Chronic back pain often leaves patients asking a frustrating question: Why can’t anyone tell me what’s really wrong?”
At Vertrae® in Dayton, Ohio, we hear this every day, especially from patients who’ve tried physical therapy, injections, or medications, but still feel weak, unstable, or stuck.
That’s why we take a different approach:
We don’t just treat the symptoms.
We look deeper at how your spine is functioning.
For many patients, the underlying issue is multifidus dysfunction, and diagnosing it requires more than a glance at an MRI.
Let’s Start with the Basics: What’s the Multifidus?
The multifidus is a small but powerful muscle that runs along your spine. It doesn’t move your body; it stabilizes it.
- It activates just before you move, keeping your vertebrae aligned
- It supports your posture during lifting, twisting, or walking
- It helps prevent strain on joints, discs, and nerves
When this muscle stops working properly, often due to injury, nerve issues, or disuse, the spine loses its core support.
The result? Chronic pain that doesn’t respond to standard care.
So How Do You Diagnose Dysfunction in a Muscle You Can’t “See”?
Multifidus dysfunction doesn’t show up on routine X-rays. It often doesn’t even show up on a standard physical exam.
At Vertrae®, we use two powerful diagnostic tools:
- Physical testing, and
- Advanced MRI review
These methods, backed by clinical research and real-world results, help us uncover the dysfunction, so we can treat the real issue, not just the symptoms.
Step 1: Physical Testing: What We Do and Why It Matters
When you come to Vertrae® for an evaluation, we begin with hands-on, non-invasive testing designed to help us understand how your spine functions in real life, not just on paper.
These tests don’t involve machines, needles, or pain. They involve simple movements and muscle engagement to check for multifidus activation and segmental stability:
- Multifidus Lift Test (MLT)- Multifidus Lift Test on Vimeo
This test helps us determine whether your multifidus is firing correctly at specific levels of the spine, especially L4–L5.
What to Expect:
- You’ll lie on your stomach while your provider gently palpates your lower back
- You’ll be asked to lift or move one leg slightly while keeping your trunk stable
- We’ll observe and feel whether your deep spinal muscles activate correctly during the movement
If the multifidus isn’t firing, your spine may lack the stability it needs, which helps explain recurring pain, even after treatment.
- Prone Instability Test- Prone Instability Test on Vimeo
This test helps us check whether your spine feels more stable when your muscles are actively engaged, a classic indicator of functional instability.
What to Expect:
- You’ll lie on your stomach with your torso resting on the table and your legs off the edge
- We’ll apply gentle pressure to your lower back while your muscles are relaxed
- Then, you’ll lift your legs slightly, activating your core, and we’ll apply pressure again
- We compare the two results to see if muscle engagement reduces the pain or instability
If the pain decreases when your muscles are active, it suggests that muscle dysfunction, not bone or disc issues, may be the true source of your pain.
Step 2: MRI: More Than Just a Structural Scan
We don’t use MRI just to look for herniated discs or arthritis. We look at your muscle quality, too.
What We Look For on MRI:
- Fatty infiltration of the multifidus
- Muscle atrophy
- Asymmetry between sides
- Loss of cross-sectional area
These changes are strongly linked to chronic low back pain and often go unmentioned in standard radiology reports.
That’s why at Vertrae®, we review every scan ourselves, focusing specifically on the multifidus and its surrounding stabilizers.
“It’s not just about what’s hurting. It’s about what’s not working.”
— Dr. Kamal Woods
Why These Tests Matter
These physical exams are:
- Safe
- Quick (just a few minutes each)
- Supported by the American Society of Pain and Neuroscience
- Highly effective when performed by a spine-specialized team
At Vertrae®, these tests help us answer one of the most important questions: Is your spine hurting because of a mechanical breakdown or a muscle that’s not doing its job?
When we have that answer, we can build a plan that truly targets the problem.
Meet Your Spine Focused Team at Vertrae®
Your evaluation is a team effort and everyone plays a vital role in helping you get the answers you deserve.
- Dr. Kamal Woods – Dual fellowship-trained spine surgeon with a focused approach to uncovering root causes of chronic back pain
- Jen, PA-C – Physician Assistant who works closely with Dr. Woods and our PT team to guide diagnostics and ensure personalized care plans
- Kris, DPT – Our Physical Therapist who leads motor control assessments and spine-specific rehabilitation
- Presley, PTA – Supports hands-on care and patient progress through every phase of physical therapy
- Shawn, PT Aide – Ensures consistency and coordination throughout your visits, from evaluation to recovery
Diagnosed with Multifidus Dysfunction… So What Happens Now?
Getting the right diagnosis is a huge step forward. But it’s also just the beginning.
You may be wondering: What do I do with this diagnosis? Can this really be treated? Will I ever feel strong and stable again?”
You’re not alone and the answers are encouraging.
In our next blog, we’ll walk you through exactly what comes next:
- What multifidus-focused therapy looks like
- How your care plan is built at Vertrae®
- And when ReActiv8® might be the right step for lasting relief
Serving Patients Across Southwest Ohio
Whether you’re in the Dayton, Cincinnati area, or the Upper Miami Valley, our outpatient spine center provides:
- Spine-only diagnosis and care
- Minimally invasive options when needed
- A conservative-first approach rooted in science and support
Ready to Find Out What’s Really Causing Your Pain?
If your back feels unstable…
If therapy helped but didn’t last…
If no one has looked beyond the surface…
📞 Call Vertrae® at 1-844-255-2225 or Request an Appointment Online
