The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review

Freeman, Michael; Woodham, Mark A.; Woodham, Andrew W.

doi:10.1016/j.pmrj.2009.11.006

Cited by 255 publications

(202 citation statements)

References 26 publications

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“…Changes in MF are strongly evident in people with cLBP 23, and many patients with LBP exhibit atrophy of the MF within days of new back pain 24, 25. This atrophy can be seen easily and reliably 26 on MRI.…”

Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

138

129

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ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

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Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

138

129

View full text Add to dashboard Cite

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“…There is evidence that persisting LBP influences lumbar motor control [3], alters brain function and structure [4], changes lumbar tactile acuity [5], decreases spinal mobility [6] and compromises postural control [7]. However, LBP does not only lead to dysfunction, it can also result in structural changes of the lumbar multifidi muscle (LMM) such as fat infiltration as a consequence of atrophy [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain

et al. 2016

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Background: Lumbar multifidus muscles (LMM) are important for spinal motion and stability. Low back pain (LBP) is often associated with fat infiltration in LMM. An increasing fat infiltration of LMM may lead to lumbar dysfunction. The purpose of this study was to investigate whether there is a correlation between the severity of lumbar dysfunction and the severity of fat infiltration of LMM. Methods: In a cross-sectional study, 42 patients with acute or chronic LBP were recruited. Their MRI findings were visually rated and graded using three criteria for fat accumulation in LMM: Grade 0 (0-10%), Grade 1 (10-50%) and Grade 2 (>50%). Lumbar sagittal range of motion, dynamic upright and seated posture control, sagittal movement control, body awareness and self-assessed functional disability were measured to determine the patients' low back dysfunction. Results: The main result of this study was that increased severity of fat infiltration in the lumbar multifidus muscles correlated significantly with decreased range of motion of lumbar flexion (p = 0.032). No significant correlation was found between the severity of fat infiltration in LMM and impaired movement control, posture control, body awareness or self-assessed functional disability. Conclusion: This is the first study investigating the relationship between the severity of fat infiltration in LMM and the severity of lumbar dysfunction. The results of this study will contribute to the understanding of the mechanisms leading to fat infiltration of LMM and its relation to spinal function. Further studies should investigate whether specific treatment strategies are effective in reducing or preventing fat infiltration of LMM.

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“…The lumbar multifidus is the largest and strongest of the low back paravertebral muscles that cross the lumbosacral level, but its exact morphology and role are complex and not fully determined (71)(72)(73)(74)(75) . Nevertheless, rather than its being a prime mover, the specialized multifidus, and especially its deep fibers, are largely credited with postural stabilization of the lumbar spine (40,61,(72)(73)(74)(75)(76)(77)(78)(79) .…”

Section: The Lumbar Multifidus Is the Core Muscle Stabilizer In The Smentioning

confidence: 99%

“…If the lumbar multifidus and its stabilizing tonic role in the spine are not restored therapeutically with specific retraining, recovery to fully normal size may not occur naturally on remission of painful symptoms (78,(107)(108)(109)(110) . Deficient lumbar multifidus function predisposes to increased risk and recurrence of low back pain, more work days lost, and increased use of medical services to treat recurrences (108) .…”

Section: Clinical Demographic and Physical Activity Relations To Rementioning

confidence: 99%

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

Masi

Nair²,

Evans³

et al. 2010

IJTMB

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Methods: Biomechanical, clinical, and physiological studies were reviewed to interpret the passive stiffness properties of HRMT that help to stabilize various relaxed functions such as quiet balanced standing. Biomechanical analyses and experimental studies of the lumbar multifidus were reviewed to interpret its passive stiffness properties. The lumbar multifidus was illustrated as the major core stabilizing muscle of the spine, serving an important passive biomechanical role in the body.Results: Research into muscle physiology suggests that passive resting tension (CNS-independent) is generated in sarcomeres by the molecular elasticity of low-level cycling cross-bridges between the actomyosin filaments. In turn, tension is complexly transmitted to intimately enveloping fascial matrix fibrils and other molecular elements in connective tissue, which, collectively, constitute the myofascial unit. Postural myofascial tonus varies with age and sex. Also, individuals in the population are proposed to vary in a polymorphism of postural HRMT. A few people are expected to have outlier degrees of innate postural hypotonicity or hypertonicity. Such biomechanical variations likely predispose to greater risk of related musculoskeletal disorders, a situation that deserves greater attention in clinical practice and research. Axial myofascial hypertonicity was hypothesized to predispose to ankylosing spondylitis. This often-progressive deforming condition of vertebrae and sacroiliac joints is characterized by stiffness features and particular localization of bony lesions at entheseal sites. Such unique features imply concentrations and transmissions of excessive force, leading to tissue micro-injury and maladaptive repair reactions.Conclusions: The HRMT model is now expanded and translated for clinical relevance to therapists. Its passive role in helping to maintain balanced postures is supported by biomechanical principles of myofascial elasticity, tension, stress, stiffness, and tensegrity. Further research is needed to determine the molecular basis of HRMT in sarcomeres, the transmission of tension by the enveloping fascial elements, and the means by which the myofascia helps to maintain efficient passive postural balance in the body. Significant deficiencies or excesses of postural HRMT may predispose to symptomatic or pathologic musculoskeletal disorders whose mechanisms are currently unexplained.

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The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review

Cited by 255 publications

References 26 publications

Muscle Control and Non-specific Chronic Low Back Pain

Muscle Control and Non-specific Chronic Low Back Pain

Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

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