Multifidus dysfunction refers to problems with the multifidus muscles, which are small but important muscles located along the spine. These muscles play a critical role in stabilizing the vertebrae during movement, helping to maintain posture, and supporting the spine during activities like bending, lifting, and twisting.

Function of the Multifidus Muscles

The multifidus muscles are deep, segmental muscles that run the length of the spine, attaching to each vertebra. Their primary function is to provide stability to the spinal column by preventing unwanted movement between individual vertebrae, especially during dynamic activities. They work in conjunction with other muscles of the core, like the transverse abdominis and the pelvic floor muscles, to keep the spine stable and well-aligned.

Causes of Multifidus Dysfunction

• Injury: Trauma to the spine, such as a fall or car accident, can damage the multifidus muscles.
• Prolonged inactivity: If you are inactive for an extended period, like during recovery from surgery or due to a sedentary lifestyle, the multifidus muscles can weaken or become inhibited.
• Poor posture: Chronic poor posture, especially when sitting or standing for long periods, can lead to dysfunction in these muscles.
• Spinal conditions: Conditions like lumbar spinal stenosis, herniated discs, or spondylolisthesis can cause the multifidus muscles to become less effective or overworked.
• Prior Spinal Surgery: Dissection of the muscles from the spine required for surgical procedures such as decompression or fusion can weaken the muscles and cause replacement of the muscle tissue with scar.

Symptoms of Multifidus Dysfunction

• Mechanical lower back pain: This is the most common symptom and can range from a dull ache to sharp, stabbing pain. This pain is often felt with movement such as bending, twisting or lifting.
• Weakness or instability: You might feel that your back is unstable, particularly when performing activities that involve bending, lifting, or twisting. Tasks such as getting out of bed in the morning, rising from a chair with prolonged sitting, or leaning over the sink may trigger the pain.
• Decreased range of motion: You may have difficulty moving your spine through its full range of motion due to stiffness or pain.
• Muscle spasms: The surrounding muscles may spasm as they try to compensate for the weakened or dysfunctional multifidus muscles.

Diagnosis

Multifidus dysfunction is typically diagnosed through a combination of thorough history, physical examination, and diagnostic imaging studies. Postural assessment, range of motion, and the strength of your core muscles is required to determine if multifidus dysfunction is present.

Treatment

• Physiotherapy: A key component of treatment, physiotherapy aims to strengthen the multifidus muscles and other core muscles to improve spinal stability. Exercises often include targeted movements that activate and build the endurance of the multifidus.
• Posture correction: Learning and practicing good posture can help reduce the strain on the multifidus muscles and prevent further dysfunction.
• Manual therapy: Techniques like massage, spinal manipulation, or myofascial release can help alleviate pain and improve muscle function.
• Core strengthening: Incorporating exercises that strengthen the entire core, including the multifidus, is crucial for long-term improvement and prevention of further issues.
• Pain management: In some cases, medications or injections may be used to manage pain and inflammation, allowing you to participate more fully in rehabilitation exercises.
• Surgery: When multifidus dysfunction is more severe, and does not respond to the above treatments, surgery may be considered. Multifidus stimulator devices have recently been used to treat this condition with promising results.

Prognosis

With appropriate treatment and rehabilitation, many people with multifidus dysfunction can experience significant improvement in their symptoms and return to normal activities. However, ongoing attention to posture and core strength is important to prevent recurrence.

If left untreated, multifidus dysfunction can lead to chronic back pain and contribute to other spinal issues, so early intervention is beneficial.