Location The Serratus Posterior Inferior muscle is an important muscle of the back which is frequently overlooked. It originates in the two bottom vertebras in the thoracic spine at the level T11-T12 and two upper vertebras of the lumbar spine L1-L2. It spreads diagonally upward to the outer part of the back, attaching to the lower border of the ribs 9-12.
FunctionThe Serratus Posterior Inferior muscle helps us carry our weight in the upright position, but also to extend and rotate our trunk. It is also one of the muscles that are involved in our respiration. Because of its attachments to the ribs, it is particularly activated with a forceful exhalation. Similarly to superficial paraspinal muscles, the Serratus Posterior Inferior muscle can develop trigger points and cause lots of back pain after prolonger spells of harsh cough.Serratus Posterior Inferior and false kidney stone attackThe muscle is located deep inside the trunk, approximately in the area where the kidneys are located. This is one of the reasons why many people attribute pain in this muscle to the pain originating from the kidneys. Having an acute attack caused by a kidneys stone is something that most people fortunately only heard from anecdotes. Developing pain in this area is however usually the first thing that comes to mind. It is true that pain related to a kidney stone frequently refers pain into the area where the Serratus Posterior Inferior is located. There are several differentiating factors that can help us to rule out pain caused by a kidney stone. One of them is the nature of the pain. Pain due to the kidney stone is usually coming and going in a wave-like pattern with intensifying and subsiding intensity. The pain is present regardless of the body position and most individuals also feel nauseous. Pain due to the trigger point in the Serratus Posterior Inferior, on the other hand, is usually constant. It tends to become more intense with certain body movements. The main differentiating factor, however, is the reproducibility of the pain with firm pressure over the trigger point in the Serratus Posterior Inferior. These are, however, only rough guidelines. Any new pain in the mid-back area should always be evaluated by a qualified health care professional.
Most characteristic pain caused by trigger points in Serratus Posterior InferiorThe trigger points in the Serratus Posterior Inferior refer pain very locally without any specific distal referral pattern. It usually develops as a result of overstretching, when trying to reach for an object overhead, but also as a result of sleeping on a very soft and saggy mattress. Having a good mattress is very important for anybody since we spend quarter to third of our life in the bed. It becomes even more important when back pain is already present. Ideally, mattress should not be extremely hard, but also not very soft. Lastly, repetitive twisting of the torso to one side, such as when picking up and passing objects during unloading a truck, or bending sideways, are two more important causes for developing trigger points in this muscle.Location of trigger points & Acupressure tipsThe trigger point in the Serratus Posterior Inferior is found around the lowest rib, few inches from the spine. The best way to massage the trigger points is to lean against the wall with a tennis or baseball ball between your back and the wall. Move up and down or sideways across the trigger point until the discomfort that you are eliciting with this massage is significantly decreased. You may need to repeat this massage on several occasions to get the discomfort fully under control. Do not roll the ball over your spine. A foam roller is not recommended to address this trigger point since it cannot provide the specific pinpoint pressure needed to address this trigger point effectively.
Summary
SymptomsLocalized muscle acheThe pain may resemble pain from Kidney stoneRestricted bending & twisting of the torsoLocation of trigger pointsPalpate around the lower ribsDifficult to pinpoint specific muscleTrigger points in this area can be present in other musclesSearch for all tender spots in the areaPain radiationOnly localized discomfortNo projection to other areas
Causes for development of trigger pointsStretching to reach overheadExcessive twisting movementExcessive bending to one sideA mattress which is too soft
Trigger points self-acupressureLocate the trigger point as described abovePlace the ball between the wall & your backLean against the ball with slight pressure eliciting max discomfort 5/10Roll the ball from side to side or up and downDo not roll over the spine
General recommendationsMove a ball over the tender area 15-20 timesFind a new spot & repeat the processApply this massage at least 2-3 x a daySeveral short daily sessions are preferableDo not apply very strong pressureIncorporate into HOME TREATMENT PROTOCOL
