The DDD which develops in the sheep model also effects multifidus muscle remodeling that may also contribute to LBP.65, 66 Experimental DDD changes multifidus pro‐inflammatory cytokine gene expression profiles67, 68 and mimics LBP changes in human spinal tissues.69 Macrophages and TNF have active roles in the subacute/early chronic phase of remodeling in muscle, adipose and connective tissues of the multifidus muscle during IVD degeneration and represent a novel therapeutic target. Here, TNF is linked to Low back pain.