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Latissimus Dorsi  Audio

Integrated functional anatomy of the latissimus dorsi. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common activation exercises, foam rolling, stretching, and strengthening exercises for the lats. 

Latissimus Dorsi 

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This course describes the anatomy and integrated function of the latissimus dorsi muscle (a.k.a. the lats, lats muscle, back muscle, and lat dorsi muscle). This muscle originates on the thoracic vertebrae, thoracolumbar fascia, lumbar vertebrae, iliac crest, and inferior angle of the scapula (shoulder blade), inserts into the intertubercular groove of the humerus (upper arm), and is innervated by the thoracodorsal nerve. This muscle is the largest skeletal muscle of the upper body, and is located on the posterior thorax (trunk and ribs); superficial to the lumbar extensors and core muscles. The latissimus dorsi is composed of an even distribution of type I muscles fibers and type II muscle fibers; however, the muscle fiber composition may be biased toward type II fibers. The latissimus dorsi muscle crosses the shoulder joint (glenohumeral joint), is the prime mover of shoulder adduction and extension, will contribute to shoulder internal rotation, and may contribute to lumbar extension, lumbar lateral flexion, and lumbar rotation. This course also describes the role of the latissimus dorsi muscle in glenohumeral arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the latissimus dorsi for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. loss of extensibility (tight lats), latissimus dorsi muscle strain, thoracodorsal nerve injury, recovery from latissimus dorsi flap orthopedic surgery, shoulder impingement, etc.), the synergistic function of the latissimus dorsi (e.g. extension and lateral flexion of the lumbar vertebra in synergy with the erector spinae), and latissimus dorsi exercises and techniques for enhancing sports performance (e.g. shoulder stability, strength, power, upper arm and back hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the Latissimus Dorsi (see videos below):

Latissimus Dorsi Self-administered Release Technique

Manual Latissimus Dorsi and Internal Rotator Stretch

Cadaver dissection of the latissimus dorsi muscle on the posterior side of the body

 Course Description: Latissimus Dorsi

The attachment of the latissimus dorsi muscle on the pelvis, thoracolumbar fascia and shoulder

By User:Mikael Häggström - Image:Gray409.png, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2892603

 (“widest, broadest”), superlative of 

 early 15c., from Old French dorsal (14c.) or directly from Medieval Latin dorsalis, corresponding to Latin dorsualis "of the back," from dorsum "back," which is of uncertain origin. (

Cadaver dissection of the latissimus dorsi muscle

Latissimus Dorsi Cadaver - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/db1a_animated.gif

The attachment of the shoulder muscles including the pectoralis major, latissimus dorsi, and bicep muscles

Attachments & Innervations: Latissimus Dorsi

The location of the latissimus dorsi muscle on the skeleton

Where is the Latissimus Dorsi Located

The muscles on the posterior side of the body, including the latissimus dorsi

Palpating the Latissimus Dorsi

Introduction to the Latissimus Dorsi

Shoulder: Primary adductor and extensor; contributes to internal rotation

Note: The latissimus dorsi does not contribute to horizontal abduction (as in wide grip/horizontal rows & reverse flyes)

Scapula: Medial slip that inserts into inferior angle may contribute to depression, downward rotation, and retraction (3, 8).

Spine: Extension, lateral flexion, ipsilateral rotation (3, 11)

Pelvis: Anterior pelvic tilt, ipsilateral elevation (10,11)

The nerves of the brachial plexus

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 807, Public Domain, https://commons.wikimedia.org/w/index.php?curid=541662

Every muscle produces an equal amount of force at both proximal and distal attachments. Movement at one attachment may be relatively fixed due to the type of joint, the motion allowed by that joint, or a much broader attachment dispersing force across a larger area. Although the latissimus dorsi disperses force over a larger area at its proximal attachment during activity; the impact of that force on the lumbar spine and pelvic motion cannot be ignored.

 Shoulder, scapular, lumbar spine, sacroiliac joint via attachment to thoracolumbar fascia and pelvis

Shoulder: flexion, abduction & external rotation

Scapula: elevation, protraction & upward rotation

Lumbar Spine: Flexion, contralateral flexion & contralateral rotation

Internal Rotation: The latissimus dorsi is a powerful internal rotator that acts synergistically with the pectoralis major (and subscapularis) in overhand throwing motions.

Extension and Adduction: The latissimus dorsi is the prime mover, acting synergistically with the 

 and long head of the triceps (and often the 

Lumbar Extension (Anterior Pelvic Tilt): Acting on the thoracolumbar fascia and posterior ilium the latissimus dorsi is a powerful extensor of the lumbar spine acting synergistically with the 

When the force of the latissimus dorsi on the thoracolumbar fascia is matched by the 

; the increase in tension improves the stability of the lumbar spine, sacroiliac joint & pelvis and helps to maintain optimal lumbopelvic alignment. This is discussed further under 

: The latissimus dorsi, as a "global muscle" of the core, may become synergistically dominant for an inhibited 

. This is relatively common in those individuals with 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 you can see evidence of this relationship during an 

overhead squat assessment with modification

. When the individual maintains their hands overhead they keep a near-neutral spine. (The stretched lats balance the significant force created by the anterior global trunk muscles when the 

 is inhibited.) When they do a squat with their hands on their hips, they lose the posterior support of the latissimus dorsi, and the 

Posterior view of muscles attaching to the pelvis, including the latissimus dorsi

By Zyryab at English Wikipedia, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=22698733

Latissimus dorsi: Note the ability to pull the humeral head anteriorly and inferiorly and internally rotate the shoulder

Arthrokinematics

Latissimus Dorsi Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

 The thoracolumbar fascia is a complex network of communicating fascial sheaths, spanning many articulations and invested by many muscles. The latissimus dorsi invests into the most superficial layer of the thoracolumbar fascia which runs continuous, crossing the lumbar vertebrae and SI joint, and investing into the 

 and medius (via the gluteal aponeurosis) - this is often referred to as the 

 or "posterior oblique sling". Research has shown that increased tension in the latissimus dorsi will contribute to the rigidity of the thoracolumbar fascia and increased stiffness (stabilization) of the lumbar spine and hip, implying a function in load transfer between the lower extremity, spine, and upper extremity (17, 18, 20). Further research has shown that low back pain results in reduced fascial shear between layers of the thoracolumbar fascia (19), a decrease in gluteus medius activity (22), leaving the question of how the latissimus dorsi may be affected when the 

 shows signs of dysfunction. The fiber direction between the latissimus dorsi, thoracolumbar fascia, and contralateral gluteus maximus implies an important relationship in the stabilization of the sacroiliac joint, and potentially load transfer and muscle synergy during cross-body patterns, often seen in functional tasks (e.g. arm and opposite leg extend at the same time during gait).

A cadaver dissection of the lats and traps on the posterior side of the thoracic spine

Latissimus Dorsi/Thoracolumbar Fascia via http://www.rvuanatomy.com

 The teres major shares a similar fiber direction, performs all of the same joint actions and invests in the anterior humerus adjacent to the latissimus dorsi. Although the teres major will not play a role in lumbosacral mechanics; the teres major and latissimus dorsi should be considered a pair at the shoulder; potentially a pair whose activity is mediated by a fascial relationship. Further, the latissimus dorsi also shares a nearly continuous fascial connection via the medial intermuscular septum with the pectoralis major (6). All 3 of these muscles may assist in adduction and internal rotation; however, it is unclear how this relationship affects extension. These muscles do have a propensity to become short/overactive during postural dysfunction, and all 3 muscles play a role in throwing motions.

Fascial integration of the latissimus dorsi, teres major, and pectoralis major at the shoulder joint

Fascial Integration of Latissimus Dorsi, Teres Major and Pectoralis Major at the Shoulder - https://ittcs.files.wordpress.com/2010/11/img_0350.jpg?w=500&h=675

Posterior oblique subsystem (notice latissimus dorsi, thoracolumbar fascia and gluteus maximus)

Subsystems

Fascial Integration

Several clinicians and texts have alluded to the propensity of the latissimus dorsi to become 

 It should be mentioned that this may happen unilaterally, especially as a result of SI joint dysfunction.

 present with limitations in shoulder flexion and abduction and a resting posture that includes excessive humeral internal rotation (1, 2). Further, the excessive anterior glide of the humerus may accompany this dysfunction (21). A short/over-active latissimus dorsi may contribute to all of these attributes.

Generally, those exhibiting LPHCD present with an anterior pelvic tilt and excessive lumbar lordosis (extension). The latissimus dorsi via its broad origin may contribute to both an extension moment of the lumbar spine and to an anterior tilt of the pelvis. Relative to the lumbopelvic hip complex the latissimus dorsi could be grouped with other short/over-active 

 and LPHCD should be considered when an individual exhibits a change in 

. Attempting to correct latissimus dorsi length and activity with 

, will likely have a little long-term effect if alterations in length and activity stem from the lumbopelvic hip complex and visa-versa. For more on the differentiation between 

The latissimus dorsi may be affected by the relative rotation (anterior and posterior) of the pelvis, may contribute to superior glide of the innominate on the sacrum, and may be affected by changes in thoracolumbar fascia tension. It has been my experience that SIJD may masquerade as upper body or shoulder dysfunction. It would appear that SI joint dysfunction may lead to an increase in latissimus dorsi activity on the same side. Often these individuals will exhibit "arms fall forward" during an overhead squat assessment, present with increased kyphosis or shoulders internally rotated in static posture, be limited in shoulder flexion, but when other muscles associated with upper body dysfunction are tested no dysfunction is found. Addressing the lumbopelvic hip dysfunction and mobilization of the SI joint will result in a return of optimal latissimus dorsi extensibility (sometimes some stretching of the latissimus dorsi is required) and a return to optimal upper body posture.

The Bridge: The latissimus dorsi is often referred to as the bridge between upper and lower body dysfunction. It is the one upper body muscle that also plays a role in altering pelvic position. For example, if an individual adopts 

 including internally rotated shoulders, this will increase latissimus dorsi muscle activity and eventually result in adaptive shortening. This increase in activity and change in length may be transmitted to its proximal attachment resulting in an increased lumbar lordosis and an anterior pelvic tilt. If the anterior pelvic tilt persists, other muscles will be affected and dysfunction will perpetuate. This scenario may be reversed - altered pelvic position leading to 

 the latissimus plays no significant role.

, the latissimus dorsi has a propensity to become 

, and Sacroiliac Joint Dysfunction (SIJD), implying that this muscle should be a focus of 

 techniques. However, the latissimus dorsi is also the prime mover for "pulling" motions and will be stressed during 

. It may be appropriate to stretch and release the latissimus dorsi before and after training, and mobilization of the shoulder and the thoracic spine may prove helpful in normalizing tone and function of this muscle. Licensed professionals (PT, ATC, DC, OT, DO) may find manual mobilization techniques beneficial. A comprehensive warm-up including activation, integration, and reactive techniques is recommended if max strength or power training will immediately follow flexibility training. Videos on techniques specific to the latissimus dorsi are below.

Excessive Lordosis (Anterior Pelvic Tilt):

 Short/Over-active on side of dysfunction

Palpation results in tenderness (trigger points or tender points) and may result in radiating symptoms along the border of the scapular, down the medial aspect of the arm, posterior shoulder, or along the posterior aspect of the obliques.

Postural Dysfunction and the Latissimus Dorsi

Latissimus Dorsi and Teres Major SA Static Release

Latissimus Dorsi and Teres Major Dynamic Release Technique

Latissimus Dorsi, Erector Spinae Static Stretch (Child's Pose)

Latissimus Dorsi Active Stretch (Child’s Pose)

Latissimus Dorsi Dynamic Stretch

Exercises and Techniques for the Latissimus Dorsi

Additional Materials on Latissimus Dorsi Strengthing

Standing Rows

Suspension Rows

Pull-Ups and Progressions

Kneeling Cable Pull Down

Chaos Row

Power Row (Sled Pull)

Rope Row

Latissimus Dorsi Strengthening Progressions

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Konrad G, Jolly J, Labriola J, McMahon P, Debski R. Thoracohumeral Muscle Activity Alters Glenohumeral Joint Biomechanics During Abduction. J Ortho. Res 24:748, 2006

Vleeming A, Pool-Goudzward AL, Stoeckart R, et al. The Posterior Layer of the Thoracolumbar Fascia: Its Function in Load Transfer from Spine to Legs. Spine 20:753-758, 1995

Carvalhais, VO., Ocarino, Jde M., Araújo, VL., Souza, TR., Silva, PL., Fonseca, ST. (2012). Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment. 

Langevin, H., Fox, R., Koptiuch, C., Badger, G., Greenan-Nauman, A., Bouffard, N., Konofagou, E., Lee, W., Triano, J., Henry, S. (2011) Reduced thoracolumbar fascia shear strain in human low back pain. BMC Musculoskeletal Disorders. 12: 203.

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

Cooper, N., Scavo, K., Strickland, K., Tipayamongkol, N., Nicholson, J., Bewyer, D., Sluka, K. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. J Euro Spine. 26 May 2015

Shin S, Kim T, Yoo W. (2013). Effects of various gait speeds on the latissimus dorsi and gluteus maximus muscles associated with the posterior oblique sling system. 

Bibliography

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Latissimus Dorsi

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