The longissimus thoracis attaches caudally to the posterior surface of the sacrum and posterior iliac crest via a broad, medially placed tendinous origin that merges with the erector spinae aponeurosis. This tendinous complex is the primary medial component of the posterior sacroiliac tension band.
Longissimus thoracis tendon pain localises paramedially in the lumbar region and may refer to the posterior pelvis. It is a contributor to sacroiliac joint syndrome when the posterior tension band is disrupted. Isometric lumbar extension exercises and posterior pelvic stabilisation programs address this component.
Degenerative change at the pelvic origin producing paramedian lumbar pain that is aggravated by sustained standing and lumbar extension, often accompanying sacroiliac joint dysfunction.
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