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Back Muscles Cheat Sheet (DRAFT) by

Back muscles or whatever

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Rhomboid Major:
Origin: Supras­pin­atous ligament of the 2nd-5th Tx
Insertion: Medial border of the Scapula
Rhomboid Minor:
Origin: Lower Ligmentum Nuchae, Spinous Processes of 7th Cx - 1st Tx
Insertion: Medial end of the Spine of the Scapula
Nerve: Dorsal Scapula Nerve (C4-C5)
Action: Scapular retraction and stabil­isation

Rhomboids palpation

- Deep to traps - rhomboid fibres feel more oblique


- SML C7-T5
- Upper traps can cause satellite Trps in Rhomboid Minor
- Causes a snapping Scapula

Serratus Posterior Superior

Origin: Aponeu­rosis of the nuchal ligament + SPs of 7th Cx vertebra and 2-3 Tx VB and their supras­pinus ligaments
Insertion: Upper borders and external surfaces of 2-5th Ribs
Nerve: 2-5th Interc­ostal nerves
Action: Elevation of the ribs - respir­ation

Serratus Posterior Superior - Palpation

- Pt's arm off bench (draws scapula laterally)
- Deep to rhomboids, ask patient to inhale


- T1-T4 SML
- Lying on a tennis ball over inters­capular region with arms across chest
- Mimics C8-T1 Radioc­ulo­pathy
- Aggravated by breath­ing­/co­ughing

Serratus Posterior Inferior

Origin: SP of the lower 2 Tx and upper 2/3 Lx and their supras­pin­atous ligaments (apone­urosis)
Insertion: Outer surfaces of the lower 4 ribs
Nerve: Ventral Rami 9th-12th Tx spinal nerves
Action: Accessory muscles of respir­ation

Serratus Posterior Inferior - Palpation

- Bottom of rib cage
- Pt exhales


- T/L SML + Manipu­lable Lesions of lower 4 ribs

Ilioco­stalis + Longis­simus Thoracis

Longis­simus and Ilioco­stalis

Origin: Fascicles attach to sites that are in relation to the ribs
Ilioco­stalis Cervicis: Posterior Tubercles of the 4-6th Cx
Insertion: 3rd-6th ribs
Ilioco­stalis Thoracis
Origin: TVPs of 7th Cx VB and superior borders of the angles of the upper 6 ribs
Insertion: Upper borders of the angles of lower six ribs
Ilioco­stalis Lumborum:
Lumbar: Origin: First four Lx TVP and posterior surface of middle layer of thorac­olumbar fascia
Insertion: Medial end of the iliac crest and dorsal segment of iliac crest, L4 and L1 fascicle
Thoracic Origin: Lower eight/nine ribs
Insertion: Medial and dorsal end of iliac crest
Nerve: Inters­egm­ental lateral branches of the dorsal rami
Action: Extends vertebral column

Longis­simus and Ilioco­stalis - Palpation

- get patient to raise feet slightly to activation
- Extend head if further up at scapula level
- Should feel ropy


- Patient runs hand up and down back - ilioco­stalis + side to side - lower rectus abdominus
- Causes Buttock pain

Inters­capular Pain




Serratus Anterior

Multifidus Thoracis


Lower Traps

Ilioco­stalis Thoracis

Serratus Posterior Superior

Sympat­hetic Intrafusal Tension Syndrome

- Muscles of the upper back more affected by this
- Tone changes due to activation of the sympat­hetic nervous system
Treatment: Patient education, decrease caffeine, increase water
Myofascial distor­tion: TrP therapy in a relaxed posture, heat afterwards
Treat associated manipu­lable lesions
CV Exercise: 3-5 x week, 15-20 mins per session Muscle tension and pain diary - pain and tension out of 10 and timing
Progre­ssive tension relaxa­tion: Patient fires middle traps for 10 seconds without moving scapula for 10 seconds - patient relaxes muscle for a few breaths - Contract again with half the tension for 10 seconds then relaxes, then half the tension again then relax
Abdominal Breathing Relaxation exercise: Breath through nose in a slow breath , don't hold breath in but hold for 3 following each exhala­tion, 3-5 breaths when patient feels stress
Once control of tension is regained, stretching starts