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The Lumbar Multifidus Muscle Complex


The multifidus is the key stabilising muscle group to the spine and the most commonly dysfunctional. Each bundle and spindle of this complex muscle produces extension and rotation and stabilises the vertebra in movements like bending, lifting and twisting.

Unfortunately, it is almost universally involved in anyone suffering chronic spinal pain. A paper presented recently at an international spine conference by Dr Zotti and colleagues documented 98% of all patients with proven nerve irritation suffer from wasting of this muscle on MRI: 

"Electromyogram diagnosed chronic lumbar radiculopathy is highly associated with L4-S1 regional multifidus atrophy on magnetic resonance imaging"

Patients with dysfunctional multifidi typically are stiffer and move abnormally with pain and weakness in different positions. Beyond an acute injury, the brain can stop communicating effectively and accurately with this key group of muscles. Unfortunately, it is very difficult to isolate, train and restore once established. Traditional physiotherapy approaches can be notoriously hit and miss for helping to rehabilitate it. Minimising injury to it through muscle sparing surgeries and interventions, where possible, is optimal. The problem is not just size and wasting but its function and activation via brain/spinal pathways. Over time the brain and spinal cord ‘forget’ how to turn this muscle on like it is supposed to be.

Dr Zotti has spent the last decade assisting in our understanding of this muscle via research with colleagues (4 completed papers and 2 in progress) and has presented or published upon key internationally recognised classical papers relating to the dysfunction of this muscle. Research he has authored has shown effective ways to train it [see video at bottom left], benefits in training the muscle prior to surgery for better outcomes and the potentially negative effects of some back pain procedures on muscle appearance [See biography]

He has also been a strong advocate of research to find the best method to isolate and train this muscle and has presented this research on the incorporation of isolated lumbar extension training to meetings [videos below]. Some of these suggested exercises on the BACK/NECK website are the synthesis of multiple scientific papers for the convenience of patients and allied health treating them (click link to the right).

In keeping with the philosophy emphasizing the importance of this muscle to good spinal function and health Dr Zotti has kept up to date with the latest evidence based therapies targeting this muscle. Traditional spine surgery has been viewed as ‘destructive’ or ‘reconstructive’ where structures are numbed, parts of anatomy are removed and potentially rods, cages, screws and disc replacement are placed to replace function. Dr Zotti is pleased to offer peripheral multifidus stimulation treatment (Reactiv8) to suitable candidates who have failed Dr Zotti’s suggested researched rehabilitation techniques. This stimulator, by contrast to other treatments for back pain (like fusion, disc replacement and nerve denervation), is restorative – in other words, it is aiming to augment your muscle and body to move in the way it is supposed to do in a minimally invasive and non-destructive fashion and enjoys high level evidence from Randomized Controlled Trials attesting to its efficacy. The ideal candidate for this would have predominantly mechanical and positional low back pain (with features of fatigue / transient improvement with muscle engagement) with minor or no leg pain and no overt instability or severe nerve compression. In appropriate candidates, success rates of 75-80% depending on the metric (pain, function, opioid use, return to work) have been demonstrated in studies of this safe and minimally disruptive therapy and are shown to last year to year -  comparatively, most high level evidence studies (Gr I-II) of more invasive and riskier procedures such as lumbar fusion or disc replacement for low back pain report success rates between 60-75%. The latter therapies typically take longer to get over and can permanently alter the spine and its movement - setting up potential future adjacent motion segment problems, which is not the case for Reactiv8, where 'no bridges are burnt'. Please discuss with Dr Zotti if you have read this page and wish to find out if you may be a suitable candidate.

forces multif.jpg

Video courtesy of getback Australia -

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