A short YouTube talk (Jeff Langmaid) urging clinicians to examine axial MRI slices for fatty infiltration/deconditioning of the lumbar multifidus muscle. He explains how healthy multifidus appears, why fatty replacement matters for prognosis and treatment planning (expect longer/more intensive rehabilitation; implications for surgery and injections), and that many physicians overlook this sign and rely only on reports.
Chapters
The number one overlooked item on MRIs is the fatty infiltration of the multifidus. I want to talk a little bit about what that means, why it's important, and also why nobody is looking for it. But you can if you have a patient that has an MRI performed. First of all, take a look at those pictures. Don't just look at the report. Furthermore, look at those axial slices. When you go down to L4.5, specifically L5S1, you can look in the gutters of what I call it, the gutters of that lamina, and you will find the multifidus hanging out there. That multifidus should look like a nice marbleized steak. And then on the outside should be the white fat. If that multifidus muscle looks more white than dark, so to speak. If you cannot tell the difference between what is the fat and what is the muscle, that is a truly deconditioned multifidus muscle. That is important because no docs are talking to their patients about that right now. But if there's that much deconditioning of the musculature, number one, it is absolutely going to mean that they are gonna need more than one or two adjustments to get where they wanna be. Right. They are truly deconditioned. So it helps you set better expectations for your patients. But if they're having that MRI performed and they are looking towards a surgical intervention or perhaps an injection, this is also important information to know. If that patient has a laminotomy, a laminectomy, and the musculature surrounding it, there's none left. It's all fat. How well do you think that's gonna. Probably not very well. Or if they think an injection, some medication, is miraculously going to take care of 50 years of degenerative change, they certainly have another thing coming. A lot of physicians are not looking at those axial pictures, and they're specifically not looking at the multifidus muscle and its integrity. That's a huge differentiator. And I would encourage you, next patient that comes in that has an mri, look at those axial pictures, take a look at multifidus. Take. See what you think about the integrity of that muscle and set a better expectation for the recovery of your patient.
