The list of attachment sites of the Latissimus Dorsi muscle is extensive. Equally as daunting is the list of movements made possible by this back muscle masquerading as a shoulder muscle. But to know the Lats is to love the Lats. Finding the ability to move with that which is constantly moving just might be the trick when it comes to working on the Latissimus Dorsi.
Rebel Massage Therapist:
My name is Allison. And I am not your typical massage therapist. After 20 years of experience and thousands of clients, I have learned that massage therapy is SO MUCH more than a relaxing experience at a spa. I see soft tissue as more than merely a physical element but a deeply complex, neurologically driven part of who you are. I use this knowledge to work WITH you—not ON you—to create change that works. This is the basis of my approach. As a massage therapist, I have worked in almost every capacity, including massage clinics, physical therapy clinics, chiropractor offices, spas, private practice, and teaching. I have learned incredible techniques and strategies from each of my experiences. In my 20 years as a massage therapist, I have never stopped growing. I currently have a private practice based out of Long Beach, California, where I also teach continuing education classes and occasionally work on my kids. If they’re good.
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0:00:50.0 Allison: Have you ever gone on a diet or subscribed to a food plan, or committed to a juice cleanse and it worked? Like it actually helped you to lose weight or sleep better, or be in less pain or resolve a chronic rash? That's the best feeling. When you find something that works for you, it seems sometimes that we spend our whole lives figuring out who we are and resolving the kinks, and there are an endless number of theories that promise to deliver results, but as you probably already know, finding the one that works for you takes a lot of trial and error, the feeling that you're starting to understand your own body and how it works is awesome. I mean, when your best friend is gluten-free and your partner is low carb and your sister is vegan, how are you supposed to know who to listen to? They all sound so damn convincing, but then you do your own research and you go through your own experiments, and you begin to uncover answers that have eluded you for so long, it's like solving a murder mystery that has been haunting Scotland Yard for centuries.
0:01:52.0 Allison: Move over Sherlock, I get it now. And you may be thinking, "I know where you're going with this, Allison. You've gotta keep trying until you find the techniques that work for you and your clients," which is true, but that's not my point. Yes, this is all true, you can find that food plan that is perfect for you and feel really proud 'cause it took you a decade to get there, and then... Like rules are something that only exist in fairytales, everything changes, eating the same foods doesn't make you feel as good as it used to, or you're gaining weight, but haven't changed anything, or you start developing leg cramps or digestion issues or insomnia, when those things were never a problem before, or they were, but you thought you figured them out, and now you're back to square one, I mean, come on now.
0:02:38.5 Allison: Life is hard enough. My point is, figuring out how the body works is a lot like trying to hit a moving target, if everything would just stand still for a minute, we could get a grasp, there are an infinite number of pieces to the puzzle, and the moment we come close to understanding any of them, much less their relationships to each other, they change, because that's what the body does constantly. It changes as we age, it changes because of life events, it changes because the forces that push and pull are not just physical, and just as soon as we thought we were Sherlock Holmes, we are now Doctor Who. It is incredibly frustrating when all of that work just fizzles, what you thought worked is no longer effective, and starting over is daunting, but here's the thing, it's not that you had it right and life is trying to maliciously pull the rug out from under you, it's that thinking linearly is always gonna disappoint you. Massage and body work, it would follow, is equally as non-linear.
0:03:42.0 Allison: Not only are techniques and modalities always changing, according to the most recent research, and not only are the approaches malleable because all of our clients are different, but the actual parts we work on are not exactly made of metal, the lack of nuts and bolts and hard edges leaves a lot of room for interpretation. This combined with the fact that many of our muscles and tissues attached to so many moving parts, it conjures up images of Elastigirl, also known as Mrs. Incredible, trying to manage a kid who turns invisible, a kid who can't sit still, and a baby who spontaneously combusts, not to mention a husband with a bruised ego, how do we even begin to help her? The answer may be more simple than you think, but before I get there, let's take a look at one muscle in particular that exemplifies this conundrum, the lats.
0:04:38.0 Allison: The Latissimus dorsi, considered by most a shoulder muscle, its attachment sites might make one reconsider. Originating at an extensive bullet point list of bony landmarks and then converging under the armpit and wrapping around to the front of the shoulder, I like to think about the lats like a sweet pea vine, have you seen them? They grow in clusters and wind up trellises using these curly tendrils that literally reach out and look for things to grab on to, so they can continue to climb. I'm about to elaborate on the origin and insertion sites of the lats here, but just keep that sweet pea plant in mind as I do. Rooted in the lower back, the lats main origin is not a bony landmark, but rather the thoracolumbar aponeurosis instead. Officially defined as a broad flat tendon, its purpose is to connect the lats and other low back muscles to the lumbar spine and posterior hip. It is actually more multifaceted than that, and I don't wanna delve too far into it, it might make for a good future episode, but this aponeurosis offers the lats, it's more official bony landmark origins, like the spinous processes of the last six thoracic vertebrae and all five lumbar vertebrae, the smaller, less noted sacral spinous processes which vary in shape and size from human to human, and the posterior iliac crest. All of this to say, this, "Shoulder muscle" has a lot of roots in the low back and hip.
0:06:05.9 Allison: But the origins don't stop there. On the lateral aspect of the thoracolumbar aponeurosis, the lats then grab on to the last three or four ribs and the inferior angle of the scapula. This is where the tendriling starts, these are still considered origins, but one might begin to notice here, not only the varying attachments, but also the moving parts, the inferior angle of the scapula alone may seem insignificant, but it moves a lot and hanging on to a moving part is no small feat. Picturing that sweet pea vine again, the lats press out from between the inferior fibers of the trapezius muscle and the deeper serratus posterior inferior muscle, extend laterally out to dovetail with the external obliques on the ribs, grasp on to that bottom edge of the scapula and then continue on to wind up superiorly towards the axillary area.
0:07:04.0 Allison: This is where things get interesting. As the fibers of the lats dive under the shoulder, they begin to twist around each other, they flip, so that the lower fibers are now the upper fibers and vice versa, they also in this moment, veritably join forces with the teres major and merge into a flat tendon at the floor of the inter-tubercular groove or sulcus at the upper portion of the front of the humerus, this just means that it dives deep and lands in between the two bony protrusions at the top of the upper arm bone, but this is important for a host of reasons. First, the lower fibers that twist up remain relatively vertical and the upper fibers that have twisted down continue more horizontally, which offers deep insights into their abilities and possibilities. Second, this dense portion of the lats also seemingly cups the lateral and anterior portion of the teres major, which in essence doesn't give the teres major much of an option of what it will do when it contracts, lats' little helper? I think more like lats' minion.
0:08:12.3 Allison: And third, the aponeurotic tendon that lies deep in the inter-tubercular groove of the humerus, lives at a particularly convoluted area, there are a lot of muscles here scrambling to grab a piece of the front of the shoulder, like the pec major and the biceps brachii, technically speaking, this area is the embryonic bud of many upper limb muscles, which makes calling the lats a shoulder muscle more understandable, but it is also because of this pre-muscular sheath that we see a few variants as to where the lats officially insert. The tendon of the latissimus dorsi being connective in nature, has been seen here occasionally binding with the tendon of the pec major, or the core co-brachioradialis or the fascia of the biceps brachii, the beginnings of frozen shoulder, perhaps what the lats actually do is another layer perspective of moving pieces. Their most distinguishable actions include extension, adduction and medial rotation of the shoulder, or what it looks like when Pee-wee Herman dances to the song, "Tequila," but because of all the tendrils and the hand holds throughout the back and the shoulder, the lats can also assist in lateral trunk flexion, trunk extension, and even a tilt of the pelvis anteriorly and to the side, and if we consider all of this, the origins, the insertions, the varying possibilities of movement, it becomes clear why working on the lats is a lot like trying to hit a moving target.
0:09:42.9 Allison: Side note, the lats primary focus on the shoulder and secondary capabilities in the side and low back is some good food for thought when considering soft tissue manipulations, but imagine for a moment about what happens when we sneeze, it's kind of like what happens at a night club if all the lights suddenly flip on, the entrancing rhythm and flow comes to a screeching halt while the beat of the techno is still driving in the background, and maybe someone hiccups, so how do we work on the lats? Like I mentioned before, it's not as complicated as you might think, simply put, your approach to the lats must be as fluid as all the moving parts they are associated with, you can work with your client, prone or not, you can work with your clients supine, or not.
0:10:30.0 Allison: You can position your client into sideline or not, you can get into the fibers of the lats via the thoracolumbar fascia or around the inferior angle of the scapula or closer to the axillary area. It doesn't matter how you get to them, what matters is that you see where your client's lats are moving and that you move with them. Believing that there is a blanket approach to address the issues that arise from a tense, strained, overused, or weak latissimus dorsi muscle is going to do nothing but frustrate you. Working with the lats is like trying to hit a moving target, or helping Elastigirl, or weeding around a sweet pea vine, or even keeping the crowd dancing after the lights go on, these are all possible, but only with a deep willingness to move with them. Returning to the idea that figuring out the human body can be a mix of exhilarating and frustrating emotions, figuring out how to work with a muscle like the lats with its complex conglomeration of parts is equally as messy, it is not going to be as simple as learning a protocol and repeating that process.
0:11:39.3 Allison: This may be a philosophy that you already know, but it is so foundational that I think it bears repeating. Seeing beyond the tissues and moving with the worlds held by your client is essential to effective work. Presence with yourself allows you the ability to move with the forces that push and pull. This is not a linear practice, it never has been, it never will be. And here we are, the end of the episode, thank you to the extraordinary crew over at ABMP for helping me get my words into your ears, and if you wanna get any of your words into my ears or more accurately into my brain, via my eyeballs from a computer screen, drop me a line at firstname.lastname@example.org, that's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other rebel massage dabblings.
0:12:57.2 S1: Members are loving ABMP Five-Minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP Five-Minute Muscles delivers muscle-specific palpation and technique videos, plus origins, insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology created in conjunction with Ruth Werner puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today, ABMP members, log in at abmp.com and look for the links in the featured benefits section of your member homepage, not a member, learn about these exciting member benefits at abmp.com/more.