The Lumbar Multifidus Muscle in Acute and Chronic Low Back Pain
Since 1994, there has been a body of research developing that is looking at the function and recovery of the lumbar multifidus in back pain.
Early findings were related to acute episodes and more recently, the multifidus in chronic back pain has been studied. A brief summary of these findings follows.
Multifidus size is reduced in Acute LBP.
In 1994 (Hides et al) a study was published which assessed the effect of low back pain on the size of the lumbar multifidus muscle using real-time ultrasound imaging. Marked asymmetry of multifidus size was seen in back pain patients with the smaller muscle being on the same side as symptoms, but this was confined to the vertebral level of the pain.
The authors surmised that the fact that reduced size, or wasting, was unilateral and isolated to one level suggested that the mechanism of wasting was not generalized disuse atrophy or spinal reflex inhibition. This atrophy is considered to be a decrease in normal low threshold recruitment.
Recovery is not Spontaneous.
However when the acute low back pain episode resolves, the wasting of the multifidus persists. Recovery of muscle size is more rapid and more complete in patients who received specific localized multifidus retraining prescribed by physiotherapists. (Hides et al 1996).
Re-training reduces recurrences of low back pain.
Specific retraining reduced recurrence of low back pain 3 years on. (Hides et al 2001).
Chronic Low Back Pain
Chronic LBP patients had significantly smaller multifidus size than pain-free subjects at the lowest two vertebral levels. The smaller multifidus was on the same side to the reported side of pain in all cases. The results of this study support previous findings that the pattern of multifidus muscle atrophy in chronic LBP patients is localized to the site of pain rather than generalized.
So there is gathering evidence that there is a lumbar multifidus deficiency in low back pain sufferers, both acute and chronic, which does not spontaneously resolve as the pain resolves. This increases the likelihood of recurring pain. Specific training of this deficiency reduces pain and improves function in the long term.
Physiotherapists are leaders in the field of specific Multifidus re-training.
- Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Spine. 1994 Jan 15;19(2):165-72.
- Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Hides JA, Richardson CA, Jull GA Spine. 1996 Dec 1;21(23):2763-9.
- Long-term effects of specific stabilizing exercises for first-episode low back pain. Hides JA, Jull GA, Richardson CA Spine. 2001 Jun 1;26(11):E243-8
- Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Hides J, Gilmore C, Stanton W, Bohlscheid E. Man Ther. 2006 Oct 26.
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