New Research Reveals a Hidden Cause of Chronic Low Back Pain: It's Not Just About Muscle Size
- Julian Simpson
- 17 hours ago
- 5 min read
Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.
New Research Reveals a Hidden Cause of Chronic Low Back Pain: It's Not Just About Muscle Size
Why Some People Continue to Experience Low Back Pain Despite Having "Strong Core Muscles"
Chronic non-specific low back pain (CNLBP) is one of the most common health conditions worldwide and a leading cause of disability.
Many people assume chronic low back pain is simply caused by weak muscles, poor posture or ageing. However, new research suggests the real problem may be more complex.
A recent study found that people with chronic non-specific low back pain demonstrated:
Significant multifidus muscle atrophy
Reduced ability to activate their multifidus muscles
Poor neuromuscular control
Reduced back strength
Increased pain sensitivity
Worse sleep quality
Higher levels of anxiety and depression compared with healthy individuals.
At Healthwise Chiropractic, we regularly help patients from Sunbury, Melton, Diggers Rest, Gisborne and surrounding areas manage persistent low back pain using a combination of evidence-informed chiropractic care, rehabilitation and movement-based strategies.
What Is Chronic Non-Specific Low Back Pain?
Chronic non-specific low back pain refers to back pain lasting longer than three months where no single structure, such as a fracture, infection or disc herniation, can fully explain the symptoms.
This is the type of low back pain experienced by approximately 85-90% of people with ongoing back pain.
What Did The Study Find?
Researchers compared individuals with chronic non-specific low back pain against healthy controls using:
Ultrasound imaging
Muscle strength testing
Surface EMG (electromyography)
Functional assessments
Psychological and sleep questionnaires
The findings revealed widespread changes affecting both the muscles and nervous system.
Key Finding #1: The Multifidus Muscle Was Smaller
One of the most significant findings was that participants with chronic low back pain had a significantly smaller multifidus muscle cross-sectional area compared to healthy controls.
What Is The Multifidus?
The multifidus is one of the deepest stabilising muscles in the spine.
Its role is to:
Control small spinal movements
Support spinal stability
Help distribute forces through the lower back
Provide feedback to the nervous system about spinal position
Think of it as one of the "fine-tuning" muscles of the lumbar spine.
Key Finding #2: The Multifidus Wasn't Activating Properly
Perhaps more importantly, the study found that people with chronic low back pain had a significantly reduced ability to contract their multifidus muscle during movement.
The researchers concluded that impaired muscle activation may be even more important than muscle size itself.
In other words:
It's not just whether the muscle is there. It's whether the nervous system can use it effectively.
Key Finding #3: Poor Neuromuscular Control Was Linked To Greater Pain And Disability
Researchers measured something called the Flexion Relaxation Ratio (FRR), which assesses how efficiently the back muscles switch on and off during movement.
They found:
Lower FRR scores were associated with higher pain levels
Lower FRR scores were associated with greater disability
Reduced muscle coordination was linked to worse function in daily life.
This suggests chronic low back pain is partly a problem of movement control, not simply tissue damage.
Key Finding #4: Function Was More Closely Related To Muscle Activation Than Pain
Interestingly, the researchers found that reduced multifidus activation was associated with greater disability but was not strongly associated with pain intensity itself.
This highlights an important concept:
Pain and function are not always the same thing.
You may:
Have less pain but still struggle with movement.
Have pain but maintain good function.
Need treatment approaches that target both movement and symptoms.
Key Finding #5: Sleep, Anxiety And Mood Matter
The study also found that people with chronic low back pain experienced significantly worse:
Sleep quality
Anxiety scores
Depression scores
compared with healthy individuals.
This reinforces modern pain science, which recognises that chronic pain is influenced by:
Physical factors
Nervous system sensitivity
Sleep
Stress
Emotional wellbeing
Lifestyle factors
What Does This Mean For Treatment?
One of the most important conclusions from the study was that treatment should focus on restoring neuromuscular control rather than simply strengthening muscles.
The researchers specifically highlighted:
Multifidus activation training
Proprioceptive neuromuscular facilitation (PNF)
Dynamic neuromuscular stabilisation
Sensorimotor retraining
as promising approaches for improving spinal control and reducing disability.
Exercises That May Help Improve Multifidus Function
1. Abdominal Drawing-In Exercise
Purpose
Activates the deep stabilising muscles of the trunk.
How To Do It
Lie on your back with knees bent.
Gently draw your lower tummy inward.
Imagine tightening a belt one notch.
Continue breathing normally.
Hold for 10 seconds.
Perform:
10 repetitions
2. Bird Dog
Purpose
Improves multifidus activation and spinal control.
How To Do It
Start on hands and knees.
Tighten your abdominal muscles gently.
Extend one arm forward.
Extend the opposite leg backwards.
Keep your spine still.
Hold:
5 seconds
Perform:
10 repetitions each side
3. Quadruped Multifidus Activation
Purpose
Targeted activation of the multifidus.
How To Do It
Begin on hands and knees.
Maintain a neutral spine.
Imagine gently swelling the muscles either side of your lower spine.
Hold the contraction.
Hold:
5-10 seconds
Repeat:
10 times
4. Bridge Exercise
Purpose
Improves lumbopelvic stability.
How To Do It
Lie on your back.
Bend your knees.
Lift your hips slowly.
Maintain a neutral spine.
Lower slowly.
Perform:
2 sets of 10 repetitions
5. Dead Bug
Purpose
Enhances spinal control during limb movement.
How To Do It
Lie on your back.
Raise arms and knees.
Slowly lower opposite arm and leg.
Keep your lower back stable.
Perform:
10 repetitions each side
How Chiropractic Care May Help
At Healthwise Chiropractic, we understand that chronic low back pain is rarely caused by a single factor.
Our approach may include:
Comprehensive Assessment
Evaluating:
Movement patterns
Muscle function
Spinal mobility
Lifestyle contributors
Chiropractic Care
Where appropriate, manual therapy may help improve spinal mobility and reduce mechanical irritation.
Rehabilitation
Targeted exercises designed to:
Improve multifidus activation
Restore spinal control
Improve movement confidence
Increase functional capacity
Lifestyle Advice
Addressing factors such as:
Sleep
Physical activity
Workstation setup
Load management
Looking For Low Back Pain Treatment In Sunbury Or Melton?
If you're struggling with persistent low back pain, understanding how your muscles and nervous system are functioning may be just as important as identifying where it hurts.
Healthwise Chiropractic proudly provides evidence-informed care for patients across:
Sunbury
Melton
Diggers Rest
Gisborne
Bacchus Marsh
Caroline Springs
Taylors Lakes
North-West Melbourne
Our team can help assess the factors contributing to your back pain and develop a personalised management plan designed to improve movement, function and quality of life.
How Chiropractic Care May Help
At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.
Treatment may include:
We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.
About the Author
Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.
He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.
His treatment focus includes:
Chiropractic adjustments
Sports chiropractic
Massage therapy
Shockwave therapy
Laser therapy
Non-surgical spinal decompression
Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.
Wang Z, Ju F, Hu D, Lu Y, Zhao C. Multidimensional Dysfunction in Chronic Nonspecific Low Back Pain: A Correlational Study of Key Clinical Measures. Pain Res Manag. 2026;2026(1):e4984566. doi: 10.1155/prm/4984566. PMID: 42218584.
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