A small muscle in your back and neck—one that even your doctor may never have heard of—may determine how much back pain you’ll experience in your lifetime. It’s the same muscle that sometime causes a lower-back popping sound when it’s out of alignment.

The multifidus provides the main stabilization for the spine bones when the body is moving. When this muscle atrophies or becomes weak and small in patients with back and neck conditions, the patients report an increase in pain and disability. Multifidus muscle damage has been shown to be a better predictor than bulging or degenerated discs as an indicator which patients are more likely to recover from back conditions. Radiologists, however, all but ignore the multifidus to focus on the status of the disc. To date there are 192 research articles listed in the United State National Library of Medicine on lumbar multififus and MRI.

The most recent article was reported in Spine Journal on March 28, 2015. This study examined the MRIs of 72 randomly chosen adults. Radiologists paid attention to the status of the muscles of the lower back, including the erector spinae (the main muscles that extend the low back) and the multifidus. As in many other studies, the radiologists noted that patients whose MRIs showed fatty infiltration of the multifidus had more disability and more lower back pain. The more the multifidus and erector muscles were trashed, the more degenerative changes were visible. The multifidus is the major stabilizer of the back bones, so when it’s damaged the bones, joints, and discs crash into one another and receive more damage from wear and tear—which is what causes the popping sound.

Given the amount of research available on multifidus and back and neck pain, every radiologist and physician who sees spine patients in the United States should be paying attention to this little muscle. Medicine needs to concentrate on finding new and innovative ways to treat mutifidus and to protect people’s backs instead of performing unnecessary disc surgery.


“Do You Have a Lower Back Popping Sound When You Move?” first appeared as a post on the Regenexx blog.