Longissimus Thoracis Trigger Points

Introduction

The longissimus thoracis is a key lower and mid-back muscle responsible for spinal extension, lateral flexion, and postural stability. When trigger points develop in this muscle, they can cause mid-back pain, lower back tightness, and rib discomfort, often mimicking disc herniation, kidney pain, or rib dysfunction.

Name and Area

  • Name: Longissimus Thoracis

  • Area: Located in the mid-to-lower back, running from the sacrum and lumbar vertebrae to the thoracic vertebrae and ribs, as part of the erector spinae group.

Indications

Longissimus thoracis trigger points may contribute to:

  • Pain in the Mid-Back and Lower Back (Mistaken for Disc Herniation or Facet Joint Syndrome)

  • Pain That Extends to the Side of the Ribcage (Can Mimic Kidney Pain or Rib Dysfunction)

  • Stiffness in the Mid-to-Lower Back, Especially After Sleeping or Sitting for Long Periods

  • Pain That Increases with Bending, Twisting, or Prolonged Standing

  • Pain or Tightness Along the Spine That Restricts Deep Breathing

  • Fatigue in the Back After Prolonged Activity or Postural Stress

Pain from this muscle is often mistaken for lumbar disc issues, rib dysfunction, or postural strain.

Muscle Action

  • Extends the Spine: Helps maintain upright posture and supports back extension.

  • Laterally Flexes the Spine: Allows side bending movements.

  • Stabilizes the Spine During Movement: Works with other erector spinae muscles to support posture and movement.

The longissimus thoracis is essential for maintaining spinal stability, supporting posture, and preventing excessive spinal flexion.

Signs and Symptoms

Individuals with longissimus thoracis trigger points often report:

  • Dull, Aching Pain in the Mid-to-Lower Back That Worsens with Movement

  • Pain That Extends to the Ribcage or Hips (Can Mimic Kidney Pain or SI Joint Dysfunction)

  • Tightness and Stiffness in the Spine That Limits Mobility

  • Pain That Worsens with Poor Posture or Prolonged Sitting or Standing

  • Pain or Discomfort When Taking Deep Breaths (Feels Like Rib Restriction or Muscle Stiffness)

  • Fatigue in the Back After Prolonged Activity (Common in Runners, Cyclists, and Weightlifters)

Pain worsens with prolonged standing, sitting, deep breathing, or sudden twisting movements.

Perpetuating Factors

Common causes of longissimus thoracis trigger points include:

  • Prolonged Sitting or Poor Posture (Common in Desk Workers and Drivers)

  • Heavy Lifting Without Proper Core Engagement (E.g., Weightlifting, Manual Labor, Moving Heavy Objects)

  • Repetitive Twisting or Bending Movements (Common in Golf, Tennis, or Rowing)

  • Excessive Forward Bending Without Spinal Support (E.g., Gardening, Shoveling, or Picking Up Objects Incorrectly)

  • Shallow Breathing or Restricted Ribcage Mobility (Limits Thoracic Spine Function and Causes Mid-Back Stiffness)

Trigger Point Referral Pattern

Trigger points in the longissimus thoracis refer pain to:

  • The mid-to-lower back (Can Mimic Lumbar Disc Herniation or Facet Joint Dysfunction)

  • The side of the ribcage (Mistaken for Kidney Pain or Intercostal Neuralgia)

  • The lower thoracic spine and SI joint (Can Resemble SI Joint Dysfunction or Hip Imbalances)

Pain from this muscle is often confused with kidney pain, spinal issues, or rib dysfunction.

Differential Diagnosis

Longissimus thoracis trigger points may be mistaken for:

  • Lumbar Disc Herniation (Lower Back Pain That Radiates to the Hips or Legs, Often Worsens with Bending or Sitting)

  • Facet Joint Syndrome (Deep Aching Back Pain That Worsens with Twisting or Extension Movements)

  • Kidney Issues (Pain in the Flank Region, May Be Accompanied by Other Symptoms Like Fever or Changes in Urination)

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

  • Thoracic Spine Dysfunction (Limited Mobility in the Upper Back, Worse with Twisting or Slouching)

A thorough spinal, rib, and pelvic examination is necessary to rule out these conditions.

Associated Trigger Points

Longissimus thoracis trigger points often co-exist with:

  • Quadratus Lumborum (Lower Back and Rib Pain, Contributes to Postural Instability)

  • Iliocostalis Thoracis (Mid-Back and Rib Pain, Affects Spinal Mobility and Breathing)

  • Latissimus Dorsi (Thoracic and Shoulder Pain, Common in Overhead Movements)

  • Gluteus Medius and Minimus (Hip and Lower Back Pain, Affects Pelvic Alignment and Walking Mechanics)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Longissimus Thoracis Iliac crest, sacrum, lumbar vertebrae Thoracic vertebrae, lower ribs Dorsal rami of spinal nerves (T1–L2)

The longissimus thoracis is innervated by the dorsal rami of thoracic and lumbar spinal nerves, which also control postural stability and spinal extension.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the mid-to-lower back and ribcage.

  • Resisted Back Extension Testing: Assess pain and weakness when extending the spine against resistance.

  • Gait and Posture Analysis: Look for hip instability, excessive lumbar curvature, or postural strain.

  • Respiratory Function Testing: Rule out restricted breathing due to rib tightness or thoracic dysfunction.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the longissimus thoracis, reducing muscle tightness and improving spinal mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the mid-back and lower ribs.

  • Massage Therapy: Helps improve circulation and reduce thoracic and lumbar muscle tension.

Stretching

  • Side Stretch: Stand and gently lean sideways to stretch the longissimus thoracis.

  • Cat-Cow Stretch: Improves spinal flexibility and relieves tension in the thoracic and lumbar regions.

Strengthening Exercises

  • Superman Exercise: Strengthens the lower back and core for better spinal stability.

  • Bird-Dog Exercise: Improves core activation and reduces strain on the mid-back.

  • Thoracic Extension Drills: Helps restore proper spinal alignment and mobility.

Postural and Movement Adjustments

  • Avoid Prolonged Sitting Without Back Support (Take Standing Breaks Every 30–60 Minutes)

  • Use Proper Ergonomics at Work (Maintain a Neutral Spine to Reduce Mid-Back Strain)

Practice Deep BreathingExercises (Encourages Proper Rib Expansion and Reduces Back Tightness)

Conclusion

The longissimus thoracis plays a crucial role in spinal extension, rib mobility, and postural stability, but trigger points in this muscle can cause significant mid-back, rib, and lower back 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

➡️ Explore our Trigger Point Index

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.