Effectiveness of Myofascial Release Technique in Latissimus Dorsi Myofascial Pain with Referred Shoulder and Chest Symptoms: A Case Study

Abstract

Background: Latissimus dorsi is a broad superficial muscle that links the thoracolumbar fascia, pelvis, lower ribs, scapular region, and humerus. Because of this extensive anatomical relationship, restriction or trigger point activity in this muscle can influence shoulder motion, thoracic posture, scapular control, breathing comfort, and functional upper-limb use. Myofascial pain arising from the latissimus dorsi may present as pain in the posterior shoulder, axillary fold, lower scapular region, lateral trunk, or anterior chest wall. In clinical practice, these symptoms may be misinterpreted as primary shoulder pathology, rib dysfunction, cervical referral, or chest-related disease. After appropriate medical screening, physiotherapy management directed toward the myofascial source can be valuable for reducing symptoms and improving function. Myofascial release is a manual therapy approach that uses sustained pressure, slow fascial stretch, trigger point release, and guided movement to reduce tissue sensitivity, improve extensibility, and normalize movement patterns.

Presentation of a Case: This case study presents a 36-year-old male patient with right-sided latissimus dorsi myofascial pain associated with referred posterior shoulder discomfort, axillary tightness, and intermittent non-cardiac anterior chest wall symptoms. The patient reported pain during overhead reaching, pulling activities, prolonged computer work, deep inspiration after exertion, and sleeping on the affected side. Examination revealed localized tenderness over the right latissimus dorsi, taut bands near the posterior axillary fold, painful restriction of shoulder flexion and abduction, increased tone of the latissimus dorsi, altered scapular mechanics, and reduced functional confidence during overhead and cross-body activities.

Intervention: A structured phase-wise physiotherapy program was implemented over six weeks. The program included myofascial release of the latissimus dorsi and related thoracolumbar fascia, trigger point pressure release, soft tissue mobilization, breathing-assisted fascial stretch, scapulothoracic mobility exercises, shoulder range-of-motion training, postural correction, progressive strengthening of the rotator cuff and scapular stabilizers, ergonomic advice, and home-based self-release and stretching activities.

Outcome Measure: Pain was measured using the Numerical Pain Rating Scale. Shoulder and thoracic mobility were measured by goniometry and functional observation. Muscle tone and tenderness were assessed by palpation. Muscle performance was assessed using Manual Muscle Testing. Functional improvement was assessed through overhead reach, dressing, sleeping comfort, desk-work tolerance, pushing and pulling ability, chest symptom frequency, and upper-limb activity tolerance.

Result: The patient demonstrated significant reduction in resting pain, activity-related shoulder pain, chest wall discomfort, and soft tissue tenderness. Shoulder flexion, abduction, and thoracic rotation improved. Latissimus dorsi tone decreased, scapular upward rotation improved, and functional reaching became more comfortable. The patient reported better sleep, improved sitting posture, reduced fear related to chest symptoms, and improved ability to perform gym and work-related activities within the advised limits.

Conclusion: This case study supports the clinical usefulness of myofascial release technique as part of a structured physiotherapy program for latissimus dorsi myofascial pain with referred shoulder and chest symptoms. Careful screening, accurate localization of myofascial findings, graded manual therapy, movement retraining, and patient education were important for successful recovery.