
The quadratus lumborum (QL) is a small but important muscle located on either side of the lumbar spine. It is a common source of lower back pain, which can be caused by overuse, stress, strain, or injury. Treatment options for QL pain include heat and ice therapy, painkillers or muscle relaxants, and trigger point injections. Physical therapy and exercises that promote mobility and stability can also help. It is important to seek medical advice for persistent or severe back pain, and to treat QL pain early to prevent further complications.
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What You'll Learn

Stretching and movement
When the QL is in a hyperactive state, certain movements can trigger symptoms such as low back tightness, soreness, and even back spasms. Therefore, it is important to stretch and move the QL in a way that relaxes and lengthens the muscle, reducing compression and irritation on the spine and nerves.
To increase the mobility of the QL muscle, try bending your trunk in the opposite direction of the side you are experiencing pain. For example, if you are experiencing pain on your right side, bend your trunk to the left. You can also try leaning forward to what you can tolerate. Another way to stretch the QL is to stand with your feet wider than your hips, with your right toes facing forward and your left toes turned out at a slight angle. Raise your arms so they are parallel to the floor, with your palms facing down. Hinge at your right hip as you extend your right fingers forward, then lower your hand to your leg or a block. Repeat on the other side.
In addition to targeted QL stretches, it is beneficial to strengthen the muscles that assist the QL and perform similar motions. This includes low-level trunk/core exercises that focus on working the QL muscle at an ideal length. Stability exercises will help to activate the QL muscle and promote pain-free movement.
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Physiotherapy
A chartered physiotherapist can help treat QL muscle pain by recommending specific exercises to strengthen the muscles and improve flexibility. These exercises aim to address the underlying causes of the pain, such as overuse, strain, or weakness. Physiotherapists can also provide guidance on appropriate exercise options to ensure a safe and effective recovery.
Physical therapy can be accessed through in-person visits or via telehealth/video consultations. It is a top treatment option for joint and muscle pain, helping to build strength, enhance mobility, and reduce discomfort. Therapists work collaboratively with patients to identify the factors contributing to their QL muscle pain and develop targeted exercise routines to manage the condition.
In addition to physiotherapy, other treatment options for QL muscle pain include acupuncture, trigger point therapy, dry needling, TENS, ultrasound, and stretching. Applying heat and ice can also help reduce pain and inflammation. It is important to consult a doctor if the pain persists despite home treatment for two weeks or if there are concerns about the severity of the condition.
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Massage and dry needling
Massage
The QL muscle, or quadratus lumborum, is a small but powerful muscle located in the lower back. It is involved in side-bending, hip hiking, and stabilising the spine during upper body movement, and it assists in breathing. QL muscle pain is often caused by a lifestyle imbalance, such as one-sided sports, work that involves carrying uneven loads, or long periods of sitting, especially with poor posture. Massage therapy can be an effective way to treat this pain and improve mobility.
Massage for the QL muscle usually starts with slow fascial techniques to soften the surrounding tissue. Therapists will work from the side toward the spine instead of from the top down to create the idea of space between the muscle layers. Friction can be applied across the fibres of the QL to encourage circulation and keep everything moving, giving cells in the area an opportunity to heal and reset. Some side stretches in the days following a massage can also help maintain the benefits of the massage.
Dry Needling
Dry needling is a modern physical therapy treatment that uses fine needles to release and re-pattern muscle dysfunction. It is a safe technique for treating many musculoskeletal conditions and can be especially effective for treating chronic pain. During dry needling, thin needles are inserted into the dysfunctional muscle trigger points, eliciting injury signals to the brain and initiating a healing process to restore and maintain normal function. This treatment can decrease muscle tightness, increase blood flow, and reduce pain.
Dry needling is often paired with electrical stimulation to enhance its effects. This combination causes a gentle contraction and relaxation of the irritable muscle, which helps the muscle relax further. The needles remain in the muscle for a short period, typically between 10 seconds and 20 minutes, depending on the treatment location, number of needles used, and treatment goals.
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Heat and ice
Ice therapy, also known as cold therapy, is often used to treat injuries or conditions that are inflamed, swollen, and suffering from tissue damage. By applying ice, you can decrease blood flow to the sore area, which helps to reduce inflammation and swelling. It is recommended to apply ice several times a day in intervals of 20 minutes or before the skin becomes numb. To prevent skin burn, it is important to place a layer of material, such as a towel, between the ice pack and the skin.
Heat therapy, also known as thermotherapy, involves raising the temperature of the affected muscle to induce muscle relaxation and pain relief. During heat therapy, the temperature of the skin and soft tissues increases, activating the body's thermoreceptors, dilating blood vessels, and increasing blood flow to the heated area. This increased blood flow brings healing nutrients to the affected area. Dr Matos recommends applying moist heat to the lower back for a few minutes before stretching.
In some cases, a combination of heat and ice therapy may be beneficial for treating muscle pain. A recent study found that both ice and heat therapy effectively reduced damaged muscle tissue following strength training, with cold therapy being more effective for treating pain immediately after a workout and up to 24 hours later. However, it is important to note that using heat on a new injury may increase blood flow to the area and potentially worsen swelling. Therefore, it is recommended to use ice first to reduce swelling and then switch to heat-based treatments once the swelling has subsided.
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Painkillers and muscle relaxants
The quadratus lumborum (QL) is the deepest abdominal muscle. It is located in the lower back, on either side of the lumbar spine, and is responsible for stabilising the pelvis and spine. It is very susceptible to pain formation due to its contraction during sitting, walking, and standing. Pain in the quadratus lumborum can be caused by overuse, stress, strain, or weakness and tension.
If left untreated, QL pain can result in stress to other areas of the body and cause further imbalances and misalignments. Therefore, it is important to treat the pain as soon as it begins. There are several ways to treat quadratus lumborum pain, including applying heat and ice, taking painkillers or muscle relaxants, and trigger point injections.
Muscle relaxants are prescription medications that can help relieve muscle spasms and spasticity. They are typically used as an alternative therapy after first- or second-line treatments have proven ineffective due to their potential side effects and addiction risks. Muscle relaxants work by depressing the central nervous system, which can make it hard to pay attention or stay awake. Therefore, activities requiring mental alertness or coordination, such as driving or operating heavy machinery, should be avoided while taking these medications. Common muscle relaxants include carisoprodol and diazepam, which are habit-forming and can cause withdrawal symptoms if stopped abruptly. Benzodiazepines, another type of muscle relaxant, can cause drowsiness and problems with balance and memory and are also habit-forming. It is important to consult a doctor or pharmacist when considering painkillers or muscle relaxants to determine the best treatment plan and follow their instructions for medication use.
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Frequently asked questions
The Quadratus Lumborum (QL) is a small muscle located on both sides of the spine between the rib cage and the pelvis. It is the deepest abdominal muscle.
QL pain is often caused by overuse, but can also be caused by weakness, tension, strain, and stress. Sitting for long periods, repetitive motions, and weak back muscles can also cause QL pain.
You can treat QL pain by applying heat and ice to reduce pain and inflammation. A doctor may recommend painkillers or muscle relaxants. Physiotherapy, stretching, and strengthening exercises can also help.
To prevent QL pain, focus on keeping your body fit and mobile. Perform movements that strengthen and stretch the QL muscle, such as side bends and stretches. Maintain good posture and ensure you are lifting heavy objects properly.











































