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Comparison of Cross-Sectional Area and Bilateral Asymmetry of the Lumbar Multifidus According to Pain Location: A Study on Patients with Low Back Pain

  • Journal of the Korean Society of Physical Medicine
  • Abbr : J Korean Soc Phys Med
  • 2026, 21(2), pp.51~63
  • Publisher : The Korean Society of Physical Medicine
  • Research Area : Medicine and Pharmacy > Physical Therapy > Other physical therapy
  • Received : December 15, 2025
  • Accepted : February 16, 2026
  • Published : May 31, 2026

Chang-yeon Chi 1,  Jong-Hun Park 2,  Suhnyeop Kim ORD ID 3

1동탄시티병원
2이김병원
3대전대학교

Accredited

ABSTRACT

PURPOSE: This study examined whether multifidus muscle morphology differs according to the specific site of lower back pain (LBP) and explored its associations with pain intensity, disability, and psychosocial factors in individuals with subacute or chronic LBP. Although muscle atrophy in LBP has been widely reported, the relevance of multifidus structure to localized pain patterns remains unclear. METHODS: Sixty-three participants with LBP were classified into unilateral left, unilateral right, bilateral, or central pain groups. Multifidus cross-sectional area (CSA) and asymmetry ratio (AR) at the L4–5 level were assessed using magnetic resonance imaging. Pain intensity, disability, and psychosocial factors were evaluated using the Numeric Rating Scale, Korean Oswestry Disability Index, and FearAvoidance Beliefs Questionnaire. RESULTS: Demographic and clinical characteristics were similar across groups. Pain intensity differed significantly, with the unilateral right pain group reporting higher scores than the central group. No significant group differences were observed for disability, psychosocial measures, CSA, or AR. Within the central pain group, men showed larger CSA, whereas women demonstrated greater AR. LBP duration was positively correlated with AR, and larger CSA was associated with reduced AR. CSA also showed a negative correlation with fear-avoidance beliefs, indicating potential psychosocial influence on muscle structure. Intrarater reliability for CSA measurement was excellent. CONCLUSION: Multifidus structural changes in subacute or chronic LBP appear more strongly associated with pain duration and fear-avoidance beliefs than with pain ntensity. Incorporating psychosocial strategies alongside interventions aimed at improving multifidus muscle condition may enhance clinical outcomes.

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