The new diagnosis code specifically for Multifidus dysfunction in the lower back went into effect in October, providing clinicians with a clearer pathway for its diagnosis. It came after a submission to the CDC by a host of medical organisations, including Brigham & Women’s Hospital and Spine Center and Harvard Medical School, with support from the American Society of Pain & Neuroscience and others.

The submission also stated that dysfunction in the Multifidus muscles can be clinically diagnosed and treated.

‘Dysfunction of the Multifidus muscles in the lumbar region is a recognised cause of chronic low back pain, which can be identified and can benefit from certain specific treatments.’

The Multifidus is made up of many small, segmental spinal muscles attached directly to the vertebral bones from the pelvis to the last vertebra in the neck.

The submission stated that the lumbar Multifidus muscles are important stabilisers of the spine, and that impaired function or weakness in these muscles is strongly associated with chronic low back pain (CLBP).

‘Pain and disability are the consequence of inadequate motor control resulting from Multifidus muscle dysfunction.

Conservative management such as motor control exercise for this condition can be beneficial when applied either early in the disease progression or in patients with mild to moderate symptoms.’

Spinal movements in every day functions such as bending and twisting are typically described as the interplay between intervertebral discs, muscles and the nervous system.

Multifidus dysfunction can result in atrophy and replacement of muscle fibre with fat, causing spinal instability and movement outside the normal range, pain and loss of mobility.

The submission stated that Multifidus muscle dysfunction can be diagnosed clinically by the assessment of muscle function, and observation of dysfunctional activation and recruitment through strength and mobility testing.

Regarding treatment, the submission stated that options include restorative activation of the Multifidus muscle. The aim is to restore co-ordinated and efficient use of the muscle groups that control and support the spine.

Historically, the issue with this approach is that the deep spinal muscles are very difficult to isolate and exercise. In freestanding strength training the gluteal muscles tend to ‘take over’ the movement, bypassing Multifidus involvement, while floor exercises and gym machines cannot effectively isolate and progressively strengthen the deep spinal muscles.

Informed by these facts, over the last 30 years getback has developed exercise therapy programs specifically for the Multifidus that address movement and stabilisation requirements for the spine.

getback™ utilises DAVID devices which enable safe and measurable exercise specifically for the Multifidus in all movement planes, flexion and extension, lateral flexion and rotation.

Exercise with specific and targeted movement of the Multifidus has been shown to decrease spinal pain when the initial rehabilitation phase uses slow, light resistance to re-establish neuromuscular co-ordination.

Once the Multifidus are producing smooth and controlled contractions, the range of pain free movement and resistance is increased to engage more of the superficial back muscles.