Understanding Low Back Pain: Insights from Joanne Macza, PT, Founder of B-Health and Boutique Physio
- B-Health Insights
- Apr 6
- 3 min read
Featured in the Spring 2026 issue of St. Louis Metro Health & Care Journal
Joanne Macza, PT, Boutique Physio Founder, OCS, Dip. MDT, Schroth-Scoliosis Certified, Manual Orthopedic Therapist, Pelvic and Women’s Health Specialist, Functional Dry Needling and KT Tape Certified
Mechanical Changes in the Spine
As Joanne outlines, the lumbar spine and pelvis naturally change over time. Factors such as:
Age
Injury
Genetics
Repetitive stress
can lead to progressive loss of mobility within the joints of the spine and pelvis.
These changes affect how the body moves and distributes load, often contributing to discomfort, compensation, and ongoing strain.
The Role of the Multifidus: “Multifidus Dysfunction Syndrome”
A key focus of Joanne’s article is the multifidus, a deep spinal stabilizing muscle that supports the spine segment by segment. Over time, and especially in people with low back pain, the multifidus often shows a primary dysfunction: limited activation and inability to remain active. Joanne calls this “Multifidus Dysfunction Syndrome.”
She highlights that over time, and particularly in the presence of low back pain, the multifidus can:
Lose activation
Decrease in endurance
Become less effective at stabilizing the spine
When this occurs, the spine loses an important layer of support, which can contribute to both acute and persistent pain.
Addressing this dysfunction isn’t just about turning the muscle on once or twice. Effective physiotherapy focuses on both activation and endurance, training the multifidus to contribute to spinal stability throughout the entire day and night. This continuous engagement helps minimize symptoms, prevent compensatory strain, and restore efficient movement patterns.
Short-Term and Long-Term Pain
Joanne emphasizes that these changes are relevant across the full spectrum of low back pain:
Short-term pain, where injury or irritation disrupts normal movement and muscle activation
Long-term pain, where ongoing dysfunction in mobility and stabilization continues to drive symptomsWithout addressing these underlying factors, pain may persist or return over time.
Low back pain exists on a continuum, ranging from short-term acute episodes to persistent chronic conditions shaped by physical, neurological, and behavioral factors. Recovery from low back pain is rarely linear. Symptoms can evolve over time depending on movement, stress, conditioning, sleep, and overall health. Modern pain science recognizes low back pain as a dynamic condition influenced by tissue healing, nervous system sensitivity, and lifestyle factors over time.
The Role of Physiotherapy
As highlighted in the article, physiotherapy is a critical component in both managing pain and restoring function. At Boutique Physio and B-Health, this includes:
Restoring joint mobility in the spine and pelvis
Re-engaging stabilizing muscles like the multifidus, with a focus on activation and endurance
Addressing movement patterns that contribute to strain
Supporting a return to prior levels of activity
This approach focuses not just on relieving symptoms, but on helping individuals move better and function more effectively over time.
Restoring Function and Moving Forward
Low back pain is often not the result of a single issue, but a combination of changes in how the spine moves and stabilizes. By addressing both mechanical joint function and muscle activation and endurance, physiotherapy can help individuals return to their prior level of function—regardless of activity level.
Learn More
To read more, see Joanne Macza’s feature in the
of the St. Louis Metro Health & Care Journal.
If you are experiencing low back pain, Boutique Physio and B-Health offer individualized care focused on restoring movement, stability, and long-term function.
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