what will be the effects of latissimus muscle stretching on symptoms in patients with chronic mechanical low back pain???
need the supported evidence
because as per my clinical observation the latissimus dorsi tightness is common the chronic patients of mechanical low back pain.
thats why we want to investigate the issue by a research study.
Dear Mr. Urrehman: It depends......
If we assume the tight muscle is exhibiting hyper-tonus ( it is shortened - activated - and obviously not at rest )
AND if we can reasonably propose the reason for this status is the muscle body is shortened to an observable amount, - as per this article:
https://www.sciencedaily.com/releases/2010/06/100624091755.htm
"Muscles have sensory organs called muscle spindles. Their task is to inform the brain of changes in muscle length. Muscle spindles therefore contain a special type of large diameter nerve filaments that signal stretch of the muscle. The Umeå scientists' studies show that muscle spindles also contain fine nerve filaments with pain receptors. When a muscle is damaged as a result of overloading, these pain receptors are activated by the release of a signal substance from the neighboring stretch-sensitive nerve filaments in the muscle spindle."
I would conclude that:
Deep tissue massage is the best approach to over stimulate nerve fiber and result in a reduction of spindle cell firing, - this along with heat will tend to improve circulation in regard to capillary flow - as a result of reduction of tissue edema. This was the observation of 1900's German research as translated by Dr. David Simons.
Incorrect stretching ( you will need to choose ) poses a risk to damage tissue and to further activate muscle spindle cells.... Thus extending the problem.
Failure to reduce edema in tissue will reduce micro-circulation ( capillary level ) - lack of use of heat or the use of cold will reduce plasma leakage and lymph recirculation, - this and chronic tension in the muscle body will result in tendinosis, - and likely pain from the tendon collagen damage.
Tendinosis not tendinitis: http://www.ncbi.nlm.nih.gov/pubmed/20086639
Avoiding agressive stretching until the muscle spindle cells are approximating normal and the muscle body is relaxed is a #1 concern.
Questions?
It all depends on where the origin of the back pain is to start. Is it discogenic, is it facetogenic, is it myotongenous? Mechanical back pain although is thought of as non-specific....I don't believe it. If it is the disc annulus that is the symptom generating patho-anatomical tissue, one scenarios is a tight Lat Dorsi would exert further intervertebral disc s) compression an in turn lead to possible nuclear migration to the interposed disc annulus granulation tissue. So, your question is very difficult to answer unless we know the origin of the mechanical back pain to start with.
The lattisimus dorsi has his origo directly in teh fascia thorco lumbalis and is with the mucle gluteus maximus on the other side reponsible to hold the fascia on an good alignment. When there are back problems that will the core stability have more problems and is the alignment of the fascia diificult. There fore there can be an higher tone neccesary to correct the wrong alignment. Streching of the muscle without knowing why can give more problems of the back. An example has Henri Kiers found that patient with back problem has more difficulty to hold the balans on an instable surface and than must the tone of the lattissimus increased to cope with this problem. Therefore find out first why the tone is increased before start an treatment
Suuces
jan van de Rakt
I agree with both Fryer and van de Rakt on this subject low back pain origin is diverse in evolution and its implication cannot be limited to one specific entity such as the Latissimu dorsi. Clinically, we are dealing with a musculoskeletal condition which by extension could even present with neurological entities. Stretching, manipulating or mobilizing the Latissimus dorsi will definitely not be required in a large population of patients depending on the aetiology. I suggest a massive screening to identify those who will benefit from your proposed treatment. It is also imperative to check the epidemiology of Latissimus dorsi dysfunction in low back pain.
Dear Shakil,
that's an interesting topic. What kind of research are you thinking about?
As my previous colleagues already said, you should define the condition of shortened lats. How do you test for this? You con probably find some help in the work by Shirley Sahrmann and by Kendall& Kendall (Muscle testing and function). LBP due to tight and shortened fascia thoracolumbalis and this again due to a short lats, that's quite tricky to show. You may think of intervening with a lats stretch (which has to be addressed specifically) compared to stretching of other muscles which also attache into the fascia thoracolumbalis.
Good luck for that study, I'm already interested in your methods and results
Markus
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