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Fibromyalgia and Myofascial Pain Syndrome symptoms and treatment of the Latissimus Dorsi

This is an excerpt from Fibromyalgia and Myofascial Pain Syndrome by Devin Starlanyl.

This wide, large, flat muscle twists around the teres major and then meshes with it before attaching at the shoulder. It enables the arm to perform multiple motions. It attaches to the hip as well as to the spine, from the bottom of the shoulder blade level to the base of the spine. This muscle links the upper and lower halves of the body. Look at figure 14.13 and note those attachments. If the pelvis is tilted or rotated, this muscle adjusts, causing compensatory rotation above. This power muscle works with the pectoralis to pull the trunk upward. It’s also an accessory muscle of respiration. It helps compress the thorax and abdomen during a hard sneeze or cough. When this muscle is tight, stretching may give little relief, and pain from the pressure of the body on the muscle could prevent uninterrupted sleep. These TrPs cause symptoms often misdiagnosed as chest disease, and can contribute to thoracic outlet syndrome.

Hunting Hints: These TrPs are often found in a cluster over the ribs, just behind and in front of the armpits. TrPs also gather in areas along the side of the ribs, the lateral aspect of the lower ribs, and a little lower than halfway between the armpit and the top of the hip (see figure 14.14). They are associated with a lax, pendulous abdomen, shortness of breath, and stitch in the side. Tennis ball pressure against the wall can find and treat them.

Symptoms: TrPs in this muscle cause a constant ache in the lower inner corner of the shoulder blade, with spillover pain down the little-finger side of the arm and hand, often including the ring and little fingers. That pain doesn’t change much with position or activity. Some patients have numbness and tingling down the arm and those last two fingers, instead of or with the pain. If it hurts to use your arms to rise up from a chair, or hurts to bring an object down from an overhead shelf, these TrPs may be calling. Latissimus dorsi TrPs are felt during sneezing and coughing. They may be misdiagnosed as chest disease. They can be associated with C3–C4, C5–C6, and/or C6–C7 vertebral dysfunction. Check other muscles for the TrPs that these TrPs can launch. I’ve experienced the lower distribution TrPs interacting with the intercostals. These TrPs may gang up with TrPs in the pectoralis major, subscapularis, and teres major muscles to cause pseudo–thoracic outlet syndrome.

Treatment Tips: Use pincer palpation with the opposite-side hand to work TrPs residing close to the underarm area, about one to two finger widths below breast nipple level. Use a safe stool or stepladder instead of reaching for heavy objects above. If you develop a stitch in your side when you run, check for these TrPs on the sides, between the top of the hip and the armpit.

Perpetuating Factors: These TrPs can develop when the arms are overused to compensate for low back pain. You may be using your arms to help lift yourself out of a chair, for example. These TrPs are often initiated by lifting overhead weight, such as use of heavy tools at shoulder level, yet down-stroke motions such as pressing down to loosen weeds can be perpetuators as well. Golfing, butterfly-stroke swimming, rowing, climbing, repetitive overhand ball throwing, and similar motions overload this muscle, as can prolonged use of crutches.

Any activity that requires repetitive extension, adduction, and internal rotation of the shoulder can be a perpetuator. People with these TrPs are often unaware of the perpetuating factor. Muscle dysfunction will occur from the latent TrP, but this nagging pain may not occur until long after the initiating event. A tight bra can perpetuate these TrPs if they restrict circulation. Circulation compromise can be compounded by episodic interstitial edema, such as occurs with circulatory problems, or insulin resistance.

Stretch: Stand with your feet together. Lift both arms over your head in a neutral position. To stretch the left side, start by grasping the wrist of your left forearm. Breathe comfortably as you bend to the right, going as far as comfortable. Exhale normally as you return to a neutral position. Switch the arms and repeat this stretch on the other side. To add to that stretch, use your right hand to grasp the wrist of your left forearm, and gently raise the arm upward. Stretch both sides. Pay attention to any unwanted movement or rising of the pelvis during the stretch. If you have difficulty with balance, reposition your feet wider apart. If you can’t raise your arms over your head, try this exercise lying down. If it is still beyond your limits, try the stretch below.

Start in yoga cobra position, breathing normally, holding it no longer than 30 seconds. Imagine you’re a cat stretching after a nap. Gently slide your hands forward until your head is down and your hands are on the floor in front of your head. Don’t overextend your head beyond upright. Turn your hands palm outward, and stretch the fingers too. Relax and exhale slowly. Take a few breaths and then gently and slowly roll over and come back up. This can be done on the bed if getting up from the floor is too much to even contemplate.

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