The Latissimus Dorsi is a large flat triangular muscle in the dorsal region of the torso. It covers the lumbar region and the lower half of the thoracic region and runs in a superolateral direction, gradually narrowing in width as it approaches and crosses over the inferior angle of the Scapula, wraps around the lower border of the Teres Major, and inserts onto the proximal humerus. This muscle extends, adducts, and medially rotates the humerus.
Figure 1• the Latissimus Dorsi Muscle
• Inferior Attachment Sites:
The Spinous Processes of T7-T12 Vertebrae
The Inferior 3 or 4 Ribs
The Thoracolumbar Fascia
The Iliac Crest
• Superior Attachment Site:
The Floor of the Bicipital Groove of the Humerus
Extension of the Humerus
Adduction of the Humerus
Medial rotation of the Humerus.
(It raises the body towards the arm when climbing).
Caution: make sure to assess the structures carefully prior to performing the following techniques. Also, ensure that the tissue has been adequately warmed up before performing any deep techniques.
1. MYOTONIC RELEASE
• Objective: To reduce and potentially eliminate contractures and adhesions commonly found in the lateral aspect of the superior fibers of Latissimus Dorsi (where the fibers cross over the inferior angle of the Scapula and then wrap around the Teres Major muscle). Contractures and adhesions in the SCM can result from chronic repetitive strain injuries, overuse injuries, traumatic muscle strains, and other injuries to the muscle or other structures in the region.
• Positioning: Have your client lying prone with the arms hanging off the side of the table (so that the starting position of the humerus is 90 degrees of abduction). Your client should be fully relaxed.
• To perform this technique, stand at the side of the table of the muscle being treated.
• Technique: First, place the hand closest to the table in a position on the Latissimus Dorsi whereby the contact hand is firmly locked around the inferior scapula, with the webspace of the hand landmarked at the inferior angle of the scapula. Then reinforce the contact hand by placing your other hand on top. (see figure 2)
Figure 2 – starting position and hand contact for a Myotonic Release technique
• Ask your client to bring the arm into an adducted position so that the Latissimus Dorsi is contracted and shortened. This action will rotate the scapula, bringing the inferior angle closer to the midline. Your hand contact, being fixed on the scapula, will move with the scapula.
• With your hand in this position, apply a reinforced thumb pressure to the superior fibers of Latissimus Dorsi. Then ask you client to move the humerus slowly into as much lateral abduction as is comfortably possible (as if doing a shoulder press exercise). This motion of the humerus will force the scapula to rotate, causing the inferior angle of the scapula to move away from the midline. With this lateral movement, your thumb pressure will be forced laterally and superiorly along the length of the superior fibers of the muscle. Maintain a reinforced thumb pressure along the length of the muscle all the way to the end of the movement. At the end of the range of motion, ask your client to bring his arm back to the starting position, and then repeat the movement. Repeat this stroke for a total of 3-5 passes.
This myotonic technique is a very effective technique in that the deep strip addresses contractures, adhesions, and trigger points in the superior fibers of your clients Latissimus Dorsi muscle. In addition, this technique simultaneously adds a range of motion element to the G/H joint, as well as a stretch element to the Latissimus Dorsi muscle itself.
2. ISCHEMIC COMPRESSION
• Objective: To release trigger points (hyperirritable bands within the muscle belly) in the lateral aspect of the superior fibers of the Latissimus Dorsi. Trigger points can occur in muscles due to injury (to the muscle itself or to other structures in the region), or due to overuse. They are a source of local as well as referred pain, and they reduce the flexibility, strength, and overall functionality of the muscle.
• Positioning: Ask your client to lie prone on the table, fully relaxed.
• To perform this ischemic compression to the latissimus Dorsi, stand at the side of the table opposite the muscle you are treating.
• Technique: First, reach across the client’s body, and palpate to find the trigger point in the Latisimus Dorsi. To locate a trigger point, palpate the muscle to feel for a taut band or a twitch response in the muscle belly. A common location of Latissimus Dorsi trigger points is in the superolateral aspect of the muscle belly, just lateral to the inferior angle of the scapula. Once you have located the trigger point, apply an ischemic compression by gradually squeezing the trigger point between the thumb and fingers of both hands. (see figure 3). The client may feel referred pain clustered around the inferior angle of the scapula, and running down the medial aspect of the arm. Keep in communication with your client, checking to ensure that you are staying within the limits of his pain tolerance. Hold this technique for approximately 20 seconds to 1 minute, until your client tells you the pain has diminished, or until you feel the muscle fibers begin to relax under your pressure. Once you feel this release, gradually release your pressure. Once you have released your pressure, apply a few effleurage strokes to flush out the area, and then follow up with a passive stretch to the muscle.
Figure 3 – Ischemic compression to the lateral aspect of the Latissimus Dorsi muscle
3. PASSIVE STRETCH:
• Objective: to lengthen the Latissimus Dorsi muscle. This will help reduce pain from trigger points and muscle tension. As well, it will improve the flexibility, strength, and overall functionality of the muscle by reducing contractures and adhesions. (If scar tissue in the Latissimus Dorsi muscle has been treated with friction techniques, a passive stretch following the friction techniques can help to realign the scar tissue functionally).
• **Stretches are most effectively performed after the muscle has been adequately warmed up with massage and/or properly administered hydrotherapy.
• Positioning: Have your client lying prone. Ask your client laterally bow their torso in a direction opposite to the side of the muscle being stretched. The client’s arm should be relaxed and resting on the table in a position of 45 degrees of abduction and lateral rotation. (see figure 4.1)
• **Prior to performing a Latissimus Dorsi stretch in this position, be sure to communicate with your client about their comfort, especially in the G/H joint. If they have had a prior G/H joint dislocation, this position of the humerus in abduction and lateral rotation can be an unstable and uncomfortable position for your client)
• As the therapist, you will begin your technique standing at the side of the table, facing the top of the table. Grasp the client’s arm with one hand (the hand closest to the table) on the humerus and the other hand on the forearm.
• Technique: To stretch the Latissimus Dorsi muscle, slowly and carefully bring your clients arm into abduction as far as the muscle allows. To move the arm through this motion, you will need to walk around to the top of the table while passively moving your client’s arm. Make sure to perform this stretch in a gentle, sustained manner, and within your client’s pain tolerance. If your client feels pain, then you have gone too far with the stretch. Also, check in with your client during the stretch to ensure that he is breathing properly. Hold this stretch for approximately 30 seconds, and then gradually release the stretch by returning your client’s arm back into the starting position. Repeat this stretch a total of three times.
Figure 4.1 • The therapist has the Latissimus Dorsi muscle in a stretched position.
The techniques highlighted in this article are courtesy of …
The Massage Students Video (DVD) Guide • Volume 1: The Torso
Dwayne Gray, RMT, is president of RMTstudents.com Inc. He is a 2003 Graduate of the 2,200-hour Massage Therapy program at ICT Kikkawa College in Toronto. Dwayne has certified in Active Release Techniques, Hot Stone Massage, Ultrasound Therapy, TENS, and IFC Therapy. He has owned a successful sports injury clinic in Burlington, Ontario, managed the world’s largest team of Registered Massage Therapists under one roof (50) with the Brydson Group, in Toronto, and now independently performs injury rehab treatments in Pickering, ON, while continuing to work to build RMTstudents.com for massage students. He can be contacted through www.RMTstudents.com.