Multifidus Atrophy and Fatty Infiltration
Multifidus atrophy can lead to ongoing back pain and spinal instability. Our personalised rehabilitation targets deep spinal muscles to restore strength, improve stability, and support lasting recovery.
Understanding the Multifidus
The multifidus is a deep spinal muscle running the length of the vertebral column. It provides precise segmental spinal stability — protecting individual vertebrae during all activities. Following any spinal injury, the multifidus can begin to atrophy (waste) within 24–48 hours due to pain inhibition, and does NOT automatically recover once pain resolves. Without targeted rehabilitation, this weakness persists and significantly increases the risk of chronic and recurrent back pain.
What is Fatty Infiltration?
With long-standing atrophy, healthy multifidus muscle fibres are progressively replaced by fat — visible as bright areas on MRI. This fatty infiltration represents a more permanent structural change associated with chronic low back pain, reduced physical function, and poor long-term outcomes. It is a key target for rehabilitation and, where relevant, regenerative medicine.
Why It Matters
- Multifidus atrophy is strongly associated with chronic and recurrent low back pain.
- The muscle does not automatically recover after back injury — targeted rehabilitation is required.
- Fatty infiltration is associated with worse recovery outcomes and greater ongoing disability.
- Early identification and specific exercise intervention can prevent progression from atrophy to fatty infiltration.
- Generic “core exercises” are not sufficient — specific multifidus retraining is needed.
Diagnosis
MRI identifies atrophy and fatty infiltration. Real-time ultrasound can directly visualise multifidus contraction and muscle size during assessment, and is also used as a biofeedback tool during rehabilitation.
Treatment
Specific, progressive multifidus rehabilitation — rather than general core training — is required. Begin as soon as possible after any back muscle injury.
- Real-time ultrasound biofeedback to teach correct multifidus activation
- Motor control and deep stabilisation exercises — progressed systematically from low-load isolation to functional integration
- McKenzie programs where disc pathology is also present
- Manual therapy to reduce pain and improve muscle recruitment
- Education on spinal mechanics and activity pacing
- Progressive return to full loading and activity
Rehabilitation & Exercise
Caution: Perform all exercises only as directed by your Healthweave clinician. Stop any exercise that increases your pain and inform your practitioner. Exercise programs are tailored to individual needs and must not be self-prescribed.
Multifidus rehabilitation is specific and progressive. It begins with isolated activation of the deep stabilisers and advances to functional integration with whole-body movements. This is fundamentally different from generic abdominal or core training.
- Isolated multifidus contraction — Identified and trained with real-time ultrasound biofeedback.
- Transversus abdominis and pelvic floor co-activation — Activates the deep stabilising muscles that support the spine.
- Four-point kneeling arm and leg raises (bird-dog) — Performed with deep stabiliser activation.
- Bridge exercises — Progressed with arm and leg challenges.
- Progressive integration — Into functional activities and lifting tasks.
- Sport-specific or occupation-specific loading — Introduced during the final stages of rehabilitation.
Specialist & Regenerative Medicine Options
- Targeted Spinal Injections — Facet joint or epidural corticosteroid injections reduce pain that inhibits multifidus activation, allowing rehabilitation to be more effective.
- Platelet Rich Plasma (PRP) Therapy — For facet or disc pathology contributing to multifidus inhibition, PRP may reduce local inflammation.
- Testosterone Replacement Therapy (TRT) — Where clinically confirmed low testosterone compounds muscle atrophy, suitability is assessed following a comprehensive pathology review. A prescription is required.
- Peptide Therapy — Where clinically appropriate and following individual assessment, certain prescribed peptides may support muscle tissue repair. A valid prescription is required.
- Prolotherapy — For associated spinal instability contributing to multifidus inhibition.
- Stem Cell Therapy — For significant structural muscle degeneration within TGA guidelines.
Our sports and exercise physicians at Prestidge work alongside your treating clinician to determine the most appropriate option for your condition, goals, and stage of recovery. All injectable and prescription treatments are subject to individual clinical assessment. Visit healthweave.com.au or prestidge.com.au to learn more.
Important: All specialist consultations, prescription treatments, and injectable procedures are subject to individual clinical assessment by a registered medical practitioner. Suitability, benefits, and risks will be discussed at your consultation. No outcomes are guaranteed. Prescription medicines are only available following appropriate medical review in accordance with TGA and AHPRA requirements. Exercise programs should be performed only as directed by your Healthweave clinician. Exercise images © CPDO / Educom Pty. Ltd. — used under licence.