The lumbar multifidus inserts via short, stout tendinous slips into the spinous processes, mammillary processes, and posterior sacrum. These tendons are the deepest structural stabilisers of each lumbar motion segment, providing intersegmental stiffness independent of the global erector spinae.
Multifidus atrophy and fatty infiltration ipsilateral to a symptomatic disc herniation is one of the most consistent MRI findings in chronic low back pain. Real-time ultrasound biofeedback targeting multifidus contraction is used in rehabilitation. Tendinous avulsions at the mammillary processes are rare but reported after severe spinal flexion injuries.
Degenerative changes at the multifidus insertion on the mammillary or spinous process producing deep unilateral lumbar pain, often associated with ipsilateral disc pathology and muscle atrophy.
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