Multifidus Trigger Points

Introduction

The multifidus is a deep spinal stabilizer muscle responsible for postural control, spinal extension, and segmental stability. When trigger points develop in this muscle, they can cause lower back pain, SI joint discomfort, and spinal stiffness, often mimicking disc herniation, facet joint syndrome, or sciatica.

Name and Area

  • Name: Multifidus

  • Area: Located along the entire spine, spanning from the sacrum to the cervical vertebrae, with the most significant function in the lumbar region.

Indications

Multifidus trigger points may contribute to:

  • Lower Back Pain That Feels Deep and Stiff (Mistaken for Disc Herniation or SI Joint Dysfunction)

  • Pain That Extends to the Buttocks or Hips (Can Mimic Sciatica or Gluteal Pain)

  • Spinal Stiffness and Restricted Movement (Difficulty Bending or Twisting the Spine)

  • Pain That Worsens with Prolonged Sitting or Standing (Common in Office Workers and Athletes)

  • Weakness or Instability in the Lower Back (Affects Balance and Core Strength)

  • Pain That Worsens in the Morning or After Prolonged Inactivity

Pain from this muscle is often mistaken for lumbar disc issues, SI joint dysfunction, or facet joint syndrome.

Muscle Action

  • Extends the Spine: Helps maintain upright posture and spinal support.

  • Rotates and Stabilizes the Vertebrae: Controls small spinal adjustments for stability.

  • Prevents Excessive Spinal Motion: Protects the lumbar spine from injury and strain.

The multifidus is essential for core stability, spinal protection, and maintaining proper posture.

Signs and Symptoms

Individuals with multifidus trigger points often report:

  • Deep, Aching Pain in the Lower Back or Along the Spine

  • Pain That Extends to the SI Joint or Buttocks (Feels Like a Dull, Spreading Ache)

  • Stiffness in the Back That Limits Bending, Twisting, or Standing Upright

  • Pain That Worsens After Prolonged Sitting or Sleeping in Certain Positions

  • Weakness or Fatigue in the Lower Back, Leading to Postural Instability

  • Pain That Improves with Movement but Worsens After Long Periods of Rest

Pain worsens with poor posture, prolonged inactivity, or excessive spinal loading.

Perpetuating Factors

Common causes of multifidus trigger points include:

  • Prolonged Sitting or Poor Posture (Common in Desk Workers and Drivers)

  • Heavy Lifting Without Proper Core Engagement (E.g., Weightlifting, Manual Labor, Carrying Heavy Objects)

  • Sudden Twisting or Bending Movements (Common in Golf, Tennis, or Rotational Sports)

  • Weak Core or Gluteal Muscles (Can Lead to Overcompensation by the Multifidus)

  • Chronic Low Back Strain or Injury (History of Low Back Pain, Sciatica, or Facet Joint Dysfunction)

Trigger Point Referral Pattern

Trigger points in the multifidus refer pain to:

  • The lower back and sacrum (Can Mimic Lumbar Disc Herniation or SI Joint Dysfunction)

  • The buttocks and posterior pelvis (Mistaken for Sciatic Nerve Pain or Gluteal Dysfunction)

  • The upper back and mid-thoracic spine (Can Resemble Postural Strain or Spinal Stiffness)

Pain from this muscle is often confused with disc herniation, SI joint dysfunction, or facet joint irritation.

Differential Diagnosis

Multifidus trigger points may be mistaken for:

  • Lumbar Disc Herniation (Sharp, Radiating Pain Into the Buttocks or Legs, Often Worse with Sitting or Bending)

  • Facet Joint Syndrome (Deep, Aching Back Pain That Worsens with Twisting or Extension Movements)

  • SI Joint Dysfunction (Pain in the Lower Back and Buttocks, Worsens with Sitting or Walking)

  • Quadratus Lumborum Dysfunction (Lower Back and Hip Pain, Contributes to Postural Instability)

  • Erector Spinae Strain (Back Muscle Fatigue and Tightness, Worse with Prolonged Standing or Activity)

A thorough spinal, pelvic, and postural examination is necessary to rule out these conditions.

Associated Trigger Points

Multifidus trigger points often co-exist with:

  • Quadratus Lumborum (Lower Back and Pelvic Pain, Affects Postural Stability)

  • Gluteus Medius and Minimus (Hip and Lower Back Pain, Affects Pelvic Alignment and Gait)

  • Iliocostalis Lumborum (Mid-to-Lower Back Pain, Common in Postural Strain and Heavy Lifting Injuries)

  • Psoas Major (Deep Hip and Lower Back Pain, Can Contribute to Core Dysfunction and Pelvic Imbalances)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Multifidus Sacrum, lumbar vertebrae, thoracic vertebrae Spinous processes of vertebrae 2–4 levels above Dorsal rami of spinal nerves (C3–L5)

The multifidus is innervated by the dorsal rami of spinal nerves, which also control postural stability and segmental spinal movements.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the lower back and spine.

  • Resisted Back Extension Testing: Assess pain and weakness when extending the spine against resistance.

  • Gait and Posture Analysis: Look for hip instability, excessive lumbar curvature, or postural strain.

  • Pelvic and SI Joint Testing: Rule out joint dysfunction or hip imbalances.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the multifidus, reducing muscle tightness and improving spinal stability.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the spine and sacrum.

  • Massage Therapy: Helps improve circulation and reduce lower back muscle tension.

Stretching

  • Cat-Cow Stretch: Improves spinal flexibility and relieves tension in the lumbar region.

  • Child’s Pose Stretch: Helps relax the lower back and decompress the spine.

Strengthening Exercises

  • Bird-Dog Exercise: Strengthens the core and lumbar stabilizers for better spinal support.

  • Dead Bug Exercise: Improves core activation and reduces lower back strain.

  • Side Planks: Helps activate the obliques and lower back stabilizers.

Postural and Movement Adjustments

  • Avoid Prolonged Sitting Without Lumbar Support (Take Standing Breaks Every 30–60 Minutes)

  • Use Proper Ergonomics at Work (Maintain a Neutral Spine to Reduce Back Strain)

  • Engage Core Muscles During Lifting and Physical Activities (Prevents Excessive Lower Back Load)

Conclusion

The multifidus plays a crucial role in spinal stabilization, posture control, and back support, but trigger points in this muscle can cause significant lower back, pelvic, and SI joint pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic back dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.