Neck Pain - Lower Back Pain - Role of Latissimus Dorsi (The Bridge)

Neck Pain - Lower Back Pain - Role of Latissimus Dorsi (The Bridge)

Latissimus dorsi is the strongest muscle of the back, and pain and spasms in this muscle can cause significant lower back pain and worsening neck pain.

It is a very large triangular muscle that extends from the armpit to the lower back. It arises from the lower six thoracic vertebrae, the lumbosacral fascia, the crest of the pelvic bone called the pelvic bone, and also from the lower three to four ribs. It inserts into the bottom of the groove on the upper front of the arm bone (humerus), known as the bicipital groove, and is located very close to the shoulder joint.

Its action is to bring the arm closer to the body (adduction), to roll the arm inward by placing the hand on the back of the body (internal rotation), and to bring the arm backwards (extension). The nerve supply to this muscle is the thoracodorsal nerve, which carries the spinal nerve root fibers of the C6, C7 and C8 nerve roots.

This very strong muscle can lift the body of the ground, such as walking with crutches, climbing a bar, and chinning the body on the horizontal bar. In these activities, it works together with the pectoralis major and abdominal muscles. It is used in swimming, particularly the downward swimming of a creepy crawly, and most swimmers have severely overdeveloped latissimus dorsi muscles, giving them a V-shape with broad shoulders that narrow to a small waist.

Rowing activities are primarily the function of the latissimus dorsi muscle. When pitching baseball, it contracts a lot in the late cocking phase. The acceleration of the arm as in throwing involves a prolongation of the contraction of the latissimus dorsi muscle, making this muscle vulnerable to injury.

Overhead activities, especially resistance activities such as climbing, are conditions that require a prolongation of contractions that injure this muscle. Pulling down and folding up requires a tremendous shortening of the contraction of the latissimus dorsi.

This muscle also lifts the lower ribs and aids in breathing. Many patients with pain and spasms of the latissimus dorsi muscle complain of pain with deep breathing and pain on the sides of the chest wall.

The latissimus dorsi muscle is the bridge between the lower back and the neck. Therefore, the neck and the entire middle and lower back must be treated to properly treat this muscle. When the latissimus dorsi muscle is not functioning properly, shoulder shrug-type lifting-type activities are performed. Therefore, pain along the slope of the shoulders, which is mainly due to pain in the trapezius muscles, cannot be treated by local treatment of only the trapezius muscle. Pain in the trapezius muscle area will therefore recur unless the latissimus dorsi muscle is treated first.

Likewise, the latissimus dorsi must always be treated when treating back pain. Because of its insertions into the thoracolumbar fascia, the latissimus dorsi muscle cannot be properly treated until the gluteus maximus muscle is included in the treatment.

Any symptom of back pain and discomfort must therefore involve the “trio treatment” involving the Gluteus Maximus, Latissimus Dorsi and Trapezius muscles.

Because the latissimus dorsi muscle is constantly subjected to prolonged contractions during activities of daily living, most people suffer from chronic tightness and shortening of this muscle. This results in a significant limitation in the shoulder's range of motion for internal rotation and extension.

Therefore, further injury to the commonly injured C6 and C7 nerve roots will further tighten and shorten the latissimus dorsi muscle, making treatment very difficult.

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