Latissimus Dorsi, like sartorius, hangs loose. It can have active trigger points without creating a lot of pain until it is unexpectedly drawn taut through a reaching movement. That quirk makes it easy to overlook this muscle as the cause of pain. It also makes it easy for the client to manage this until it becomes a level 3 trigger point.
This pattern comes from the fibers that cross over the lower border of the scapula where about 25% of lats attach. This means that it is the range of motion between the scapula and the humerus that matters.
Mobilizing the glenohumeral joint is key. The strain-counterstrain technique is simple and reliable for this. Lower thoracic vertebrae can also contribute to the activation of this trigger point.
The latissimus dorsi os often overlooked in postural distortion and addressed too late in the treatment plan. It is easy to adjust posture so that the lats are slack and not generating pain, except in brief moments of stretch or contraction. The C-shaped side-bend that is indicative of unilateral shortness is often attributed to other muscles that are contracted to keep the lat from being painfully stretched. When bilaterally short, the chest caves and the diaphragm closes. These muscles that are short to bend the torso and protect the lat(s) often become the focus of structural corrections.
The trigger points along the floating ribs do not often generate enough pain for the client to complain but create strong restrictions in the low back. The quadratus lumborum and erectors can be very difficult to release without first releasing these governing trigger points.
Consider Referring Them Out
The pain in the mid-back is easily confused for other sources. Serratus posterior inferior, iliocostalis lumborum, and diaphragm all produce pain in this area. As well, the gall bladder and kidneys produce pain in the lower ribs. Careful examination is recommended and a referral to an MD is usually appropriate.
Get Their Head on Straight
Mobilization for the lower releases the nerve roots that innervate the latissimus dorsi. Mobilizing the upper cervical helps the lower cervical vertebrae to stabilize.
Mobilize Binding Joints
Mobilizing the humeral head also relaxes the latissimus by changing proprioceptive input from the local joint.
The lamina groove protocol releases local joints along the spine to improve proprioceptive input to the latissimus dorsi.
This protocol treats the latissimus dorsi, primarily through direct work in the muscle fibers. It can be a difficult muscle to treat as it easily slips out of the way during stroking movements. This routine solves that by treating it with compression while in a side-lying position.
Self-care can be important when this has become chronic. Have them follow up with these self-care ideas. Ice-and-stretch or a vapocoolant patch can be very helpful if they have continued symptoms.
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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.
*This site is undergoing major changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.