Muscle deep-dives
Iliocostalis Thoracis trigger points: referred pain, palpation and release
A clinical deep-dive on Iliocostalis Thoracis: trigger point locations, the referred pain pattern they produce, palpation landmarks, activating factors and an evidence-based release protocol.
Published:
Why this muscle causes pain
Iliocostalis thoracis is the most lateral of the erector spinae in the thoracic region, running between ribs and helping extend and side-bend the trunk while controlling the spine against gravity. Its referred pain can wrap around the chest and mimic visceral or cardiac pain.
Where the trigger points sit
Points lateral to the paraspinal mass at mid and lower thoracic levels, close to the rib angles.
The referred pain pattern
Upward referral toward the upper back and shoulder blade, downward referral toward the lumbar region, and wrap-around pain over the lateral chest wall.
How to find it by palpation
With the patient prone, palpate a couple of finger-widths lateral to the spinous processes at the rib angles; flat or cross-fibre pressure over the taut band reproduces the familiar pain.
What sets it off
Prolonged flexed sitting, lifting with rotation, sustained forward-leaning work, coughing spells, scoliosis and leg-length asymmetry.
Self-care that actually helps
Thoracic extension and rotation mobility, postural and workstation changes, foam-roller or ball release along the paraspinals. Clinically: needling and manual therapy after screening cardiac or pulmonary causes of chest wall pain.
Symptoms this muscle produces
Clinically, this muscle turns up in the workup of back of shoulder pain, mid-thoracic back pain, abdominal pain, appendicitis-like pains, bloating/nausea/abdominal cramps and low back pain. Those are the complaints its referral zone overlaps, which is why a patient may present with any of them and never mention the muscle itself.
Muscles covered
Studies cited
Every claim in this article traces back to one of the sources below.
- Kietrys 2013 — Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(9):620-34 ↗
- Gattie 2017 — The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133-49 ↗
- Boyles 2015 — Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther 2015;23(5):276-93 ↗
- Charles 2019 — A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther 2019;23(3):539-46 ↗
- Cagnie 2013 — Physiologic effects of dry needling. Curr Pain Headache Rep 2013;17(8):348 ↗
- Fernández-de-las-Peñas 2019 — Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019;12:1899-911 ↗
- Shah 2015 — Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015;7(7):746-61 ↗
- Halle 2016 — Pertinent dry needling considerations for minimizing adverse effects. Int J Sports Phys Ther 2016;11(5):651-62 ↗
- Boyce 2020 — Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther 2020;15(1):103-13 ↗
- Hong 1994 — Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994;73(4):256-63 ↗
- Simons & Travell — Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins, Baltimore ↗
