A Major Role in Back Pain: The Multifidus

By M.L. Tallent, DC

Digital Exclusive

A Major Role in Back Pain: The Multifidus

By M.L. Tallent, DC

Digital Exclusive

Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits. While there can be many modes of injury and causes of back pain, the anatomical structures primarily affected are typically muscles, discs or facet joints.

One extremely important back muscle is the multifidus. The multifidus muscle travels the length of the spine and attaches on both sides of each spinous process. It contains many fibrous tendon clusters which provide support and stability to the spine.

The function of the multifidus is to extend the vertebral column laterally, flex and contralaterally rotate the vertebral column. Tension or trigger points can typically cause biomechanical stress on the articulating facet joints, which can result in facet syndrome, leading to hypertrophic changes in the joint.

Epidemiology of the pain can be from various causes such as injury (e.g., auto accident, back strain), sports, postural dysfunction from prolonged or recurrent positions, scoliosis, or hyperlordosis or hypokyphosis.

Multifidus Strength and Low Back Pain: Research

An MRI case series published in 2014 in the Journal of Radiological Case Reports documented atrophy of the multifidus in chronic low back pain patients.1 That same study also noted "a decrease in atrophy with fatty replacement in the two patients who performed multifidus-focused low back exercises (15 percent and 39 percent on the left and 7 percent and 32 percent on the right respectively), and an increase in the patient who underwent spinal manipulation alone (41 percent and 53 percent)."

A study published in the European Spine Journal (2002) compared healthy subjects with LBP patients by measuring multifidus electromyographic activity during exercise. Participants with low back pain showed a decreased amount of muscle activity compared to participants with no pain.2

How to Stabilize And Strengthen the Multifidus

Multifidus conditions best respond to exercise to release a contracted muscle or strengthen a weakened state. In strengthening the multifidus muscle, you must first learn to recruit the muscle. While standing, place both hands on the waist and palpate the multifidus. Take a breath in and slightly attempt to extend; you will feel engagement take place.

Lying prone across a pillow, draw your stomach in and then press one hip into the pillow by gently rocking. Hold for 5 seconds; alternate sides. By palpating the multifidus while doing this, you will begin to feel the muscle engage. Once recognition of the multifidus is achieved, the patient can progress into more advanced exercises to stabilize and strengthen the multifidus.

Cat-Camel Pose: On all fours, arch the back slowly like an angry cat, then relax and let the low back sway downward, holding 5 seconds in each position. Do 10 repetitions.

Quadruped: On all fours, alternate raising one hand off the table and the opposite knee, only to the height that a book can slide under.

Bird Dog: This advanced exercise is similar to the quadruped; the patient extends one arm and the opposing leg in a pointing fashion. Once again, hold for a five count on each side.

Standing Forward Bend: The patient palpates the multifidus and slowly leans into flexion, keeping the upper torso erect until they feel the multifidus activate. Hold for 5 seconds, then extend back to a relaxed position.

While back pain may occur with various injuries, mobility, stability and exercise of the multifidus can reduce episodes of pain and expedite recovery for patients experiencing lower back problems.


  1. Woodham M, et al. Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series. J Radiol Case Reports, 2014 May;8(5):27-34.
  2. Danneels L, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Eur Spine J, 2002 Feb;11(1):13-19.