The quadratus lumborum is one of the hardest-working muscles in the human body. It connects the upper and lower bodies by connecting the hip bone (iliac crest) to the lower back vertebrae and the 12th rib. It stabilizes the spine and allows the upper and lower body to move independently.
The muscle is notorious for pain in the lower back, top of the hip, and buttocks. The pain may descend into the upper thigh. What is not as commonly known is the muscle can also refer to pain in the pelvis, groin, and lower abdomen.
QL pain can be debilitating. The pain is often sharp and stabbing when moving, coughing, or sneezing. The aching pain can be ever-present, not letting up whatever positions you may try, though lying on a firm surface may provide some relief.
Where Is The Quadratus Lumborum Muscle?
The quadratus lumborum is a low back muscle that connects the hip bone (iliac crest) and the lower back vertebrae (L1, L2, L3, L4) to the 12th rib.
For Detailed Quadratus Lumborum Muscle Anatomy See: QL Anatomy Page
The Movements (Functions) Of The Quadratus Lumborum
The quadratus lumborum muscle is an important component of upright posture. It also plays a role in:
- Side bending the trunk (lateral flexion)
- Straightening of the spine (standing upright)
- Helps to raise the hip when you lift your thigh
- Stabilizes the lower back and pelvis
- Assists with exhalation (breathing out)
- Supports and protects the internal organs
Quadratus Lumborum Muscle Pain And Symptoms
QL muscle pain can make your life miserable. The pain is most often felt in the lower back, where the muscle connects to the top of the hip bone. The pain extends toward the middle of the lower back, where the muscle connects to the spine. The pain is often stabbing and sharp, making you hesitant to move. Moving the leg on the affected side often brings on stabbing pain in the back and around the hip joint.
Another worrying symptom is the referred pain to the front of the body. You may fear a urinary tract infection or kidney stones. Women may think something is happening with the uterus or ovaries. Men may feel pain in the scrotum and testicles. A doctor should check these potential medical conditions. If you get a clean bill of health, then it is time to consider the possibility of QL trigger points.
Symptoms include:
- Pain in the lower back, constant deep aching even at rest
- Pain in the hips and buttocks
- Groin pain
- Pelvic pain
- Pain down the front and/or back of the thigh
- Low abdominal pain
- Stabbing back and or abdominal pain when coughing or sneezing
A list of muscles including the quadratus lumborum that may be involved in and influence these conditions:
ABDOMINAL PAIN | ANKYLOSING SPONDYLITIS | BUTTOCK PAIN | DEGENERATIVE DISC DISEASE | GROIN PAIN | LOW BACK PAIN | PELVIC PAIN | QUADRATUS LUMBORUM SYNDROME | SCIATICA | STENOSIS | TROCHANTERIC BURSITIS | UPPER LEG PAIN
The Causes Of Quadratus Lumborum Pain
Two of the main contributors to unexplained QL back pain are sleeping on a soft mattress and sitting too much, which puts incredible stress on the QL muscle along with other muscles in the lower back and hips.
Other causes:
- Lifting heavy objects
- Twisting while lifting
- Slouching when sitting or standing
- Leg length discrepancy: One leg is shorter than the other. You may have been born with a shorter leg, or it can be due to injury. It often occurs after the leg has been in a cast or splint.
- The QL muscles are often affected when you slip and or fall
Sports and activities that affect the quadratus lumborum:
- Golfing
- Baseball and softball
- Tennis
- Kayaking
- Horseback riding
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Quadratus Lumborum Treatment Suggestions
Using Cold and Heat for QL Back Pain
Cold and heat packs can help relieve muscle pain and promote faster healing. Many people tend to reach for a hot pack or heating pad. Heat feels good on muscle aches and pain, but too much heat can contribute to inflammation, leading to more pain. People think of cold packs as freezing and uncomfortable, which they can be, but if you can hold out for a couple of minutes, the discomfort goes away, and it starts to feel good. The question is, how do you know which to use?
Ice A Muscle Strain
If you have strained the muscle, even a mild strain, you know immediately because you feel pain. Use ice packs for the first 48 hours to help reduce inflammation. Wrap the pack in a towel, leave it on for 20 minutes, then remove it. Leaving ice packs on for extended periods increases the risk of freeze burn to the skin and other soft tissue damage. This treatment can be done hourly if needed. Once the first 48-72 hours have passed, you can begin alternating cold and heat treatments.
Sudden Onset Pain
Sudden-onset pain can be caused by sleeping on a soft mattress, sitting for long periods, slouched posture, or repeatedly doing the same movement too much, such as twisting or bending.
Begin with a 20-minute cold pack treatment. If it helps reduce the pain, continue with cold treatments for 24 hours, then alternate cold and heat treatments. Stop if you experience more pain or muscle cramping during the first treatment. Wait 20 minutes, and then apply heat. Continue with 20-minute heat treatments throughout the day(s) as needed. Again, you should only use heat for 20 minutes, then stop. Longer treatments may feel good but may increase inflammation in the area and lead to more pain.
How to alternate cold and warm treatments
Apply a cold pack for 20 minutes after trigger point treatments. Wait for 30 minutes and apply a warm pack for 20 minutes. It is important to wait between cold and warm treatments. Applying the alternate treatment too soon reduces the benefits of both treatments. You can do this protocol multiple times throughout the day.
Support and Compression
Back braces can play a significant role in managing QL back pain. The compression provided supports the lower back and abdominals reducing pain and improving mobility. Choose a brace with a wide band and adjustable side straps to adjust the compression and ensure full support for the QL muscle. Using a back brace can be a game-changer in finding relief for quadratus lumborum pain relief.
I recommend the Professional's Choice Low Back Support Brace for chronic low back pain. It is pricey but well-made and will last for years. It radiates body heat back into the muscles, which helps relieve pain and improve mobility. Though the band is wide, it is comfortable and is fully adjustable to provide the right amount of compression.
Recommended Pain Relieving Gels
Sombra Warming Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. It is an excellent choice for pain caused by trigger points, muscle/joint overuse and stiffness, and arthritis. Apply a thin layer of Sombra to the area of soreness, do not massage during application. Use it before bed for nighttime pain relief. Sombra can be reapplied every 6 hours. Do not apply before hot/cold treatments or before a massage treatment. (Not sold in stores)
Biofreeze Professional Strength Pain Relieving Gel an excellent pain-relieving gel recommended for those with sudden-onset muscle pain or recent injuries. It is better than warm therapy gels and creams for muscle pain caused by inflammation as it cools the area much like ice. Simply rub the gel on the area of soreness; do not massage during application. It can be safely applied every 6 hours. If your pain is from a recent injury, use Biofreeze. Do not apply before massage, trigger point treatment, or other hot/cold treatments
Trigger Points In The Quadratus Lumborum Muscle
Quadratus Lumborum Muscle Trigger Point Self-Treatment
Quadratus lumborum trigger points are relatively easy to find and treat. Many massage therapists, physical therapists, and chiropractors are trained in TrP therapy and can show you how to find and treat the specific TrPs of the quadratus lumborum.
If you are interested in learning how to self-treat low-back pain, The Trigger Point Therapy Workbook is an excellent how-to book. It describes the TrP phenomenon, includes diagrams showing TrPs' locations, and provides instructions on how to treat them.
NOTE: If you plan to use the workbook, you will need one of these tools for treatment.
The first option is massage balls. You place the ball between your lower back and the wall, applying pressure to the tender areas. Then, you gently roll the ball around to massage the muscle.
The other tool often used is the Thera Cane Massager. The Thera Cane is used on the QL muscle to treat one TrP that cannot be treated with a massage ball. It is also recommended for those with mobility or balance problems, as you do not have to lean and balance against a wall to treat the muscle.
Treatment consistency is vital to deactivate trigger points entirely. QL muscles respond best to 2-3 treatments of 1-2 minutes spread throughout the day.
How To Avoid Quadratus Lumborum Pain
- Evaluate your mattress. Does it provide support, or do you sink into it while sleeping? Sleeping on an overly soft bed contributes to back and other muscle pain throughout the body.
- Limit sitting time, get up, walk around, and stretch. If you have a desk job, consider investing in a standing desk to alternate standing and sitting through the day. Add a lumbar support to your chair to support the lower back.
- When lifting, use your legs for power. Don't rely on your back, shoulder, and arm muscles for strength.
- Never twist at the waist while lifting. Secure the item, then turn the body using your legs.
- Be aware of body mechanics and your conditioning level when playing sports. Golf, tennis, baseball, kayaking, and other activities that require hard twisting movements at the waist are problematic for the QL muscle.
- Horseback riding is good for strengthening back muscles overall. However, it is still sitting. Additionally, the QL muscle is working to stabilize and balance the upper body with the lower body, which can cause the muscles to be overworked. If you go for a long ride, get off periodically to walk. Your back and your horse will thank you!
Interesting Facts About The Quadratus Lumborum
- The quadratus lumborum is often involved in lower back pain.
- It is known as the ‘hip hiker’ muscle because it raises the hip (think of how you raise your hip to balance a child you are carrying).
- It is a key stabilizer of the lower spine and plays an important role in maintaining posture and spinal alignment.
- The quadratus lumborum muscle allows the separation of movement between the upper body and the lower body. Two examples are keeping the hips and legs still while moving and twisting the upper body and arms or moving the legs while keeping the upper body still.
- People who have one hip noticeably higher than the other are often experiencing problems with the quadratus lumborum.
Muscle Groups
Abdominal, Low Back | Arm | Chest, Shoulder, Upper Back | Face, Head, Neck | Foot | Hand | Hip, Pelvis | Leg (Lower) | Leg (Upper) | Spine
Areas of Pain
Abdominal Pain | Ankle Pain | Arm (Low) Pain | Arm (Upper) Pain | Back (Low) Pain | Back (Upper) Pain | Chest Pain | Elbow Pain | Foot Pain | Groin Pain | Hand Pain | Head Pain | Hip Pain | Knee Pain | Leg (Low) Pain | Leg (Upper) Pain | Neck Pain | Pelvic Pain | Shoulder Pain | Wrist Pain
If this information helped you, please share it so others can benefit.
References:
Clay, J. H., Allen, L., Pounds, D. (2015). Clay & Pounds' Basic Clinical Massage Therapy: Integrating Anatomy and Treatment (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins
Davies, C,. Davies, A., (2013). The Trigger Point Therapy Workbook: Your Self-Treatmend Guide For Pain Relief (3rd ed.). Oakland, CA: New Harbinger Publications
Finando, D., Finando, S. , (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch (1st ed.) Rochester, VT: Healing Arts Press.
Muscolino, J., (2016) Kinesiology: The Skeletal System and Muscle Function (3rd ed.). Maryland Heights, Missouri: Mosby.