Muscles
Iliocostalis Thoracis Trigger Points
Symptom Area: Upper Back, Shoulder and Arm
Iliocostalis Thoracis Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. Lateral paraspinal column of the thoracic spine; trigger points refer pain around the chest wall and down toward the low back.
Where you feel it
When the Iliocostalis Thoracis holds active trigger points, you usually notice it as abdominal pain, appendicitis-like pains, bloating/nausea/abdominal cramps, low back pain and mid-thoracic back pain. Where the pain spreads: Upward referral toward the upper back and shoulder blade, downward referral toward the lumbar region, and wrap-around pain over the lateral chest wall. What often sets it off: Prolonged flexed sitting, lifting with rotation, sustained forward-leaning work, coughing spells, scoliosis and leg-length asymmetry.
Overview
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.
Trigger point locations
Points lateral to the paraspinal mass at mid and lower thoracic levels, close to the rib angles.
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.
Palpation & testing
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.
Common causes
Prolonged flexed sitting, lifting with rotation, sustained forward-leaning work, coughing spells, scoliosis and leg-length asymmetry.
Self-care & clinical treatment
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.
Treatment protocol
For Iliocostalis Thoracis, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and 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.
Regional precaution for clinicians: Over the upper back and shoulder girdle the pleura lies immediately deep to thin muscle, so pneumothorax is the key risk; needling is performed tangentially or against a bony backstop (rib, scapula), never perpendicular to an intercostal space.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- Burning pain between the shoulder blades at the desk: the trigger points that cause it
- Mid-Thoracic Back Pain: which trigger points cause it and how to treat them
- Bloating/Nausea/Abdominal cramps: which trigger points cause it and how to treat them
- Low Back Pain: which trigger points cause it and how to treat them
- Appendicitis-like Pains: which trigger points cause it and how to treat them
- Thoracic Back Pain: which trigger points cause it and how to treat them
References
- • triggerpoints.net — reference
- • 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
- • 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
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • 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
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • 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
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • 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
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
