Back pain is one of the most common complaints, but not all back pain is the same. For some, the cause isn’t a herniated disc or arthritis—it’s spinal instability caused by dysfunction of a deep spinal muscle called the multifidus.
Let’s explore what spinal instability means, why it occurs, and how the right rehabilitation can help you regain control and confidence in your movement.
What Is Spinal Instability and How Does It Affect You?
Spinal instability refers to excessive movement between two vertebrae, resulting in pain, a sense of “giving way,” or feeling like you can’t trust your back. It’s not about dramatic dislocations or slipping bones but rather a lack of control in the deep stabilising muscles that should keep your spine steady during movement or load-bearing activities.
This condition can be tricky to diagnose because it often isn’t visible on scans. Many people with spinal instability have normal MRIs or X-rays, which can be frustrating when they’re told there’s “nothing wrong.” If you’re experiencing recurring back pain, especially after small tasks or changes in posture, the issue may lie in muscular function rather than structural damage.
Meet the Multifidus: The Hidden Stabiliser of Your Spine
The multifidus is a small but essential muscle that runs along your spine, attaching vertebra to vertebra. Unlike the larger back muscles that help you bend or lift, the multifidus is responsible for fine-tuned control and segmental stability. It reflexively activates to stabilise your spine during movement.
Here’s the challenge: after an episode of low back pain or injury, the multifidus often stops functioning properly. It can shrink (atrophy), become delayed in activation, or even switch off entirely. Even when the pain subsides, this dysfunction can persist, leaving your spine unsupported and prone to further irritation.
Real vs. Perceived Damage: Why Pain Doesn’t Always Mean Injury
A key concept in managing spinal instability is understanding the difference between real tissue damage and perceived threat.
After an injury, your nervous system becomes more protective, often sending pain signals even after the physical tissues have healed. This is especially common in spinal instability, where muscle dysfunction creates a sense of vulnerability. Your brain detects subtle cues—like micro-movements or poor control—and interprets them as unsafe, triggering a pain response to protect you.
The Role of Rehabilitation: Rebuilding Confidence and Control
The good news? Spinal instability caused by multifidus dysfunction can be effectively managed through targeted rehabilitation. The focus is on retraining the deep stabilising muscles and reprogramming your brain’s movement patterns to reduce pain and improve function.
1. Motor Control Training
This involves gently activating the deep core muscles, including the multifidus and transversus abdominis. These exercises are subtle and precise, focusing on reconnecting your brain with the muscle rather than big, dramatic movements.
2. Functional Strengthening
Once control is regained, exercises progress to include more dynamic and functional tasks. These integrate balance, coordination, and strength in ways that reflect real-life movement.
3. Movement Re-education
Injury often leads to compensatory movement habits. Rehabilitation helps restore efficient, confident movement and reduces fear-avoidant behaviours that can perpetuate pain.
4. Load Tolerance and Gradual Exposure
Spines thrive on movement—but only when they feel safe. A key part of rehabilitation is gradually increasing the load and complexity of movements, helping your body rebuild trust in itself.
Why It Matters
Spinal instability due to multifidus dysfunction isn’t about structural failure—it’s about neuromuscular control. Understanding that pain doesn’t always mean damage is empowering. It shifts the focus from fear and fragility to strength and function.
With the right guidance, most people can make significant improvements through targeted rehabilitation. While it’s not a quick fix, it’s a sustainable solution—building a more resilient back that moves well, feels strong, and supports your daily life with less pain and more confidence.
In Summary
Spinal instability doesn’t mean your spine is broken—it means your stabilisers need support. Through informed rehabilitation, you can restore control, reduce pain, and move forward with confidence.
Meet Our Team
At Completely Aligned, our experienced practitioners are here to help you on your journey to better spinal health. Dr. Gemma Percy, an osteopath with a special interest in strength and conditioning, is highly skilled in creating tailored rehabilitation programs to restore stability and confidence.
