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Treating Trigger Points in Multifidi - Dr. Jonathan Kuttner M.D.


These trigger points can be troublesome to locate and treat, but there are some simple tips that can help make it easier

Multifidi are deep muscles that act as shock absorbers and tension buffers between the spine and the prime movers of the trunk. Their fibers go from the top of the neck to the posterior sacrum.

When these muscles shorten, stiffen, and tighten, the shock-absorbent quality is lessened or lost and the neuromuscular integrity of the spine is affected.

The multifidi and rotators both work to stabilize the structures of the spine and fine-tune the spatial relationship between the vertebrae.


Multifidi rotate, extend, and flex the spine at all levels. Extend and laterally rotate the pelvis, and help to stabilize the vertebral column. These are core muscles.


Multifidi Trigger Points  

Multifidi Trigger Points



Multifidi Trigger Points

Multifidi Trigger Points - Referred Pain Patterns



Multifidi Trigger Points - Referred Pain Patterns

Multifidi Trigger Points - Referred Pain Patterns



Multifidi Trigger Points - Referred Pain Patterns

Multifidi Trigger Points - Referred Pain Patterns



Multifidi Trigger Points - Referred Pain Patterns

Multifidi Trigger Points - Referred Pain Patterns


Trigger Points

Cervical multifidi refer more superficial pain to the occiput and vertebral neck, and sweep pain to the rhomboids.

The multifidi trigger points at the thoracic (chest) level cause back and shoulder blade pain patterns. Low back multifidi trigger points at the L1–L5 level can refer pain to the front of the body, at the level of the abdomen; they may also perpetuate IBS, no matter what initiates it.

There are reports that this front referral may occur at any level, but it has not been documented in the chest and neck.

Multifidi trigger points can cause an amazingly relentless, deep low backache that is resistant to treatment.

The pain may feel as if it originates in the bone. There may be a distinct palpable or even visible bulge of muscles along the affected area of the spine.

When the multifidi of the sacral spine are involved, the base of the spine may appear swollen.

Low back pregnancy pain can be caused by multifidi trigger points, as the unbalanced body tries to compensate for the growing child within.

At the S1 level, multifidi trigger points refer pain to the tailbone. Lower paraspinal muscles can refer pain to the upper buttock and kidney area, or produce pain in the groin and scrotum. Symptoms may include retraction of the testicle.

Multifidi trigger points can cause marked restriction of spinal ROM, as well as nerve entrapment symptoms, including supersensitivity, numbness, and lessened sensitivity of the skin in the area of the trigger point.

Other symptoms may occur depending on which nerves are entrapped. If trigger points are allowed to persist, the multifidi involved may atrophy; studies have shown this in chronic low back pain patients (Wallwork et al. 2009).

We suspect that multifidi trigger points can cause sufficient tightness to pull vertebrae slightly out of alignment, leading to degenerative disc disease.

This poses the question: could myofascial TrPs be a common cause of OA? When TrPs are routinely diagnosed and treated promptly, one of the scourges of aging may be prevented or at least minimized.

Notable Perpetuating Factors

A sudden bend and twist motion may initiate the pain, often immediately. Whiplash, diving accidents and other sports injuries, and falling on the head or other shock to the spine can initiate multifidi trigger points, as can pushing muscles to work when they are fatigued and/ or chilled.

Then all it might take is a sudden bend and twist motion. “I just moved my back the wrong way and it went out” is a frequent comment.

It may take a while to return. Low back pain in pregnancy may initiate multifidi trigger points. A long second-stage labor can either initiate trigger points or aggravate existing ones.



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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 




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