Case of the Week 12-19-11: The "Lat Strain" | Modern Manual Therapy Blog

Case of the Week 12-19-11: The "Lat Strain"

I am glad that the cases remain popular and I get a lot of feedback stating they are the reader's favorites! Starting the blog in July, I meant to post cases frequently, hence, the title Case of the Week. Well, 13 years of practice only had so many interesting cases... so the weekly case writing dropped off a bit, sorry about that guys! Here is a really quick one.

The patient is a 36 yo male who recently started working out with kettlebells. He works out regularly, but just last week started using the Fung Protocol. The first time went well, so he decided to increase the weight for the next round. His RPE went up just a bit, but it went well. However, the next day, he woke with what felt like a lat strain on the right. His symptoms were described as "soreness" and felt below the right axilla and were diffuse. It was reproduced with resisted shoulder extension, depression, and shoulder internal rotation, slightly. It was also worsened with lat with right UE overhead and adducted with trunk SB away. Throughout the day, it got worse, and was described as 3-4/10 initially, and by the evening it was 5-6/10. Lifting his baby increased the complaints, but scapula setting and core bracing abolished the pain.

Despite there being no complaints with deep breath, coughing, sneezing, or trunk rotation, the patient told his wife, also a DPT, to palpate his right rib cage for any positional faults. One of the right ribs was posteriorly rotated!

His wife placed the ulnar border of her right hand on the posteriorly located rib while the patient actively rotated to the right. After 3-4 sets of 10 reps, the pain subsided almost immediately and in a few hours was completely abolished!

Special thanks to Nicole Religioso, DPT, MS for fixing my "lat strain" so quickly. That was yesterday, and I am completely pain free today!

Discussion: Because my baby girl, Emmy has really taken a liking to her Dada lately, I have to pick her up and hold her only to put her down anytime she finds something interesting. When I decided to brace my core and set my scapula, I was pretty surprised to find it completely abolished the pain of my "lat strain."

I'll film a quick vid of this technique soon as update the post.


  1. Dr. Ben Fung, PT, DPTDecember 21, 2011 at 1:54 AM

    Can't wait to see the video! Sorry my protocol did a number on you - I guess its another testament to that kettlebell exercises engage musculature much more than expected. Glad your RPE/exertional experience went well.

  2. Yeah, I made it 21 minutes by adding in double arm swings. That was what probably did it, but after my wife treated it, I was able to work out again. Looking forward to your next post, great job with the HA.

  3. Dr. Ben Fung, PT, DPTDecember 21, 2011 at 5:32 PM

    Thanks! The C/T Junction GPM V was what I went with - just as you said... supported by science!