The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle

Tracy L. Wallwork, Warren R. Stanton, Matt Freke, Julie A. Hides

Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F=29.1, p=0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F=6.6, p=0.02). This result was not present at other vertebral levels (p>0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.