Serratus Posterior Inferior Pain

What is a Serratus posterior inferior pain?

Serratus posterior inferior pain and dysfunction typically remain localized. Referral patterns are seen in certain muscles. When there is a malfunction, an agitated muscle will follow predictable patterns known as referral patterns, which manifest as pain in other parts of the body. The rotator cuff is a good example of this. Many patients with rotator cuff injuries experience pain in the crease between their bicep and deltoid muscles, even though the rotator cuff muscles are located on the posterior shoulder.

This isn’t the case with the SPI. The SPI might be the cause of your pain in this location. Unfortunately, this muscle is deep. It is superficial (above) the erector spinae group and deep (under) the lats. This makes it difficult to recognize because you can’t see it.

Another thing to think about is that visceral dysfunction may be referred to this location. This is where kidney stone sufferers most frequently experience pain. Discomfort that is not muscular may be the cause of your severe, persistent discomfort that does not go away when you shift positions. You should see a doctor right away in this situation.

One frequently ignored cause of lower back pain is the serratus posterior inferior.
It’s crucial to keep in mind that this muscle serves as a supporting structure for the lower back, anchoring the four lower ribs and helping to pull them down and back, even if its primary function is proprioception.

Tightness and trigger points are frequently ignored, and the significance of the serratus posterior inferior is frequently forgotten.

The quadratus lumborum, longissimus thoracis, and iloicostalis all work with the serratus posterior inferior.

Additionally, it might function as a kinesiological monitor or spinal stretch receptor system in conjunction with the serratus posterior superior.

Causes

Serratus posterior inferior pain is frequently caused by:

• Serratus posterior inferior muscle strain from lifting, twisting, or sudden movements
• Poor posture, especially prolonged slouching or sitting
• Overuse during activities like heavy lifting, sports, or repetitive work
• Direct trauma or impact to the lower back area
• Respiratory issues causing overworking of the muscles during breathing
• Referred pain from nearby structures, like the thoracic spine or ribs.

Symptoms

Common symptoms of serratus posterior inferior pain include:

• Deep, aching pain in the lower back near the ribs
• Pain that worsens with twisting, lifting, or deep breathing
• Stiffness and reduced flexibility in the lower back
• Tenderness when pressing over the muscle
• Occasional sharp pain during sudden movements

Trigger Points of Serratus Posterior Inferior

A rare local pain that radiates across and around the muscle may be caused by trigger points in the serratus posterior inferior.

This could go through the chest to the front of the body, as well as across the back and across the lower ribs.

Patients usually report this sensation as a chronic soreness.

After other trigger sites have been deactivated, persistent pain frequently persists.

The therapist should use this as a good indication to look for any previously unidentified trigger points in the serratus posterior inferior.

A rare local soreness that radiates across and around the muscle may be caused by trigger points in the serratus posterior inferior.

Diagnosis

Breathing deeply is one method of evaluating SPI discomfort or dysfunction. This method is known as “box breathing.” Inhale, hold, exhale, and hold are the four stages. Every phase will have the same duration.

Take a seat comfortably so that your lungs can expand completely.

• Inhale deeply and completely, giving your lungs three to four seconds to expand.
• Take a three to four-second break.
• Exhale slowly for three to four seconds.
• Pause for three to four seconds.

This breathing method can be used as both a therapeutic and a diagnostic tool! Finding the location of tense breathing muscles can be useful as a diagnostic tool. In this instance, you can have some tightness in the SPI if you experience tension in your lower back during inhalation. This is due to the fact that when the rib cage is inflated and the lungs are full of air, the SPI will be stretched to its maximum. You can also have some tightness in that area if you exhale forcefully.

The good news is that you may use this breathing exercise to loosen up any additional breathing muscles, including the SPI. I advise performing 10–12 rounds of this breathing cycle while seated comfortably. Because that’s precisely what this workout is, think of it as a stretch! The origin and insertion of the SPI spread apart when the lungs fully inflate, providing a nice stretch for the muscle.

Additionally, this activity can soothe the body by stimulating the parasympathetic nervous system. This can lessen how much of pain felt in various bodily parts. One useful tool in the toolbox for addressing respiratory muscle pain and dysfunction is box breathing.

How to Relieve Serratus Posterior Inferior Pain?

If you experience pain in this area, you may also want to try using a massager such as the QL Claw. Finding the location of the SPI is a helpful approach for this muscle. To do this, you would locate the lowest two ribs on your back (ribs 11 and 12) and follow them all the way to the spine.

After that, as the claw applies some physical effort to the muscle, you can lie your body on it and take deep breaths. Let your body relax into the claw as you breathe in. This may lessen muscle tension and aid to relieve pain.

Massage and Soft Tissue Treatments

In order to relieve tension and encourage relaxation in the serratus posterior inferior muscle, massage and soft tissue therapies may be helpful. Here’s how to massage this area and give soft tissue treatments:

Warm-Up:

Warming up the muscles and surrounding tissues is crucial before beginning a massage or soft tissue therapy. This can be done by putting heat packs on the area, stretching gently, or making small motions.

Positioning:

Place the customer in a comfortable position, such as sitting with their back supported and exposed or lying face down on a massage table.

Palpation: To find the serratus posterior inferior muscle, start by feeling the region surrounding the lower ribs and lower thoracic vertebrae. Feel for any trigger points, tense spots, or sore spots with your fingertips.

Techniques for Massage:

• Effleurage: To warm up the tissues and encourage circulation, begin with light effleurage strokes down the muscle’s length.
• Petrissage: To target deeper layers of muscle tissue and relieve tension, use kneading and squeezing motions.
• Stripping: Using your thumbs or fingertips, apply strong pressure from the muscle’s origin to its insertion point along its length.
• Trigger Point Release: To release trigger points, identify any sore or constricted areas in the muscle and administer ischaemic compression or prolonged pressure.

Stretching: To further relieve tension and increase flexibility, use stretching exercises after massaging the serratus posterior inferior. To stretch the muscle, gently ask the client to bend laterally or extend their arms upwards.

Serratus Posterior Inferior Stretch

Side-Lying Overhead Stretch

A pillow is necessary for this serratus posterior inferior stretch.
You can lie down on a bed or a yoga mat.

• lie on your side.
• Place your head on a pillow.
• Make a little arch with your back.
• Over your head, extend your upper arm.
• For 15 to 30 seconds, hold this stretch.
• Do this for 3 to 5 sets.

Foam Roller Stretch

• You will need an exercise ball or a foam roller for this serratus posterior inferior stretch.
• Go into child’s pose while kneeling on a yoga mat. Push your butt back and extend your arms forward onto the exercise ball or foam roller.
• Now, roll forward with the help of the foam roller or exercise ball to give your back a great stretch.
• Hold 30 seconds.
• Roll back to the beginning point after that.
• Repeat for 3-5 sets.

Soft Tissue Mobilisation: To treat adhesions or scar tissue inside the muscle, apply soft tissue mobilisation treatments like myofascial release or instrument-assisted soft tissue mobilisation (IASTM) if required.

Feedback: Keep in touch with the client during the massage or soft tissue treatment to make sure they are comfortable and to modify the pressure or technique as necessary. To improve relaxation and ease muscular release, promote deep breathing.

Post-therapy Care: Encourage the client to drink lots of water to help flush out any toxins generated during the massage or soft tissue therapy. Encourage self-care practices or mild stretching exercises to preserve the treatment’s effects in between sessions.

Your patients’ pain, mobility, and general well-being can all be improved by implementing massage and soft tissue therapies for the serratus posterior inferior muscle into your practice. As usual, it’s critical to seek out the proper training and certification in manual therapy techniques and to tailor your approach to each person’s needs and preferences.

References

• Marks, D. (2024, June 6). Trigger point treatment – serratus posterior inferior. Niel Asher Education. https://nielasher.com/en-in/blogs/video-blog/trigger-point-treatment-serratus-posterior-inferior?
• Debutify. (2025, January 30). Serratus posterior inferior pain and dysfunction. Back Muscle Solutions. https://backmusclesolutions.com/blogs/the-ql-blawg/serratus-posterior-inferior-pain?