Evolutio Journal
Lat pain: why the side of your back hurts and how to settle it
That deep ache along your side after pull-ups, rowing or a long swim. What is actually going on, what to do this week, and when to see a physio. Written by a sports physio clinic in Richmond, Melbourne.
Lat pain is usually an overload problem rather than a damaged one. Too much pulling volume, too soon, on a muscle that also spends your working day in a shortened position.
Keep moving, drop the pulling for a week or two, and load it back up gradually. Most mild strains settle in one to two weeks, moderate ones in three to four.
Waking up sore? Jump to sleeping positions. Muscle locking up? See spasms and cramping. In Melbourne and want it looked at? See getting assessed here.
If you have numbness or tingling down your arm, weakness in your grip, or pain that interferes with breathing, stop reading and get it assessed.
You felt something during your last set of pull-ups. Or you woke up with a deep ache along your side after yesterday's rowing session. Either way, everything now seems to involve it. Reaching for your coffee. Putting on a shirt. Taking a proper breath.
The latissimus dorsi is the largest muscle in your back. It runs from your lower spine and pelvis all the way up to your upper arm, which is why lat pain feels like it is everywhere at once. It is involved in every pulling movement you do, it helps stabilise your trunk, and it attaches to your ribs, which is the reason a sore lat can make breathing uncomfortable.
What we see most in Richmond
At our clinic in Richmond the pattern is fairly consistent.
Pull-up and rowing volume. The single most common cause. A benchmark workout with a few hundred metres of rowing and high-volume pull-ups, or a return to CrossFit after a break with the same numbers you were doing before. We see a lot of this from the Melbourne CrossFit community, and our CrossFit injury prevention guide covers how to manage the volume.
Swimming. Freestyle and butterfly are almost entirely lat-driven. A jump in squad volume, or a stroke change, will find the limit of what your lats can tolerate.
Climbing. Overhanging routes hold the lat in a loaded, lengthened position for long stretches. Melbourne has a serious bouldering scene across the inner north and east, and we see the results of it most weeks.
The desk factor. This is the one people underestimate, and it is the most common pattern we see in Melbourne. Eight or nine hours at a laptop in the CBD leaves the whole front of your shoulder girdle shortened and your mid-back doing very little. Then you ask the lat for maximum output at 6pm. The muscle is not weak because you are unfit. It is underprepared because of what the other nine hours of your day looked like.
Most lat pain is not an injury. It is a mismatch between what you asked for and what the muscle was ready for.
What it feels like
A deep ache along the side of your back, often anywhere between your lower ribs and your armpit. Pain when reaching overhead or across your body. Discomfort that shows up with coughing, sneezing or a deep breath, because of those rib attachments. Stiffness after sitting for a while.
A sudden sharp pain with a tearing or popping sensation during a lift is a different story. That suggests an actual strain rather than overload, and it is worth having assessed properly.
Numbness or pins and needles down your arm. Weakness in your grip. Pain that genuinely interferes with breathing rather than just feeling uncomfortable on a deep breath. Severe pain that is not improving with rest. No change after a week of sensible self-management.
Left-sided chest or back pain with shortness of breath, sweating or nausea is a medical emergency, not a muscle problem. Call triple zero.
The first week
Two things matter here, and neither is resting completely.
Keep moving. Gentle, pain-free movement maintains blood flow and prevents the stiffness that makes week two worse. Walking, easy arm movement, and anything that does not provoke it. Bed rest does nothing useful for a muscle.
Drop the pulling, keep everything else. Pull-ups, rows, lat pulldowns, swimming and climbing come out for a week or two. Lower body work, core, and pain-free pressing all stay in. You lose far less fitness than you think, and you keep the habit of training, which matters more.
On ice and heat: ice can take the edge off in the first couple of days if it helps you move more comfortably. After that, gentle heat before movement tends to be more useful. Neither is doing the healing. They just make the useful things easier to do.
You may have seen RICE recommended for this. Current guidance has moved on from strict rest toward early protected movement, which is what the advice above reflects. Our note on the PEACE and LOVE approach covers why.
What to actually do, week by week
Days 1 to 5: restore movement
Doorway lat stretch. Forearm on the frame, step gently forward until you feel a stretch along your side. Thirty seconds, three times each side. Easy to do between meetings.
Side-lying reach. Lie on your good side, reach the top arm overhead and let it fall gently. Breathe into it. Thirty to forty-five seconds.
Child's pose with a side reach. From child's pose, walk your hands to one side until you feel it along your ribs. Thirty seconds each way.
None of these should hurt. A stretch you have to brace against is too much.
Days 5 to 14: start loading it
This is the part that actually changes things. Stretching makes you comfortable; loading makes you resilient.
Band pulldowns. Light resistance, controlled, focusing on the bottom half of the range. Two sets of twelve to fifteen.
Wall slides. Back against the wall, arms sliding up and down with control. Unglamorous, and very good for restoring the overhead position.
Dead bug with an overhead reach. On your back, lower one arm overhead while keeping your ribs down. Two sets of eight to ten each side.
Week two onward: rebuild the pattern that hurt you
Slow eccentric pulldowns or ring rows. Take three to five seconds lowering. Loading a muscle through its lengthening phase is what builds tolerance back.
Then reintroduce your actual training, starting at roughly half your usual volume and building over two to three weeks. You progress on how it responds the next day, not on the calendar.
Not settling after a week, or not sure whether it is your lat at all? A 45-minute assessment in Richmond will tell you what is actually going on.
Book an assessmentSleeping with lat pain
This is the single most searched question about lat pain, and for good reason. The muscle wraps around your side, so almost every sleeping position loads it somehow, and a night of bad sleep makes the next day's pain noticeably worse.
Sleep on your unaffected side with a pillow between your knees to keep your spine neutral. Put a second pillow under your top arm so the sore lat is supported rather than hanging across your body all night. That second pillow is the part most people miss.
On your back works well too. A pillow under each forearm keeps your arms slightly away from your sides and takes the stretch off.
Avoid sleeping on your front. It rotates your neck and holds one arm overhead for hours, which is close to the worst position for an irritated lat.
If you wake up sore without having trained, your sleeping position is probably the cause rather than any injury. Sleeping with an arm tucked under a pillow, or curled tightly on one side, holds the lat in a shortened position for six or seven hours. It usually settles within a few days of changing position and doing the stretches below.
Lat spasms and cramping
A lat spasm feels different from a strain. It comes on suddenly, grips hard, and often eases within minutes to hours rather than building over days. People describe the muscle feeling locked.
Common triggers are a sudden overhead reach, a heavy pulling session without much of a warm-up, dehydration, or the muscle guarding protectively after an injury elsewhere.
What helps in the moment: stop what you are doing and breathe slowly, because tensing against a cramping muscle prolongs it. Gently lengthen it by reaching the arm overhead and leaning away, but only to the point of mild stretch. Heat helps more than ice for a spasm. Drink something, particularly if you have been training hard or it is a hot Melbourne day.
One-off spasms are usually nothing. Repeated spasms in the same spot are worth assessing, because the muscle is often guarding against something else going on in the shoulder or thoracic spine.
When it is not your lat
Several things sit in the same postcode and get mistaken for lat pain. This is worth knowing before you spend three weeks stretching the wrong thing.
Thoracic spine irritation. Facet joints and discs in the mid-back refer pain straight into the lat region. If your pain changes with spinal position or twisting rather than with reaching, this is worth considering.
Myofascial trigger points. Tight, tender points in the lat or the muscles around the shoulder blade that refer pain elsewhere. These respond well to hands-on treatment and dry needling.
Rotator cuff problems. Shoulder pathology often refers pain down into the upper back and around the shoulder blade. If overhead movement is the main problem rather than pulling, look at the shoulder.
Rib joint irritation. The joints where your ribs meet your spine can become irritated and produce sharp, breathing-related pain that feels muscular but is not.
Referred pain from the neck. The lower cervical spine refers into the upper back and shoulder blade readily.
How long it takes
Mild strain, managed sensibly: one to two weeks. Moderate strain with some loss of strength: three to four weeks. Significant tearing: six to eight weeks, and worth getting properly assessed.
Chronic tension from the desk-plus-training pattern is different. It is not a healing timeline, because nothing is torn. It settles when the underlying imbalance changes, which usually means mid-back strength and some honesty about how you sit.
Keeping it away
Balance your pulling and pressing. Most people who develop lat pain have been doing a lot of pulling and not much mid-back or rotator cuff work.
Progress volume gradually. Particularly returning after a break. The most common presentation we see is somebody doing week-twelve numbers in week one.
Move during the workday. Something every half hour or so. It does not need to be a routine, it just needs to not be nine hours of the same position.
Warm up before pulling volume. Two minutes of band work before the first pull-up is worth more than the stretching you will do afterwards.
Cyclists, check your position. A reach that is too long keeps the lats loaded for the whole ride. Our partners at Ciclo do bike fitting in the same building, and it is often the fix when cycling-related back pain keeps coming back.
Getting it assessed in Melbourne
You do not need a GP referral to see a physiotherapist in Australia. You can book directly, and most people do.
What it costs. Initial assessments at private clinics around Melbourne generally run between $120 and $220. If you hold private health extras cover, you claim on the spot through HICAPS and pay only the gap, which is usually somewhere between $50 and $90. Our own fees are published here.
Medicare. You may be eligible for a rebate on up to five allied health sessions a year under a Chronic Disease Management plan, but you need your GP to set that up first. It applies to longstanding problems rather than a lat you strained on Tuesday.
If it happened at work, which is more common than people expect with desk-related lat and thoracic pain, WorkSafe Victoria generally covers assessment and treatment. Bring your claim number.
We are on Bromham Place in Richmond, a short walk from Richmond Station, and easy to reach from Cremorne, Abbotsford, Collingwood, South Yarra, Hawthorn and the CBD. If you are further out, the Australian Physiotherapy Association has a find-a-physio directory covering all of Victoria.
Common questions
Why does my lat hurt when I breathe?
The lat attaches to your lower ribs, so an irritated or inflamed muscle can be uncomfortable on a deep breath or a cough. It is common in swimmers, rowers and climbers. Discomfort on a deep breath is usually muscular. Genuine difficulty breathing is not, and needs urgent assessment.
How long does lat pain take to heal?
Mild strains usually settle in one to two weeks, moderate ones in three to four, and significant tears in six to eight. Chronic tension from desk work plus training does not follow a healing timeline, because nothing is torn. It improves when the underlying pattern changes.
Can I keep training with lat pain?
Yes, with modification. Drop pulling movements, swimming and climbing for a week or two. Keep your lower body work, core and any pain-free pressing. Come back at about half volume and build from there.
What is the best sleeping position for lat pain?
On your unaffected side with a pillow between your knees and a second pillow supporting your top arm, or on your back with a pillow under each forearm. Avoid sleeping on your front, which holds the lat in a poor position for hours.
What causes lat muscle spasms?
Usually a sudden overhead reach, heavy pulling without a warm-up, dehydration, or the muscle guarding after an injury nearby. Gentle lengthening, slow breathing and heat help in the moment. Repeated spasms in the same place are worth getting assessed.
Should I use heat or ice?
Ice can help in the first couple of days if it lets you move more comfortably. After that, gentle heat before movement is generally more useful. Neither is doing the healing, so do not rely on either.
Why does only one side hurt?
Usually because of asymmetry somewhere. Carrying a bag on one shoulder, sleeping on one side, reaching for a mouse all day, or a sport that loads one side more. It is very common and not a cause for concern on its own.
Can lat pain cause arm numbness?
Not usually. Numbness points more toward a nerve issue coming from the neck or thoracic outlet than from the muscle itself. Persistent numbness or weakness should be assessed rather than managed at home.
How much does physio for lat pain cost in Melbourne?
Initial assessments generally run $120 to $220 across Melbourne. With private health extras you claim on the spot through HICAPS and typically pay a $50 to $90 gap. Medicare rebates apply only under a GP-arranged Chronic Disease Management plan.
Do I need a referral to see a physio in Melbourne?
No. Physiotherapy is a primary contact profession in Australia, so you can book directly. You only need a GP referral for a Medicare rebate under a Chronic Disease Management plan, or for WorkSafe, TAC and DVA claims.
If your lat has not settled after a week or two, or you are not certain it is your lat at all, come and see us. We are on Bromham Place in Richmond, a short walk from Richmond Station and easy to reach from Cremorne, Abbotsford, Collingwood, South Yarra and the CBD. First appointments are 45 minutes, with a written plan sent within two days.
Alex Drew is the founder and director of Evolutio Sports Physio in Richmond, Melbourne, and has been treating patients since 2013. General information only, not a substitute for individual assessment. Related: back pain, shoulder pain, remedial massage, and our shoulder rehabilitation guide.
