Is there an association between paraspinal muscle size and low back pain (LBP)?

This systematic review looked at 25 studies to help find the association between LBP and the size and composition of the paraspinal muscles.

Conclusion #1: There is evidence to support that reduced cross-sectional area (CSA) of multifidus is associated with LBP and predictive of LBP recurrence.


Conclusion #2: There is conflicting evidence for a relationship between multifidus fat infiltration and LBP.


Conclusion #3: There is conflicting evidence that erector spinae, psoas, and quadratus lumborum CSAs are associated LBP.


Regrettably, we still do not have a study that tells us of the best method of increasing multifidus CSA or activating it. Here is what I suggest.

Avoid prolonged slouched sitting!

Perform a “pelvic pump” by rhythmically going from a posterior to an anterior pelvic tilt position 5-10 times every 1-2 hours. As simple as it sounds this maybe one of the best interventions for preventing atrophy of the lumbar extensors.


Go ahead, do 5 pelvic pumps wherever you’re sitting. I am doing these pelvic pumps as I am writing this APTEI Report. I also pelvic pump when I’m driving and when I’m on a plane.

In my mind, I am preventing fatty infiltrations from invading my multifidus!

Reference: Ranger T et al Is the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J. 2017 Jul 26.

Pelvic Rocks

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