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Atlas · Mid Back

Latissimus Dorsi

Latissimus dorsi links the lower trunk to the upper arm and contributes to pulling the arm down and backward. Pain near the posterior armpit after pulling or throwing needs comparison with tendon injury, adjacent shoulder muscles and rib or nerve symptoms.

Latissimus Dorsi
Body region
Mid Back · Upper Back
Trigger points
4
documented in this muscle
Common symptoms
3
patterns cataloged
Contributors
3
Factors to assess

Muscle overview

Symptoms and first steps

Practical first steps

  • Reduce high-force pulling temporarily while keeping comfortable shoulder motion.
  • Use a lighter row or supported reach rather than testing painful pull-ups repeatedly.
  • Rebuild load and sport speed in separate steps.

When to seek assessment

  • A sudden pop, posterior-axillary bruising or marked pulling weakness needs examination.
  • Persistent hand numbness, unexplained abdominal or flank symptoms, or pain with breathlessness requires assessment beyond the muscle.

Latissimus and teres major share the posterior axillary fold but have distinct humeral attachments. Sudden bruising or weakness in this fold after throwing or a heavy pull warrants an injury assessment.

Examination, palpation and treatment evidence

Illustrated overview

Latissimus Dorsi

Blue highlights the muscle. Crosses mark representative trigger-point sites; shaded areas show possible referred pain. These examples do not correspond one-to-one with the numbered points below. Patterns vary and cannot diagnose the cause of pain.

Illustrated overview

Latissimus Dorsi · Anatomy and referred pain 1

Representative source regions. The illustrated markers and pain pattern are not individual assignments to the numbered trigger points.

Open full-size image

Trigger points

1. TrP1

Location. Mid to lower back, side

Trigger point map
Latissimus Dorsi — Latissimus Dorsi · Trigger-point examples 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Referred pain map
Latissimus Dorsi — Latissimus Dorsi · Referred-pain pattern 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Pain referral. Posterolateral trunk and shoulder region

Pain Pattern

  • Posterolateral thorax
  • Posterior shoulder and axillary fold

What This Pain Feels Like

Pulling or reaching overhead may provoke posterolateral trunk or shoulder pain. Compare the posterior axillary fold, shoulder and ribs. Accompanying hand, abdominal or unexplained flank symptoms need their own assessment.

What Patients Report

  • Posterolateral back ache
  • Pain near the posterior armpit
  • Pain during pulling or reaching

What Makes It Worse

  • Pull-ups
  • Swimming
  • Reaching overhead
  • Rowing
  • Carrying heavy bags
  • Coughing
Browse related exercises (9)

Symptoms patients report

Posterior armpit pain with pulling Compare a row, pull-down or climbing movement at a tolerable load.

Discomfort with overhead reach Record shoulder range and whether trunk extension substitutes for the lift.

Acute pain after throwing or a forceful pull Inspect for bruising, a changed fold and strength loss.

Contributors to assess

Increased pulling volume Review swimming, climbing, rows and pull-downs, including rest between sessions.

High-force throwing or traction A discrete event can injure the latissimus or teres-major tendon.

Shoulder mobility and task demands Limited comfortable elevation can alter how the trunk and shoulder share the movement.

For clinicians and supervised training

Clinical reference

Finger tingling, abdominal symptoms and unexplained flank pain require separate assessment; a latissimus pain map cannot establish their source.

Anatomy and palpation

Anatomical relationships

Latissimus arises broadly from the lower thoracic spine, thoracolumbar fascia, iliac crest and lower ribs. It narrows toward the posterior axillary fold and attaches to the floor of the humeral intertubercular groove, contributing to extension, adduction and internal rotation.[1][2]

  • The posterior axillary fold contains latissimus and teres major.
  • The broad superficial sheet extends over the posterolateral lower thorax toward the iliac crest.

Nearby structures. Teres major inserts on the medial lip of the groove; pectoralis major inserts laterally. The thoracodorsal neurovascular bundle runs on the deep surface of latissimus. Ribs and intercostal tissues lie beneath its thoracic portion.

Palpation

Patient position. Side lying with the arm supported slightly forward, or seated with a supported arm and relaxed trunk.

Find the landmarks

  • Locate the posterior axillary fold from the outside, without entering the axillary hollow.
  • Follow the superficial muscle sheet down the lateral back toward the lower ribs.

Examination sequence

  1. Inspect the fold and lateral chest for swelling or bruising.
  2. Ask for a gentle downward/backward press of the supported arm to orient to the muscle, then relax.
  3. Compare light contact over accessible tissue and repeat a comfortable pull or reach.

Document the findings

  • Familiar load-related local pain can guide rehabilitation.
  • Focal tendon-region pain, bruising or contour change after injury needs a separate tear assessment.

Limits and precautions

  • Avoid deep axillary pressure or attempts to reach through the rib cage; do not needle or inject from atlas coordinates.
[1][2]

Examination and tests

2

Graded shoulder adduction and extension[1][2]

Compare pulling strength and localize effort-related pain.

Position
Seated with elbow bent and upper arm slightly forward, supported in a comfortable position.
Technique
Resist a gentle downward/backward press at the upper arm while limiting trunk lean. Compare pain location and force, then test each direction separately if needed.
Positive finding
Familiar posterior-axillary pain or substantial side-to-side weakness.
Interpretation
Provides a pulling-load baseline; marked loss after trauma raises concern for latissimus/teres-major injury.
Limitations
Teres major, pectoralis and posterior deltoid can contribute. This is not an isolated-muscle or trigger-point test.

Supported overhead reach with trunk control[1][3]

Assess available shoulder elevation and compensatory trunk motion.

Position
Supine with knees bent and ribs relaxed, or seated with the back supported.
Technique
Raise the arm slowly with the thumb upward while observing trunk extension. Compare comfortable assisted motion and the other side; record where pain occurs.
Positive finding
Restricted elevation, posterolateral pulling discomfort or substantial trunk substitution.
Interpretation
Helps select a tolerable reach exercise and identifies the need for shoulder joint/cuff assessment.
Limitations
Range depends on the joint, cuff, pectoral muscles and trunk; it does not measure isolated latissimus length.

Distinguishing other causes

Latissimus or teres-major tendon injury[2]

Findings that matter. A sudden throwing or pulling event, posterior-axillary bruising or altered contour and weakness.

Next step. Arrange sports/orthopaedic assessment; imaging must include the relevant tendon and injured region.

Rotator cuff-related shoulder pain[3]

Findings that matter. Painful elevation or cuff loading with broader shoulder symptoms.

Next step. Use a regional shoulder examination and rehabilitation plan.

Peripheral nerve or cervical disorder[3]

Findings that matter. Persistent distal tingling, sensory change or weakness extending beyond shoulder pulling.

Next step. Perform a neurological examination rather than assuming finger symptoms are muscular referral.

Rib, chest-wall or nonmusculoskeletal pain[1][3]

Findings that matter. Focal rib pain, breathing-related symptoms, systemic illness or unexplained abdominal/flank complaints.

Next step. Examine the relevant chest or abdominal presentation before local muscle treatment.

Treatment selection and progression

Self-care and activity

Adjust pulling and overhead volume[1][2]

Consider when. Stable load-related symptoms after significant injury has been excluded.

Reduce the most provocative pull-ups, rows or swimming sets. Use lighter supported pulling and comfortable reach to retain activity.

Dose and review
Trial a lower-load week with the same daily symptom and activity record.
Progression
Restore repetitions, then resistance or sport speed, changing one variable at a time.
Stop or reassess
An acute pop, bruising or progressive weakness requires reassessment.
Evidence and limits
This is a practical load-management adaptation. Injury series support individualized rehabilitation rather than a fixed return date.

Exercise and rehabilitation

Graded pulling and shoulder reach[1][3][2]

Consider when. Assessed muscle-region pain or a cleared injury rehabilitation program.

Begin with a supported overhead slide and a light row with the elbow near the trunk. Add resisted adduction or extension when comfortable.

Dose and review
Starting example: one set of 6–8 controlled repetitions on alternate days, adjusted to symptoms and injury stage.
Progression
Increase comfortable range and load before faster throwing, swimming or climbing demands.
Stop or reassess
Reduce exercise for lasting aggravation; new weakness or contour change needs examination.
Evidence and limits
Movement selection follows muscle function and shoulder rehabilitation principles. There is no validated latissimus trigger-point exercise dose.

Clinician-delivered care

Supervised rehabilitation after a latissimus-region injury[2]

Consider when. A diagnosed latissimus/teres-major injury selected for nonoperative care.

A sports clinician stages recovery of comfortable motion, pulling strength and sport-specific loading, using injury location and severity to guide progression.

Dose and review
Set review intervals and loading stages from the individual injury. A ten-pitcher series aimed for return at three months; that is not a deadline for other patients.
Progression
Restore controlled adduction/extension and repeated sport tasks before full-speed return.
Stop or reassess
Recurrent acute pain, loss of force or inability to progress warrants repeat injury assessment.
Evidence and limits
The small uncontrolled series reported return to pitching in all ten athletes, with one recurrence and one later retirement for ongoing symptoms. It cannot identify an effective local injection, laser or massage protocol.

Reassessment and follow-up

  • Compare pulling pain and force with the same elbow, shoulder and trunk position.
  • Record overhead range and the amount of trunk substitution.
  • Track row/pull-down load, repetitions and next-day response before adding speed or sport volume.

Evidence and sources

  1. University of Washington Muscle Atlas: Latissimus Dorsi

    2026 · University anatomical reference

    Accessed September 2026; access year. Supports attachments, actions and innervation. Examination contacts and starting exercises below are clinical adaptations, not validated trigger-point tests.

  2. Latissimus dorsi and teres major tears in professional baseball pitchers: a case series

    2009 · Injury case series

    Ten pitchers with MRI-confirmed latissimus/teres-major injuries received nonoperative care. Nine returned at three months, but there was no comparator. Imaging must cover the injured tendon; this is not a general recovery deadline or myofascial-treatment trial.

  3. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline

    2025 · Clinical practice guideline

    Assessment, education and active rehabilitation for rotator cuff tendinopathy. Recommendation 26 permits regional manual therapy for short-term pain relief; no isolated deltoid or latissimus effect or universal manual dose is established.

Associated Trigger Points