Nothing puts more wind in your proverbial blogging “sails” than running into someone who has read (and enjoyed?) your content.  A real person, in real life, telling you they really read and really enjoyed your blog…this really happened!  You know who you are, and if lightning strikes twice and you’re reading this again – sincere “thanks”.  It means a lot and you have inspired this piece, and that’s not even sarcastic.  Yet.

And with all of the incredibly valuable, content-rich, thought-provoking, and passion-inspiring pieces I devise – the given feedback was centered on the enjoyment of my Sarcastic Anatomy series which is typically a half-disgruntled, half-educational, fully-sarcastic appraisal of our body’s lesser known muscular infrastructure. So not unlike the chanting requests for a 2 AM karaoke encore of Kelly Clarkson’s “Since You’ve Been Gone”, I find it time to oblige my fan(s).  So without further ado, I present the latest Sarcastic Anatomy.

Sarcastic Anatomy: Multifidis. Mulfitidus. Maltifidus. Whatever.

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You know how you can sometimes gauge how pretentious and annoying someone is, based only on their name? Like Atticus or Blanche. Well, now that I’ve offended at least 2 readers…that’s exactly how I feel about multifidus. {eye roll}

Etymology – Latin meaning “much, many, or multitudes”.  Multifidus Lumborum specifically meaning “split in to many” and the Latin word lumbus literally meaning “loin”…which is where things start getting weird.

And of course these guys claimed such a biblical name, they take credit for e’rything.

“We stabilize the spine”

“We rotate the neck”

“We extend and keep you upright”

OK, OK…chill dude, you’re tiny and have a lot of help. {even more dramatic eye roll}


Why the weird name? – Appreciating that as a group multifidi extend from the sacrum to our cervical spine, but are comprised of segment-specific attachments like branches of a Christmas tree – the “multitudes” name make sense. Certainly not the strangest muscle name either…I’m looking at you gastrocnemius – “stomach of the leg”…really?  If you haven’t noticed yet, Latin really just makes our muscles sound more like Hogwarts unicorns from Middle Earth versus scientific anatomical syntax. Just my 2 cents, but I’d employ a more powerful vernacular – Gluteus Maximus?  You must mean BootyExtensor3000.


Function – Segmental spine stability and accessory motion of our vertebral segments – as well as that weird tingle when you drive over a small dip really fast in your car.


Sounds made up, how do I know they are real? – They can be visualized on MRI/RUSI, otherwise cadaveric dissection, and because Netter said so.  Essentially grainy digital images, dead people, and taking other people’s word for it – sold yet?








Whether you have low back or neck pain due to a traumatic injury or more gradual onset; multifidus is likely directly or indirectly affected. Injuries ranging from whiplash dysfunction, acute disc herniation, “pinched nerves”, mechanical low back pain and thoracic (upper back) pain all involve multifidus in some form.  And it’s fairly safe to say multifidus is deconditioned/weak, not activating properly, and may have even incurred fatty infiltrate.  Suffice it to say, marbling is delicious on your grill cut, but a troubling concern when mentioned during your radiologist visit.  Yes, multifidus obesity is REAL – and that is an epidemic no one is talking about!  I don’t care if I’ve just offended 50% of the multifidi out there, we need change.



Want one of the most frustrating and confusing tasks of your life? Try cueing a patient for an isolated multifidus contraction. "Swell into my fingers without arching your back." "Reach your invisible tail up towards the back of your head." "Tense as if holding flatulence in church and elongate the spine." Or maybe we go straight for “lifting the elevator” that lives in your pelvic floor – which is a guaranteed way to make a grown man blush, giggle, and almost pee all at the same time. It goes downhill quickly and will leave many patients puzzled, if not completely offended.


The joke is on us though, because all you really need to do to activate multifdus is flap your arms around in front of you, walk, or look somewhere with your eyes. Seriously, ol’ multitudes himself is one of the first muscles to fire in preparation for almost any movement, including eye movements. It’s really not supposed to be a contest, but these divas recruit with a “me first” mentality and have to be first in line when it comes to EMG-latency.

The training is well-intended though – we know multifidus is paramount in the segmental stabilization and accessory motion of our spine and protects us from disc injury, facet degradation, nerve insult and evil spirits in general. Scholars maintain Chuck Norris’ multifidus had the tensile strength of steel, yet allowed him to rotate his spine 360 degrees – but this is no surprise considering his training regime.


But for the rest of us, multifidus facilitation is enigmatic  – and other modalities are needed to appreciate and facilitate a real change.  Specifically, dry needling (with or without electrical stimulation) has given clinicians an ability to impart a direct stimulus to these nebulous creatures and affords patients both therapeutic histological changes as well as improved awareness for corrective exercise implementation.   In some cases multifidus can even be the pain-generating culprit behind proposed facet joint pain or degenerative joint disease of the spine.   Here’s a clip of dry needling for lumbar multifidus (soundtrack of soothing background music available on iTunes).



So if you are struggling with clinical outcomes from dry needling, or otherwise. Even for very specific, peripheral diagnoses consider including multifidus in the treatment plan.  Then reinforce any changes from dry needling with movement!

…or you can hold your flatulence.

If you’re experiencing low back, mid back or neck pain – it may be worth seeing a Physical Therapist for a full assessment.  And if previous therapy wasn’t entirely successful, dry needling may be an option to empower the stampede of mythical stabilizing unicorns in your spine that is…multifidus.

Sincerely sarcastic,

Paul Killoren PT, DPT