Longissimus Thoracis: Pain Pattern and Treatment
The longissimus thoracis is the long middle column of the erector spinae, running from the sacrum and pelvis up the back beside the spine to the ribs and vertebrae of the mid back. Its documented pattern is pain sent downward: a trigger point in the mid or lower back sends pain to the buttock, several levels below where the point sits. That gap between the sore spot and the felt pain is why it is missed. This is a sub-page of the erector spinae group page.
Attachments and action
Origin: The back of the sacrum, the posterior iliac crest, the lumbar spinous processes, and the transverse processes of the lumbar vertebrae, through the common erector tendon.
Insertion: The transverse processes of all the thoracic vertebrae and the lower nine or ten ribs between their tubercles and angles.
Action: Extension of the spine; with one side working, side-bending; it holds the trunk against forward bending.
Where the pain is felt: The buttock, low and toward the middle, and the sacroiliac area. The trigger point itself sits higher, in the mid or low back beside the spine, and is often not where the patient hurts.
Common causes: Lifting with the back bent; a long stretch bent forward, as over a sink or a workbench; sitting slumped; a sudden twist under load; a leg-length difference or a tilted pelvis.
Patients say: "My buttock hurts but the sore spot is in my back." Buttock pain that hip work did not change. "It goes away when I lie flat and comes back when I bend."
When to get evaluated: Back and buttock pain with numbness or weakness in the leg, changes in bladder or bowel control, fever, unexplained weight loss, or pain that wakes you and does not ease with position needs medical evaluation before anything else.
How this muscle is examined and treated
Examination tests forward bending and return, side-bending, and presses the column beside the spine from the mid back down for the point that reproduces the buttock pain. Needling here addresses the muscle over the back at the level found, not in the buttock. Assessment and treatment happen in the same visit.
Related conditions
Low Back PainHip & Glute PainSciatica
This page is educational. It describes muscle referral patterns commonly associated with pain; it does not diagnose your condition. Individual patterns vary. For evaluation of your specific pain, see a licensed clinician. Seek immediate medical care for emergencies. Eugene Baek, L.Ac. · New Jersey License 25MZ00080600