Multifidus

The Multifidus is a deep muscle of the back.

Anatomical Attachments:

• Origin: Attaches to the posterior aspect of the iliac crest and sacrum, Sacroiliac ligament, mamillary process of the lumbar vertebrae, the transverse processes of the thoracic vertebrae, and the articular processes of C4, C5, C6 and C7 vertebrae.
• Insertion: Attaches to the spinous processes of the superior vertebrae.

Action: Extends, laterally flexes and rotates the vertebral column, in addition to extending and laterally rotating the pelvis.

Nerve Supply: Posterior rami of all spinal nerves.

Nerve Entrapment: Entraps the dorsal rami of the spinal nerve. Individuals complaining of this nerve entrapment may have symptoms of decreased or increased sensitivity or pain to the skin of the neck and back.

Vascular supply: Posterior intercostal and lumbar arteries; deep cervical branch of the costocervical trunk arteries.

• Primary: The pain refers around the spinous processes L1-L5, anteriorly to the abdomen; S1 which projects pain down to the coccyx; this referral radiates laterally from the level of T4 -T5 to the inferior angle of the scapula; trigger points located in the cervical region of the Multifidus referred pain from the Suboccipital region referring down the posterior neck to the approximate segmental level of T3 and laterally to the Rhomboids. There is also a lateral distribution at the base of the neck and upper back region.
• Author's note: Multifidus cervical trigger points may be in concert or confused with other trigger points in the cervical region. When considering points in the lower Multifidus, additionally consider trigger points of the Rotatores.
• Satellite or associated triggers: Latissimus dorsi, Quadratus lumborum, Serratus posterior superior/inferior, contralateral superficial muscles, Psoas.

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Trigger Point Signs and Symptoms: Pain in the back, buttock, abdomen, restriction of spinal motion and activity.

Trigger Point Activating and Perpetuating Factors: Prolonged sitting for hours, acceleration/deceleration injury, bending and twisting of back when muscles are fatigued or chilled, trauma.

Differential Diagnosis: Degenerative disc disease, (Segmental, Subluxation, Somatic dysfunction) Spinal Radiculopathy (Bulging Prolapsed, Herniated Disc), Sacral nerve compression (Sciatica), Scoliosis, Thoracolumbar osteoarthritis, Renal disease, Gallstones, Sprain/Strain Syndrome, Military neck (Absence of normal cervical spine lordosis), Cervical Spine Hyperlordosis, Thoracic Spine Hyperkyphosis, Lumbar Spine Hyperlordosis, Ankylosing spondylitis, Scoliosis, Intervertebral or Vertebral stenosis, Rib Subluxation (Slipping Rib Syndrome), Spinal cord cancer, Metastatic tumors in ovaries or prostate, Dissecting aortic aneurysm, Renal or Urethral stones, Pelvic inflammatory disease, Endometriosis, Hodgkin’s disease, Sacroiliitis, Cauda equina, Prostatic disorders, Coccygodynia, Subacute meningitis or Peripheral neuropathy, Polymyalgia rheumatica, Fibromyalgia, Polymyositis, Systemic lupus erythematosus, Osteoporosis, Osteoarthritis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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