The Chief of the Physiatry Department at Kaiser recently referred a patient to me for a fairly common condition: multifidi atrophy. This is a condition in which healthy muscle tissue of the back is replaced with fat and connective tissue. This is typically a result of trauma, surgery, or inactivity. The multifidi muscles are small muscles in the back that help with structural stability and can often be the culprit in prolonged cases of pain with herniated discs or facet arthropathy. Multifidi atrophy results in the inability of the muscles to support the joints and discs, thus leading to instability of the spine.
Lumbar instability is a major contributor to chronic low back pain,1 especially in cases when there are no obvious lesions, but when we instead see “degeneration” or “back arthritis”. These muscles are known to be a pathological component of persistent pain after lumbar surgery as well.2 Interestingly, the nerve that is targeted for nerve ablation of the facet joints (RFA) is the same nerve that innervates the multifidi muscles, which is why I rarely recommend nerve ablation to my patients. Recently, they have developed new treatments to help address this. One is called the Activ8 which is an implantable stimulator that helps these muscles to fire appropriately.
Thankfully, PRP has been shown to help regenerate the multifidus tissue.3 When we heal and regenerate the multifidi we create stability of the spine, resulting in decreased stress on the facet joints and the discs, which in turn results in decreased pain and decreased chronic inflammation. Of course, the regeneration of the tissues involves both PRP as well as activation of the muscles through appropriate PT and exercise. This simple fix can make a world of difference for many patients.
Dr. Kristian Flores, MD, ND, began his medical journey as a Naturopathic Doctor. He then earned his Medical Degree, completing an Internal Medicine internship as well as a residency in Physical Medicine and Rehabilitation (also known as Physiatry). As a Board-Certified Physiatrist, Dr. Flores specializes in the prevention, diagnosis, and rehabilitation of people disabled by disease, disorder, or injury. He works extensively with patients suffering from acute and chronic pain conditions such as spine pain and sports injuries. His practice also includes helping patients with disabling conditions such as brain injury, long-covid, and hypermobility disorders.
Sources
1. Eman Masry Abdelaty, Salwa Shendy, Osama Lotfy, Karima Abdelaty Hassan First published: 20 August 2023 https://doi.org/10.1002/pri.2047. The difference in multifidus muscle morphology and motor control in non-specific low back pain with clinical lumbar instability and healthy subjects: A case-control study.
2. Pan D, Liu K, Huang M, Sun T, Zhang Z. Multifidus lesions: A possible pathological component in patients with low back pain after posterior lumbar surgery. Medicine 2024;103:9(e37239).
3. V. H. Dzhyvak, I. M. Klishch, O. I. Khlibovska, S. S. Levenets. Potentials and impact of platelet-rich plasma (PRP) on the regenerative properties of muscle tissue. Biopolymers and Cell. 2024. Vol. 40. N 1. P 3–13 http://dx.doi.org/10.7124/bc.000AA9
