Quadratus Lumborum (QL) – ‘The Joker of low back pain’

QuadratuslumborumWhat is the Quadratus Lumborum (QL)?

The Quadratus Lumborum is a quadrangular shaped muscle which attaches to the bottom rib, the verterbrae in your lower back and the top of your pelvis. It acts as a stabiliser of the lower back and can laterally flex the spine. It extends your lower back when working with the other side and it aids forced exhalation, for example when coughing.

Why is it relevant?

Myofascial trigger points in the QL muscle often mimic symptoms of discogenic low back pain i.e. back and leg pain caused by a problem such as a ‘slipped disc’. However 32% of such presentations have been shown to have QL muscle myofascial dysfunction as their primary issue, rather than a disc problem.

image courtesy of Wikipedia

What are Myofascial Trigger Points?

The most common cause of muscle pain is a phenomenon called ‘Myofascial Trigger Points’. These are points of exquisite tenderness within a taut band of tight muscle which causes pain to refer in a particular pattern (Gerwin,1984). Myofascial trigger points often develop following overload of a particular muscle.

How do I activate Myofascial Trigger Points in the Quadratus Lumborum?

As mentioned above, QL trigger points can be activated by overload of the muscle. Bending and reaching movements (especially if holding something heavy) as well as other awkward movements is the most common method of injury. Other triggers include:

  • Major body trauma like car/motorbike accidents
  • Repetitive activities
  • Having a genetically short leg that causes a lateral tilt in pelvis
  • Walking or running on a sloping surface (side of the road)
  • A soft bed

What are the signs and symptoms of a Quadratus Lumborum muscle problem?

The QL muscle refers pain to a variety of areas about the lower back, abdomen and hip. These areas of pain include:

  • The sacroiliac joint (junction between the lower back and the pelvis)
  • The lower buttock
  • The front of the hip
  • The lower quadrant of the abdomen or groin
  • Over the outside of the hip i.e. over the greater trochanter

Aside from pain in these areas, you may be unable to turn in bed, stand or walk. Lying down will likely ease the pain. Coughing and sneezing may also be painful. Your pain may feel intense, or have a deep achy quality to it. It may also have a sharp, knifelike quality at times, particularly during movement.

Another possible consequence of Quadratus Lumborum muscle pain and trigger points is the development of ‘Satellite Trigger Points’. As pain referring from the QL muscle projects over the gluteal muscles, secondary or satellite trigger points can therefore be activated within the gluteal region. In other words, pain that travels over a muscle can cause trigger points to develop within that muscle. This often results in pain referring down the leg, mimicking a ‘sciatica’ type presentation.

What treatment options are available for Quadratus Lumborum dysfunctions?

Our management of a Quadratus Lumborum issue would include the use of medical acupuncture, also referred to as dry needling (sometimes with neuro-electrical stimulation) to deactivate the trigger points in the QL itself, and in the surrounding musculature. We would also use soft tissue release techniques and manual therapy as an adjunct. Once the main pain driving trigger points have been largely deactivated, treatment would focus on exercise rehabilitation to improve the strength and function of the musculature in the lower back region to reduce the likelihood of a recurrence. Physio Pilates is an excellent way to aid a full return to function following an acute episode of back pain involving the Quadratus Lumborum muscle, or indeed many other lower back structures.

Article by Rachel Neary.

Travell JG, Simons DG, Myofascial Pain and Dysfunction The Trigger Point Manual; The Lower Extremities. Vol 2, 1993.
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