Are your Back Muscles Getting Infiltrated with Fat?

Ok, yes, I’m using a provocative blog title to get your attention, guilty! But hear me out: these were the exact words I read from a new patient’s lumbar MRI report yesterday: “Fatty atrophy of the paravertebral muscles.”

A Common Yet Overlooked Finding

I wish I could say this is a rare finding in our patient demographic (i.e., adults with scoliosis and kyphosis), but unfortunately, it’s not. I read this finding over and over in the spinal MRI reports of our patients.

It often gets buried under the seemingly more important findings, such as nerve root compression, foraminal narrowing, facet arthropathy, and central canal stenosis.

It’s time to spotlight this common occurrence, to explain what is happening physiologically, and to discuss how this situation can be improved and possibly even reversed.

The Impact of Sedentary Lifestyles

In Physical Therapy school, we were bombarded by adages such as “Use It or Lose it” and “Motion is Lotion.” Our professors were trying to drill into our heads how important movement, motion, and exercise are to human health. They were training us to become the exercise experts that we are today.

So many of our current musculoskeletal aches and pains come from sedentary lifestyles; sadly a hallmark of modern, developed, industrialized nations. Graduating from high school, college, or grad school marks the transition into the working world, where many jobs require 8 hours of desk and computer work.

This transition often correlates with a reduction in physical activity and exercise. When we stop using our muscles to bike, jog, dance, lift weights, etc., our muscles atrophy (become smaller), and our cardiovascular system and lungs become less efficient.

Reversing Fat Infiltration with Exercise

We’ve been familiar with the principle of muscle atrophy for a long time, but it wasn’t until 2019 when researcher Paul Hodges published his findings of not only atrophy of the back muscles in patients with low back pain but actual fat infiltration of the back muscles, especially the multifidus, a deep stabilizer muscle of the spine.¹

Um, whaat? That sounds freaky, and much worse than the terminology we used to use, casually, about “being out of shape”. Now we have to worry about our muscles becoming fat-filled if we don’t exercise?! Guh, yes. 

The best solution for this problem is to prevent it in the first place by prioritizing exercise throughout the lifespan. Exercise takes many, many different shapes and forms, and I always encourage patients to try different types of exercise until they find something that’s enjoyable or at least not torturous. If you find even the slightest hint of pleasure in a Tai Chi class, Ju Jitsu class, or climbing up a rock wall, you’re more likely to continue doing it. 

This becomes especially important for our teenage patients with Adolescent Idiopathic scoliosis (AIS). Historically, we did teens with AIS a disservice by limiting their physical activity. The advice coming from doctors and therapists a few decades ago sounded like this: “Don’t do rotational sports.” “Don’t do gymnastics.” “Carrying a heavy backpack could make your scoliosis worse.”

This advice had far-reaching psychological and physiological consequences: kiddos stopped doing sports they loved, became more fearful of movement, and infantilized themselves because their doctors and parents were infantilizing them. This led to a sedentary lifestyle, muscle disuse and atrophy, and deconditioning of the cardiopulmonary system. Their scoliosis got worse!

Sidenote: kids who are physically active have been proven to show less scoliosis progression than their sedentary counterparts.²

To be clear, all of those statements have been debunked, and the advice of the present day is much different. Today, we encourage kids and teens diagnosed with scoliosis to continue their current sports and activities. We encourage sedentary kids to become more active. We teach all of our patients about the importance of bone health and the importance of high-impact movements and strength training to create strong bones.

And what about those back muscles? How can we strengthen our erector spinae and our multifidii muscles in order to prevent the dreaded fat infiltration? If our muscles are infiltrated with fat, can we reverse it?

Strengthening the Back Muscles with Schroth

Enter Schroth. Schroth is all about strengthening the spinal muscles; concentrically on the convex side of the scoliosis, and eccentrically on the concave side of the scoliosis. This promotes spinal muscle symmetry and insulates you from having to worry about fat in places it shouldn’t be. 

And if it’s already there, fear not. There is evidence that specific exercise protocols including multifidus activation (hello, beloved bird dog exercise that I teach to patients every day) have been shown to reverse atrophy of lumbar multifidi muscles AND that these exercises can reduce low back pain.³ Boom.

It’s a new year, and we all have aspirations for 2025. Might yours include a visit to SchrothDC to learn more? We hope so.

References:

1. Hodges PW, Danneels L. Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. J Orthop Sports Phys Ther. 2019 Jun;49(6):464-476. doi: 10.2519/jospt.2019.8827. PMID: 31151377. 

2. Negrini A et al. Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage. Eur J Phys Rehabil Med. 2023 Apr;59(2):222-227.doi: 10.23736/S1973-9087.23.07489-0. Epub 2023 Mar 9.

3. Woodham M, Woodham A, Skeate JG, Freeman M. Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series. J Radiol Case Rep. 2014 May 31;8(5):27-34. doi: 10.3941/jrcr.v8i5.1401. PMID: 25426227; PMCID: PMC4242062.