The serratus posterior inferior arises from a thin tendinous sheet from the spinous processes of T11-L3 and inserts onto the outer surfaces of ribs 9-12, depressing the lower ribs during forced expiration. The aponeurotic origin blends with the thoracolumbar fascia.
Serratus posterior inferior trigger points refer pain to the lower back and posterior lateral chest in a pattern that may mimic renal or musculoskeletal low back pain. Its aponeurotic origin at the thoracolumbar junction is a site of strain injury. The muscle is identified during paraspinal approaches to the lower thoracic spine where it must be elevated to access the posterior ribs.
Traction injury at the thoracolumbar aponeurotic origin producing posterior lower chest and upper lumbar pain, often misdiagnosed as lumbar disc or renal pathology, responsive to dry needling and thoracic extension exercises.
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