Latissimus Dorsi, Rhomboids, Teres Major and Posterior Deltoid Vibration Release

Key Practical Points from Effects on Local Vibration

• Pre-exercise local vibration reduces functional signs and chemical markers of delayed onset muscle soreness (DOMS) and may improve performance in subsequent frequent workouts.
• Local vibration is effective for reducing acute muscle pain (and can be added to a home program via the devices like the Hypervolt by Hyperice® or similar devices).
• Local vibration alone may be sufficient to increase strength in deconditioned muscles/individuals.
• Current research implies that adding vibration to self-administered release techniques (SMR) (e.g. foam rolling) enhances benefits for DOMS, pain pressure sensitivity, and increasing proprioception. Further research is needed to refine protocols and determine whether adding vibration to SMR enhances benefits for increasing range of motion and improving power performance when used as a warm-up.

Protocol for Using Percussion Massage Device

1. Start with a higher setting and superficially (with gentle pressure) trace the entire surface of the muscle.
   • Setting 3 is likely appropriate for the lower body.
2. Take a mental note of dense or sensitive points. Manual therapists may use the opposite hand to palpate for taut bands and nodules (trigger points).
   • Stay away from areas where the bone is superficial. Using percussion massage devices over bone may be uncomfortable, painful, and/or cause bruising. Placing a finger or thumb over bony protuberances will prevent accidental contact.
3. Using a piece with a smaller surface area and lower setting (setting 1), return to the dense/sensitive points using deeper compression.
   • It may be helpful to add tension or slack by shortening or lengthening the target tissue
4. The Brookbush Institute recommends 30 seconds to 2 minutes per muscle group, and 5 minutes as an upper limit even in the case of multiple trigger points.

Best Body Position:

• Lying prone with arms out-stretched or hands under forehead (shoulder flexion)
• Child's pose with hands out stretched works well for the latissimus dorsi  if the patient/client can comfortably maintain the position.

Bony Areas: (Block with a thumb or finger when approaching these areas)

• Spinous process
• Spine of Scapula

Muscles:

• Latissimus dorsi is a superficial muscle with a quasi-triangular shape, having a broad origin that runs from the lower thoracic vertebrae to the thoracolumbar fascia to the posterior iliac spine, and narrows as it passes the inferior angle of the scapula, converging into a thick tendon that disappears into the axilla and inserts into the intertubercular groove of the humerus.
  • Common Trigger Points: The inferior angle of the scapula, or 2 - 4 centimeters inferior to the inferior angle of the scapula in the middle of the belly of the muscle.
• Teres Major is a tube-shaped muscle that courses from the inferior angle of the scapula, along the lateral border of the scapula, to an insertion near the insertion of the latissimus dorsi.
  • Common Trigger Points: In the middle of the belly of the muscle, approximately in the middle of the length of the lateral border of the scapula.
• Posterior deltoid is a superficial muscle, that can often be visualized if your patient reaches across to touch their opposite shoulder, revealing a line that "separates" the posterior deltoid muscle from the triceps.
  • Common trigger points: Center of the muscle belly.
• Rhomboids lie deep to the lower trapezius in an area boxed in-between the muscles origin from the C7 to T5 spinous processes, to the muscle's insertion along the vertebral border of the scapula.
  • Common Trigger Point: Along the vertebral border of the scapula