The first thing you need to know about the Quadratus Lumborum, or QL, is that you have two of them, one on either side of your spine in your lower back. (For simplicity of discussion I will refer to “the QL” singularly.) These muscles are a vital part of a team of powerful core muscles that surround your spine below your ribs and they function like the two sides of an old balance scale, raising and lowering each side of the pelvis in relation to the torso. The QL along with a few of its neighbors is responsible for a lot of the stability or lack thereof in the lumbar spine. Pain at the site of the QL is one of the most familiar and ubiquitous feelings of pain in the lower back that we all experience. The unique actions and placement of this muscle means that it is literally a hub for pain and dysfunction. If you’ve ever had significant lower back pain and spent time with Dr.Google trying to figure out where it was coming from and why, then you probably came across one of the many articles that name the pesky QL as the cause of your woes. This article will address the QL as related to lower back pain in addition to other areas of pain with which it is less commonly associated.
For starters, let’s get a look at this thing and figure out what we are dealing with. Below is an image that depicts the entire QL and then separates it into three distinct areas according to the boney attachment site of each section. I love this picture because it illustrates the role of this muscle in stabilizing the lumbar spine (it looks a bit like the long supporting guy wires that suspend and hold up tall radio towers).
Now, take a moment to imagine how the position of the whole body might change when the upper and lower ends of the QL are brought closer together as this muscle contracts. Maybe the hip rises up, or the trunk does a bit of a side-crunch, or possibly a bit of each. When you take it a step further and stand up and try contracting the QL, what do you feel? If the answer is not much, then try placing your fingertips on your low back just above your hips and then your shift weight from your left foot to your right foot. Still a bit fuzzy, try the same shifting move but lift the un-weighted foot a few inches off the ground. This puts a high demand on the QL to contract and stabilize you from falling over, so you should really be able to feel that puppy firing now. Ok, got it? Good.
Now that we know where this thing is and we are comfortable in understanding its importance in stabilization and balance let’s look at some common ways that you might experience a problem with your QL
- Lower back pain!
- Pain while bending or twisting at the waist.
- Aches and pain in the hip (feels like a really sore butt)
- Pain in the side of the hip (feels like in/around the joint)
- Restricted range of motion in flexion, extension, or rotations of the hip and lower trunk areas.
- Painful or restricted breathing.
- Sharp pain in the lower back when coughing.
- Restricted ROM and associated pain in the shoulder
Numbers 1-5 seem logical when you consider the location/actions of the QL and if you are experiencing any of these, there is a good likelihood that your QL is involved in your pain/dysfunction. Close proximity to the diaphragm and the upper attachment of the QL provide the link for number 6 & 7. To explain how the shoulder can be affected, I’d like you to try standing up and experiencing something once more.
So go ahead and reprise your role as the silly person shifting from one leg to another while holding you lower back. (Encore, you were so good the first time!) If you weren’t last time, this time you will want to be near to a chair, wall, or other solid object in case you lose you balance. Ready?
Ok, now begin by shifting your weight over the right hip and lifting the left foot a bit. While in this position, really accentuate the QL contraction to the fullest by also side-crunching your torso the right (if you need to use something now to not fall over, use the left hand and try not to grip and hold if you can, just a light contact should do for most people). Once you feel like you have really gotten the bottom-right side of your ribs as close as possible to the upper-right border of your pelvis, try raising your right hand overhead as high as you can (without pain), taking note of how far it gets and the level of effort around the shoulder needed to get it there. Now, relax a moment. When ready, shift your weight over the left hip and lift the right foot a bit. Once you feel balanced standing on only the left leg side-crunch your torso to the left. Close off all the space between your lower left ribs and the upper left hip. Lastly, raise your RIGHT arm (the same arm as before) as far as you can toward the ceiling and note again how far it goes and the effort around the shoulder needed to get it there.
What did you notice when comparing the feeling of raising the right arm while leaning right vs while leaning left? Did the arm get a bit higher when you leaned to the left or to the right? Was the effort to raise your arm more or less when leaning to the right? Did you find it easier to balance over the left side or the right side?
For most people there is more effort needed to raise the right arm while leaning to the right side along with a substantial drop in range of motion. The opposite will be true while raising the right arm and leaning to the left side. Of course, this exercise had you using many more muscles than just the two QLs, and a number of other factors will determine how well you were able to move you arm. This scenario is intended to elicit a distinct feeling of moving your body with a short, tight and contracted QL. When even one of your two QLs is chronically overused and becomes hypertonic and contracted then movements large and small are negatively effected and you may experience pain.
So now you know where it is, what it does, how it feels for your body to use it, what you might expect to feel if something’s not right, and the things that seem unrelated could actually be a problem in this muscle. Now let’s talk about how to care for it.
Caring for your QL:
The best thing you can do is be proactive and check in with your QL to see how it’s doing BEFORE it starts howling! The simple shifting exercise you already tried is a great way to do this kind of checking in. Another key way to prevent injury to the QL is to develop a habit of mindfully moving from your center of gravity, rather than throwing your arms and legs where you want them to be with your center trying to catch up (and your QLs working overtime to may sure you don’t just fall right over). The important difference between these two ways of moving (other than power, efficiency, ease, and grace) is that moving with your center first minimizes strain on the lumbar spine and that means less work for these often over-worked muscles.
Maintaining a limber QL is an essential part of preventing and treating a variety of common lower back and hip conditions. The mid section of the body is perhaps not the easiest area to get a big stretch. I find breathing vigorously with the diaphragm in sequence with a few active stretches typically yields the best results. Be careful not to maintain deep side-bending positions for especially long, as this puts undue strain on the lumbar spine.
- MANUAL THERAPY
Moderate pressure directly on the area of the QL (lower back, on both sides of the spine, just beyond the thick bulky erector muscles closest to the spine, in the area between the lowest rib and the top of the pelvis) with a pair of tennis balls is a great way to show your tender QL some love. If you’re never tried this simple and effective self-care technique, give it a shot. A few minutes of youtube education and some experimenting with the tennis balls while leaning against a wall and/or lying on your back is an investment you can’t afford not to make.
At Phila Massages, we help members with difficult QL issues everyday and we are here to help you should your QL begin to howl. Of course, if you are experiencing significant pain in one or both of your Quadratus Lumborums you should consult with your regular doctor.
This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.