Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain
Abstract
Objective To compare the lumbar multifidi muscle volume devoid of fat local to the site of pain in persons with and without chronic unilateral lower lumbar pain.Design Prospective cross-sectional design.Setting University biokinesiology laboratory.Participants Active individuals (n=14) with chronic unilateral lower lumbar pain (>1 y) were matched for age, height, weight, and activity level with healthy individuals (n=14). Individuals with back pain had minimal disability (Oswestry Disability Index [mean ± SD], 14.9%±6.3%) at the time of testing.Interventions Not applicable.Main outcome measures Multifidus and erector spinae muscle volumes at the L5-S1 levels, multifidus muscle volumes at the L4 and S2-3 levels.Results Average multifidus volume was diminished by 18.1% between groups (P=.026) only at the L5-S1 levels. There was no difference between painful and pain-free sides. There were no volume differences between groups above L5, below S1, or in erector spinae at the L5-S1 levels.Conclusions The results of this study indicate that despite a low level of disability and an activity level similar to that of matched control subjects, considerable localized, bilateral multifidus atrophy is present. Such impaired size of the multifidus will likely reduce its capacity to control intersegmental motion, thus increasing the susceptibility to further injury. Unlike acute unilateral low back pain (LBP), muscle size is reduced bilaterally in persons with chronic unilateral LBP.
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Chronic low back pain can become a complex condition in its own right, with persistent central nervous system changes and structural changes in the back.
“There is growing evidence that cLBP, like other chronic pain conditions, can progress beyond a symptomatic state to a complex condition unto itself,109 involving persistent anatomical and functional changes in the central nervous system9, 93, 100 in addition to structural changes in the back (e.g., degenerative spinal changes, atrophy or asymmetry of para-spinal muscles).10, 11, 14”
From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [14]
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- Authors
- Beneck, G. J., & Kulig, K.
- Affiliations
- California State University System (US)
- University of Southern California (US)
- Corresponding author
- Beneck, George J.
- ORCID
- Kulig, Kornelia
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 93
- Issue
- 2
- Pages
- 300-306
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W1977914246
- Cited by
- 159
- References
- 62
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 13 · 2022: 20 · 2021: 12 · 2020: 10 · 2019: 18 · 2018: 11 · 2017: 10 · 2016: 10 · 2015: 12 · 2014: 14 · 2013: 5 · 2012: 2
- FWCI
- 7.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Keywords
- chronic low back pain, multifidus, muscle atrophy, erector spinae, muscle volume, lumbar spine, Oswestry Disability Index, physically active individuals
- MeSH terms
- Adult, Analysis of Variance, Chronic Disease, Cross-Sectional Studies, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Muscular Atrophy, Prospective Studies, Matched-Pair Analysis, Low Back Pain, Muscle, Skeletal
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