Longissimus – Massage Therapy Notes

Therapist Notes include:
Anatomy review,
Syndromes and Conditions,
Assessment notes,
Treatment Preparation,
NMT protocols and more…


Here, you will find massage therapy notes for the longissimus of the erector spinae muscle group. It is complex in its structure, function, and pain patterns. It is effectively approached when treated in the context of the more extensive system of intrinsic back muscles.


Pain Along the Crest of the Hip with Stiff Low Back

This pain pattern is one of the most common low back patterns for people over 40. As the sacroiliac joint begins to fuse, this area has more burden when flexing the trunk.

This trigger point pattern is similar to several other patterns in the area, including the over-worked quadratus lumborum. As I stated previously, this muscle needs treatment as part of a more extensive, more complex system.

Palpation, symptomatology, and other assessment tools are needed to separate this from the other muscles in this area. Fortunately, treatment of the intrinsic back, including pelvic balancing, is consistently effective.

Pain in the Buttock with Aching into the Low Back

This trigger point is less common and often overlooked. Instead, therapists are more likely to assess and treat glutes. Glutes seem indicated as they are local to the pain and produce similar patterns.

Again, palpation, symptomatology, and other forms of assessment are needed to separate this from the other muscles in this area. It is easy to spend too much time working in the glutes when this is the culprit. I often use ice-and-stretch of this area to assess. If that relieves the pain, I can target my treatment more effectively by focusing on the longissimus thoracis.

Pain Behind Ear with Tension in the Neck or Behind the Eye

This pattern is uncommon. Consequently, you should assess the other patterns that create pain in the ear.


Longissimus is particularly complicated and variable in the studies of its anatomy. Take the time to understand its local joints and attachments.

anatomy for longissimus of the erector spinae

Musculoskeletal Anatomy

About these Illustrations…

This post on anatomy contains the standard information about origin, insertion, function, and innervation. It also includes information on functional considerations and anomalies. This is also the place to find all posts related to this muscle.

Integrative Treatment Sequencing

Assessment and Sustained Release of
Superior Vertical Strain


This trigger point is associated with several craniostructural releases. However, the superior vertical strain pattern is often the most effective release for this ancillary trigger point.

This post focuses on assessing, releasing, and re-assess the superior vertical strain pattern. This pain pattern is typical and leads to many other structural issues, like Forward-Head Posture and anterior pelvic tilt.

Thoracolumbar Joint Release

This specific cranial atlantooccipital release directly releases restrictions in the thoracolumbar joint. The ancillary trigger points soften and often release completely during this release.

This technique quickly releases cranial governors when you want to focus on local treatment around the thoracolumbar joint.

suboccipital supine
neuromuscular protocol

Upper cervical

If you’re working on the capitis and cervicis sections of the longissimus, don’t miss this pre-treatment.

In the previous section, the atlantooccipital release is consistent at releasing the thoracolumbar joint. However, the cranial base needs more thorough work for lasting relief in the cervicis and capitis sections of the longissimus.

Practitioners often work the lamina groove for this muscle group. While working the lamina groove, you can treat the suboccipital area while the client is prone.

Balance the Pelvis

Pelvic balancing provides longer-lasting results so that direct treatment is easier, more effective, and longer-lasting.

Most therapists have a method of pelvic balancing based on their particular approach. For example, I prefer craniostructural work with SOT blocking. However, I also use METs, strain-counter strain, and some NMT techniques. Use the pelvic balancing approach that works best for your particular bodywork approach.

soft mobilization of vertebrae

Local Joints

The longissimus is typically very responsive to soft joint work. You can feel the muscles relax with gentle pressure, and the trigger points release as the joints shift.

In this area, local joint work is particularly effective. The tone of the muscle is quick to change as the joints release. It is easy to monitor the surrounding musculature as you work in this area. The envelopes of paraspinal muscles soften as the vertebrae and ribs shift.

If you’d like something more active, use the lamina groove routine mentioned below.

Pelvic Ligaments and the Sacrum

The longissimus lumborum and the lower sections of the longissimus thoracis attach to the top of the sacrum. Take time to deal with joint problems and soft tissue restrictions around the sacrum.

You can see notable changes in the low back musculature by working the sacral surface and sacral joints. When treating trigger points in erectors, this is essential preparation.

This routine for the sacroiliac ligament works that surface in detail. Additional palpation for tight, ischemic tissues can be essential in locating and treating key irritations. Again, watch how the erectors change in tone as restrictions in this area release.

lamina groove
neuromuscular protocol

Lamina Groove

This is a relaxing routine with lots of gentle stimulation that clients love. In the final passes, the binding joints of the spine tend to open more completely as trigger points release.

Monitor the tone of the erector bundle as you work. You’ll see it relax and soften. Consequently, direct work is easier, more effective, and longer-lasting.

  • When treating the thoracis section, include the rib heads along the lower thoracic vertebrae.
  • If you are focused on the cervicis and capitis sections, start with the suboccipital region. Also, make sure to work the upper thoracic as both capitis and cervicis usually attach as low as T5.
erector spinae
neuromuscular protocol

Detailed Trigger Point Work

This classic routine relaxes the muscle bellies of the erector spinae more effectively after the governing pieces release. Pelvic balancing, lamina groove work, and pelvic ligament work soften this group. They become more responsive as the natural curves of the back normalize. With proper preparation of governing components, the work is easier on the practitioner and the client. Results also last longer as the body becomes better at self-correcting.

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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written materials and instructed classes since the mid-90s. This includes anatomy, trigger points, cranial, and neuromuscular.

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