Role of latissimus dorsi in chronic mechanical low back pain due to thoraco-lumbar dysfunction

Randomized controlled single blinded clinical trial.

To identify prevalence of thoraco-lumbar dysfunction (TLD) and analyze the role of latissimus dorsi in it.

30% of chronic mechanical back pains are reported to be due to TLD. The thoraco-lumbar muscles control the dynamic and postural stability of the lower spine. Though core stabilization exercises are widely recommended for low back pain, but no reports are available for exercises specific to thoraco-lumbar dysfunction.

30 subjects in age group of 25 to 40 years with non traumatic, chronic mechanical low back pain were identified for study and randomly divided into two groups. Group-A (n=15): only core stabilization exercises and Group-B (n=15): latissimus dorsi strengthening and core stabilization exercises. Primary outcome measure was pain intensity (VAS score). Secondary outcome measures were general health (SF-36) and back pain disability (Aberdeen back pain disability score). Outcome measurement scores were compared using unpaired student t-test.

42% of all subjects had back pain of TLD origin. 88% of TLD subjects had latissimus dorsi strength < 4. Highly significant improvement in general health (p <0.0001), and significant improvement in disability score (p= 0.0017) was observed in the Group-B subjects. Re-assessment after 3 and 6-months reflected better scores in Group-B subjects. Conclusion: Identification of TLD as a cause of low back pain is recommended in all non-traumatic, chronic, mechanical low back pains. Strengthening of latissimus dorsi relieves thoraco-lumbar related back pain.