all sorts of downstream negative effects as a result. Pain, injury, soft tissue damage, arthritis, weak posture, and so on can be a result of our stabilizing muscles not functioning properly or can be the cause of the dysfunction in the first place.

The group of muscles we will be talking about today are the multifidus muscles or the multifidi. They reside deep to our spine at the posterior aspect or on the back side of the vertebrae. These muscles subconsciously stabilize our spine helping to aid in normal motion without pain or tissue damage. Picture the vertebral column being a stack of marbles. This stack will not be vertically oriented for very long without a stabilizing force acting upon it and as such will crumble and fall over rather quickly without the proper structures in place for stability purposes. The multifidi act to stabilize the spinal column by not allowing it to fall into individual pieces as the marbles would. So, their importance and value to our well-being cannot be understated.

Now when we have an injury event take place, are sedentary, undergo a spine surgical operation etc… we can have the multifidi become inactivated. If these muscles remain “off-line” they can atrophy and undergo a process called fatty infiltration or fatty replacement. This is where the muscle is literally replaced by fatty tissue just like the marbling you see in a nice juicy steak – think ribeye. Once this fatty infiltration process has commenced it can be very difficult to undo as there is limited evidence if this can be undone. As a result of our main spinal stabilizing structure which was once strong muscle tissue now being weak fatty tissue we can experience all types of pain syndromes. Chronic low back pain sufferers will see this fatty replacement on MRI scans. Unfortunately, people involved in injury events: motor vehicle accidents, truck accidents, slip and fall events, sports injuries, work injuries and so forth can see this fatty infiltration on imaging studies if the proper rehabilitation has not taken place in a timely manner.

Here are a few MRI images outlining the fatty infiltration process

Grade 0 (None)     Grade 1 (Slight)    Grade 2 (Severe)

So, the current thought on how to prevent / treat this fatty infiltration of our own “steaks” besides avoiding any and all potential injury activities is to seek the proper care of a medical provider who is specifically trained in the treatment of spinal injuries. Do not delay treatment as the “clock” is ticking from the time of injury until the fatty infiltration takes place. The generally accepted treatment protocol for spinal injuries includes an anti-inflammatory / healing phase followed closely by an active stability / strengthening phase. This will ensure the proper healing of the injured tissues and then the subsequent rehabilitation / reactivation of the muscles. Both of which will help to minimize and / or eliminate any fatty infiltration of the spinal stabilizing musculature. These treatment protocols tend to be quick and rather low-tech compared to a lot of the gym activities we may be used to.

We at North Florida Spine and Injury Center are trained in how to detect these bio-mechanical faults and aid in the healing / rehabilitation of your injury. You may be a chronic pain sufferer who has been to numerous physicians and been given oral medications as the sole “treatment”. You may have had a failed surgical operation and just feel like you have nowhere else to turn. If you have been recently involved in an injury event, please do not delay treatment. We are here for you. If you have any further questions on this subject or anything related please do not hesitate to give us a call as we would be privileged in being a part of the healing process.

Dr. Adam Zeccardi DC, FIAMA