Latissimus Dorsi Trigger Points

Introduction

The latissimus dorsi is a large back muscle responsible for shoulder extension, adduction, and internal rotation. When trigger points develop in this muscle, they can cause pain in the mid-back, shoulder, and down the arm, often mimicking rotator cuff injuries, nerve compression, or rib dysfunction.

Name and Area

  • Name: Latissimus Dorsi

  • Area: Located on the posterior torso, spanning from the lower thoracic and lumbar spine to the humerus.

Indications

Latissimus dorsi trigger points may contribute to:

  • Pain in the Mid-Back, Shoulder, and Side of the Torso (Mistaken for Rib Dysfunction or Thoracic Spine Issues)

  • Pain That Extends Down the Arm to the Hand (Can Mimic Nerve Compression or Rotator Cuff Problems)

  • Pain When Lifting the Arm Overhead (Common in Swimmers, Climbers, and Weightlifters)

  • Tightness in the Side of the Body That Restricts Deep Breathing

  • Weakness in Pulling Movements (Difficulty with Pull-Ups, Rowing, or Carrying Heavy Objects)

  • Pain That Worsens When Sleeping on the Affected Side

Pain from this muscle is often mistaken for shoulder injuries, thoracic outlet syndrome, or rib dysfunction.

Muscle Action

  • Extends the Shoulder: Moves the arm backward.

  • Adducts the Arm: Pulls the arm toward the body.

  • Internally Rotates the Shoulder: Turns the humerus inward.

  • Assists in Deep Breathing: Helps expand the ribcage during forceful inhalation.

The latissimus dorsi is essential for upper body strength, posture, and deep breathing mechanics.

Signs and Symptoms

Individuals with latissimus dorsi trigger points often report:

  • Pain in the Mid-Back, Shoulder, or Down the Arm

  • Weakness in Pulling Movements (Difficulty with Rows, Pull-Ups, or Swimming Strokes)

  • Pain or Tightness Along the Side of the Body (Can Restrict Breathing and Thoracic Mobility)

  • Pain That Extends Into the Shoulder Blade (Common in Weightlifters and Overhead Athletes)

  • Pain That Feels Like a Band Around the Chest (Can Mimic Rib Dysfunction or Lung Problems)

Pain worsens with overhead movements, pulling exercises, or prolonged poor posture.

Perpetuating Factors

Common causes of latissimus dorsi trigger points include:

  • Repetitive Overhead Movements (Swimming, Rock Climbing, Baseball, Tennis, Volleyball)

  • Prolonged Poor Posture (Hunched Shoulders, Rounded Upper Back, Forward Head Position)

  • Heavy Lifting Without Proper Form (Overuse from Weightlifting, Construction Work, or Manual Labor)

  • Side Sleeping on the Affected Side (Causes Chronic Muscle Compression and Tension)

  • Shallow Breathing Patterns (Restricts Rib Expansion and Overloads the Latissimus Dorsi)

Trigger Point Referral Pattern

Trigger points in the latissimus dorsi refer pain to:

  • The mid-back and side of the torso (Can Mimic Rib Dysfunction or Postural Fatigue)

  • The shoulder and down the inner arm (Mistaken for Rotator Cuff or Nerve Issues)

  • The side of the chest and ribcage (Can Resemble Intercostal Neuralgia or Breathing Dysfunction)

Pain from this muscle is often confused with thoracic outlet syndrome, rotator cuff tears, or rib dysfunction.

Differential Diagnosis

Latissimus dorsi trigger points may be mistaken for:

  • Rotator Cuff Injuries (Weakness and Pain in Shoulder Movements, Worsens with Overhead Lifting)

  • Thoracic Outlet Syndrome (Pain, Numbness, or Tingling Down the Arm Due to Nerve Compression)

  • Intercostal Neuralgia (Sharp, Shooting Rib Pain That Worsens with Deep Breathing)

  • Postural Strain (Tightness and Discomfort from Poor Ergonomics or Long Hours at a Desk)

  • Lung or Rib Dysfunction (Pain in the Side or Back That Worsens with Breathing or Movement)

A thorough shoulder, rib, and thoracic spine examination is necessary to rule out these conditions.

Associated Trigger Points

Latissimus dorsi trigger points often co-exist with:

  • Serratus Anterior (Rib and Side Pain, Affects Deep Breathing and Shoulder Stability)

  • Teres Major (Shoulder Pain and Weakness in Overhead Movements, Mimics Rotator Cuff Dysfunction)

  • Lower Trapezius (Upper Back and Shoulder Blade Pain, Common in Postural Strain)

  • Quadratus Lumborum (Lower Back and Side Pain, Affects Pelvic Stability and Postural Alignment)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Latissimus Dorsi Thoracolumbar fascia, lower ribs, lumbar and thoracic vertebrae Humerus (intertubercular groove) Thoracodorsal nerve (C6–C8)

The latissimus dorsi is innervated by the thoracodorsal nerve, which also controls shoulder movement and upper back stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the mid-back, shoulder, and side of the ribcage.

  • Resisted Shoulder Extension and Adduction Testing: Assess pain and weakness when moving the arm backward or pulling it toward the body.

  • Thoracic Mobility Testing: Look for limited ribcage expansion or spinal stiffness.

  • Postural Assessment: Check for rounded shoulders, forward head posture, or excessive thoracic kyphosis.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the latissimus dorsi, reducing muscle tightness and improving shoulder and rib mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the mid-back, shoulder, and ribcage.

  • Myofascial Release: Helps improve circulation and reduce upper body muscle tension.

Stretching

  • Lat Stretch Against a Wall: Stand sideways to a wall, extend the arm overhead, and lean away to stretch the latissimus dorsi.

  • Foam Roller Thoracic Stretch: Improves thoracic spine mobility and rib expansion.

Strengthening Exercises

  • Pull-Ups and Lat Pulldowns: Strengthens the latissimus dorsi for better shoulder stability and posture.

  • Dead Hangs: Helps decompress the shoulder joint and improve lat flexibility.

  • Core Stability Exercises: Supports proper movement mechanics and reduces back strain.

Postural and Movement Adjustments

  • Avoid Prolonged Slouching (Maintain a Neutral Spine During Sitting and Standing)

  • Ensure Proper Overhead Lifting Form (Engage the Core and Avoid Overloading the Lats)

  • Practice Deep Breathing Exercises (Encourages Full Rib Expansion and Reduces Lat Tightness)

Conclusion

The latissimus dorsi plays a crucial role in shoulder function, upper body strength, and posture, but trigger points in this muscle can cause significant back, shoulder, and rib pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent future dysfunction.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.