Logan Steele
The quadratus lumborum (QL) is a deep core muscle located in the lower back, which spans from the lumbar spine to the pelvis. It is a strong muscle designed to support the spine and lift things, but it can be prone to injury and tightness. QL pain is a common contributor to lower back pain and can be caused by overuse, overstretching, or remaining in the same position for a prolonged period. To loosen the QL muscle, it is important to focus on both mobility and stability. This can be achieved through various stretching exercises and yoga.
| Characteristics | Values |
|---|---|
| Location | The QL muscle is located on the posterior (back) side of the trunk and abdominal wall with a left and right side. |
| Function | The QL muscle contributes to the specific motions of same-side trunk side bend, rotation, and extension of the trunk to one side. It also helps with breathing and keeping the core strong. |
| Causes of Tightness | Overuse with a specific activity, compensating for a weakness elsewhere, or doing too much too soon of a new activity. |
| Symptoms | Low back tightness, soreness, and back spasms. |
| Treatment | Mobility and stability exercises, yoga, tissue release, and QL muscle release exercises. |
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What You'll Learn
QL muscle guarding, back spasms, and other triggers
The quadratus lumborum (QL) is a large muscle located on the back side of the trunk and abdominal wall. It is the deepest abdominal muscle and is found below other muscles, under the lats and paraspinals. The QL muscle is responsible for lateral flexion of the spine and extension of the lumbar region of the spine. It also contributes to the specific motions of same-side trunk side bend, rotation, and extension of the trunk to one side.
The QL muscle can become extremely hyperactive, causing it to go into a 'guarding' state. This can be due to overuse with a specific activity, compensating for a weakness elsewhere, or simply doing too much too soon that your body isn't used to. When the QL is in a hyperactive state, moving in and out of trunk positions that either flex or stretch the muscle can trigger symptoms such as low back tightness, soreness, and even back spasms.
To release the QL muscle, it is important to focus on both mobility and stability. This involves doing gentle mobility exercises that move the QL muscle through its entire length without causing sharp pain or triggering back spasms. Stability exercises that target other muscles can also help to promote reciprocal inhibition of the QL muscle, allowing it to relax and making trunk and low back movement less painful.
In addition to mobility and stability exercises, there are other ways to treat QL muscle guarding, back spasms, and other triggers. Applying heat and ice can help reduce pain and inflammation, and massage tools such as the QL Claw can be used to release trigger points in the QL muscle. Maintaining good posture, lifting heavy objects properly, and sleeping in a position that reduces back pain can also help prevent QL muscle pain.
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Mobility and stability exercises
The quadratus lumborum (QL) is a deep lower back muscle that is crucial for spinal strength and stability. It is a large muscle located on the posterior (back) side of the trunk and abdominal wall, with a left and right side. The QL muscle contributes to the specific motions of same-side trunk side bend, rotation, and extension of the trunk to one side.
In the early phases of rehab for quadratus lumborum pain, it is important to focus on both mobility and stability exercises. By focusing on gentle mobility exercises, you will be promoting movement of the QL muscle through its entire length while ideally not causing sharp pain or triggering back spasms.
- Seated QL stretch: Position yourself to the side of a seat until you are almost off the edge. Extend the leg out in front of you, allowing the weight of the body to even out and straighten the side of the torso. Stretch the QL by reaching your arm overhead and bending the trunk away from the side.
- Side plank: Elevate your torso and legs off the ground, keeping your body tight and straight with a neutral spine throughout the duration of your sets. Aim for two minutes of total work in the side plank position on each side. This can be achieved through sets of 20, 30, or 60 seconds.
- Overhead Paloff Press: Secure a resistance band to a fixed object at shoulder height. Grab the band and step out from the fixture to create significant tension. Kneel and face 90 degrees away from the band fixture. Press the band overhead, pausing at the top.
- From a kneeling position, extend your right leg to the side with your toes facing forward or to the right. Bend to the right, placing your right hand along your leg. Extend your left arm up and over, reaching to the right. Extend through your left fingertips and roll your left ribs up toward the ceiling.
- Stand with your feet wider than your hips, your right toes facing forward, and your left toes out at a slight angle. Keep your hips facing forward. Raise your arms so they are parallel to the floor, with your palms facing down. Fold halfway forward, pausing when your torso is parallel to the floor. Lower your left hand to your right leg, a block, or the floor. Raise your right arm straight up, turning your palm away from your body. Gaze down at the floor, to the side, or up at your extended hand. Hold this position for up to 1 minute. Repeat on the left side.
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Yoga as a treatment for chronic low back pain
The quadratus lumborum (QL) is a large muscle located on the posterior (back) side of the trunk and abdominal wall. It is responsible for lateral flexion of the spine and extension of the lumbar region of the spine. When the QL muscle goes into a 'guarding' state, it can cause low back tightness, soreness, and even back spasms.
Yoga has been studied as an intervention for chronic low back pain (CLBP) over the past 10 years. It is a mind-body therapy that is often recommended to treat not only back pain but also the stress that accompanies it. Yoga poses like cat-cow, lotus pose, and triangle pose may help strengthen and relax muscles, which may relieve back pain.
A study conducted by Dr. Robert Saper at Boston University School of Medicine and Boston Medical Center found that yoga was as effective as standard physical therapy for treating moderate to severe chronic low back pain. The study involved 320 predominantly low-income, racially diverse adults with moderate to severe chronic low back pain. The participants were randomly divided into three treatment groups: one group received 12 weekly yoga classes designed for people with chronic back pain, one received 15 physical therapy visits over 12 weeks, and one was given educational material about self-care for chronic low back pain. The researchers found that all three groups reported improvement in physical function and pain reduction. However, people in the yoga and physical therapy treatment groups were more likely to stop taking pain relievers after one year.
Another randomized control trial evaluated the impact of Iyengar yoga on pain intensity and health-related quality of life in subjects with nonspecific chronic low back pain. The study compared yoga therapy to conventional exercise therapy, with a 6-month follow-up. Both interventions resulted in significant benefits, with the yoga intervention having a greater impact.
Overall, yoga appears to be a well-positioned intervention for chronic low back pain, especially as healthcare shifts towards caring for patients with chronic diseases and designing preventative strategies. A carefully adapted set of yoga poses, practiced under the guidance of a well-trained instructor, may help reduce chronic low back pain and improve function.
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Identifying the QL muscle
The quadratus lumborum (QL) muscle is a deep muscle located in the lower back, with one on each side of the spine. It is part of the posterior abdominal wall and is often mistakenly referred to as one of the muscles of the back. Its complex organisation makes it difficult to identify precisely the actions that occur through the contraction of its fibres.
The QL muscle is flat and quadrangular in shape, with each muscle of the pair being an irregular quadrilateral. The muscle is generally located medially to the aponeurosis of the transverse abdominal muscle. The QL muscle is an integral part of the thoracolumbar fascia, a myofascial system that covers the posterior trunk and involves parts of the lower and upper limbs.
The QL muscle originates from the iliolumbar ligament and the internal lip of the iliac crest, attaching to the 12th rib, the iliac crest, and the transverse processes of the lumbar spine. The number of attachments to the vertebrae, and the extent of its attachment to the last rib, may vary. The muscle is in close proximity to many structures, with the colon, kidneys and diaphragm located ventrally, and the intrinsic back muscles lying dorsomedially.
The QL muscle is a significant means of access for anaesthesia during surgery on the back, lower limbs, or abdominal area, thanks to its strategic position and the entropic scheme of its fibres. It is also important for stabilisation of the vertebral column and the rib during various movements of the spine. When both QL muscles contract simultaneously, they extend the spine. When one QL contracts, it causes lateral flexion of the spine or hip hitching.
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QL muscle pain causes and treatments
Quadratus Lumborum (QL) is a large, deep muscle located on the posterior side of the trunk and abdominal wall. It is found below other muscles, under the lats and paraspinals. The QL muscle contributes to the specific motions of same-side trunk side bend, rotation, and extension of the trunk to one side.
Causes of QL Muscle Pain
The QL muscle can become extremely hyperactive and enter a 'guarding' state due to overuse or overstretching. This can be caused by a specific activity, such as playing golf or shovelling snow for extended periods. It can also be caused by the QL compensating for a weakness elsewhere or doing too much of a new activity that your body is not used to. When the QL muscle is in a hyperactive state, moving in and out of trunk positions that either flex or stretch it can trigger symptoms of significant low back tightness, soreness, and even back spasms.
Another way the QL muscle can be injured is by becoming extremely lengthened and causing a strain. When this happens, the muscle has gone past its maximum length and is overstretched, causing microtears in the muscle fibres.
Occupational stresses such as prolonged sitting or standing at the workplace or continuous lifting activities can also cause QL muscle pain. Constantly standing in the same position will reduce blood flow and pave the way for pain. Additionally, the weakness of the back extensor muscles can put a load on the QL muscle and cause pain.
Treatments for QL Muscle Pain
There are various treatments available for QL muscle pain:
- Stability exercises: Targeting the QL muscle with stability exercises can help it contract and relax, breaking the cycle of muscle guarding, back spasms, and other triggers of low back pain.
- Mobility exercises: Focusing on gentle mobility can help move the QL muscle through its entire length without causing sharp pain or triggering back spasms.
- Light stability exercises: Working the QL muscle with light stability exercises with minimal to no pain can achieve contraction and relaxation.
- Trunk stability exercises: Performing trunk stability exercises focused on other muscles can promote reciprocal inhibition of the QL muscle, helping it to relax and making trunk and low back movement less painful.
- Stretching: Stretching the QL muscle is one of the best ways to relieve and prevent pain in this muscle.
- Heat or cold therapy: Heat therapy can increase blood flow and open up blood vessels, bringing healing nutrients to the affected area. Cold therapy, on the other hand, can decrease inflammation and swelling by reducing blood flow to the sore area.
- Physical therapy: A physical therapist can help identify the causes of QL pain and manage it with targeted exercises to improve flexibility and strength.
- Trigger point therapy: Trigger points within the QL muscle can cause severe pain. Trigger point therapy, including dry needling and TENS, can provide relief from trigger point pain and reduce muscle tension and sensitivity.
- Acupuncture: Acupuncture can help bring healing to sore muscles.
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