Quadratus Lumborum Muscle Trigger Points and How To Relieve Your Pain

Trigger points in the quadratus lumborum (QL) are notorious for pain in the lower back, top of the hip, and buttocks that often extends down into the upper thigh. What is not as commonly known is that trigger points (TrPs) in the muscle can also refer pain in the pelvis, groin, and lower abdomen.

QL pain can be debilitating. The pain is often sharp and stabbing when you move or cough and sneeze. The aching pain can be ever-present, not letting up whatever positions you may try. Laying on the floor or a very firm mattress may help reduce the pain, but you will still feel it.

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 while men may feel pain in the scrotum and testicles. These potential medical conditions should be checked by a doctor. If you get a clean bill of health, then it is time to consider the possibility of QL trigger points.

Contents Of Article:

Muscle Location

Trigger Point Symptoms 

Trigger Points Cause

Trigger Point Prevention

Trigger Point Treatment

Interesting Facts 

Muscles With Similar Pain Patterns

Quadratus Lumborum Muscle Pain Pattern

Quadratus Lumborum Muscle Referred Pain Pattern

Trigger Points Information

Trigger points are small knots found in the muscle that when pressed increase pain in the area or send referred pain to another area of the body. To learn more about trigger points read Muscle Trigger Points and How They Contribute To Muscle and Joint Pain.

Where is the quadratus lumborum muscle?

The quadratus lumborum is a low back muscle that connects the hip bone (iliac crest), lower back vertebrae (L1, L2, L3, L4)  to the 12thrib.

What Movements Does It Control?

  • Side bending the trunk
  • Straightening of the spine (standing straight)
  • Stabilizes  low back
  • Helps to raise the hip when you lift your thigh
  • Assists with exhalation (breathing out)
  • Supports and protects the internal organs
The Quadratus Lumborum Muscle


Quadratus Lumborum Origin, Action, Insertion

Looking for detailed muscle anatomy? The Quadratus Lumborum Anatomy Page has origin, insertion, innervation, and blood supply information. It also lists agonists and antagonists for each muscle action.

Quadratus Lumborum Trigger Points Symptoms:

Trigger points (TrPs) in the QL muscle 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 and over toward the middle of the lower back where it connects to the spine. The pain is often stabbing and sharp which makes you hesitant to move. Moving the leg on the affected side often brings on sharp pain not only in the back but also around the hip joint.

TrPs may also refer pain to down into the top of the thigh and into the pelvis and groin area.


  • Pain in the low 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

What Causes Trigger Points To Develop?

Two of the biggest contributors to QL back pain are sleeping on a soft mattress and sitting too much both of which put incredible stress on the QL muscle as well as 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 shorter than other. This can be the way you were born or due to injury. It is often seen after a 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
TWD Recommends:
The HailiCare Posture Corrector fully supports the back and abdominal area while gently pulling your shoulders back which helps retrain muscle memory to maintain proper posture. Start slowly, wearing the brace only 20-30 minutes a day slowly increasing the time you wear it.

It is natural to slump while sitting. The Vertteo Full Lumbar Black Support is larger than other supports and helps you sit up straight comfortably reducing back and abdominal pain.

How To Avoid Development of Trigger Points In The Quadratus Lumborum Muscles

  • 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.
  • Limit sitting time, get up and walk around and stretch. If you have a desk job consider investing in a standing desk to alternate standing and sitting through the day.
  • Evaluate your mattress. Does it provide support or do you sink into the mattress while sleeping? Sleeping on an overly soft bed not only contributes to back pain but to muscle pain throughout the body.
  • Be aware of body mechanics and your conditioning level when playing sports. Golf, tennis, baseball, kayaking, and other activities that require hard twisting movement at the waist which is problematic for the QL muscle.
  • Horseback riding on a whole is good for strengthing back muscles. However, it is still considered sitting. Add to that the QL muscle is working to stabilize and balance the upper body with the lower body and that can cause the muscles to be overworked. If you are going for a long ride, get off periodically to walk. Your back and your horse will thank you!
TWD Recommendation:

A lumpy or too soft mattress wreaks havoc on the body. It can cause pain throughout the body and is especially hard on the lower back.

I have two mattresses that I recommend. The first is the Casper Sleep Essential which is on my bed. This mattress is firm but has enough softness to provide support. I have had this mattress for 3 years and highly recommend it to those who like a firm but not hard mattress. 

The Snuggle-Pedic Mattress is a mattress I have slept on several times and I can recommend it. It is not as firm as the Casper, but provides needed support. Recommended for those who need support but prefer a softer feel.

Quadratus LumborumTrigger Point Treatment

QL 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 The Trigger Point Therapy Workbook is an excellent how-to book. It describes the TrP phenomenon and includes diagrams showing you where TrPs are located and how to treat them.

NOTE: If you plan to use the workbook you will need one of these tools for treatment.

The first is massage balls that will be used by placing the ball between you and the wall. This applies pressure to the TrP and allows you to gently roll the ball around and massage the muscle. The Kieba Massage Lacrosse Balls are the right size and hardness to get the job done.

The other tool that can be used is the Thera Cane Massager. The Thera Cane is used to treat one particular TrP that cannot be treated with a massage ball.  It is also recommended for those who have mobility or balance problems as you do not have to lean and balance against a wall to treat the muscle.

Treatment consistency is important to full deactivate the trigger points. QL muscles respond best to 2-3 treatments of 1-2 minutes spread throughout the day.

TWD Recommends:

The best resource to learn how to treat small painful knots is The Trigger Point Therapy Workbook. The authors explain trigger points and their effects in everyday language, not medical speak. I recommend this book to anyone interested in learning to treat their own muscle pain.

If you are buying the Trigger Point Workbook to self-treat the QL muscle you will need a hardball for treatment. The Kieba Massage Lacrosse Balls are a good choice to use on the thighs and other areas throughout the body.

The Thera Cane is the other tool recommended by the TrP Workbook. This tool is easy for most people to use. You do not have to contort your body or have a lot of hand strength. You can easily reach most areas of the body including the glutes, low back, and back of the thighs.

Using Cold and Heat for QL Back Pain

Heat on muscle aches and pains feels good. Heat is your friend and your worst enemy!  Heat reduces your pain and stiffness so more is better, right? Sorry but the answer is no. Heat does promote relaxation but it also can promote inflammation in the area which is a huge contributor to your pain. Camping out on a heating pad feels good but once you remove the heat the pain comes roaring back. Heat treatments should last 20 minutes, 30 minutes top, no longer.

The best treatment course is to alternate between hot and cold treatments. I know, you think ice treatments are torture they are just so cold. The secret to cold treatments is to endure the first 1-2 minutes then you will be surprised that it will start to feel good. The next secret to cold treatments is you leave it on 20 minutes only. Longer duration and you risk damaging the skin and soft tissues.

How to alternate cold and warm treatments

Apply a cold pack after treatments for 20 minutes. Wait at least an hour then apply a warm pack for 20 minutes. You can do this multiple times during the day. It is important to wait at least an hour when switching treatments, otherwise, it reduces the benefit of the treatment.

Cureve Hot Cold Pack can be used for warm and cold treatments. I recommend using cold packs for 20-minutes after a TrP treatment. Use a warm treatment when the muscle is tight and needs to relax.

TWD Recommends:

Biofreeze Professional Gel  is recommended for the pain and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain. Recommended by medical professionals and trainers. 

How Long Before I Feel A Reduction In Pain?

Most notice a reduction in pain and stiffness after just a few days of treatment. QL trigger points can be stubborn and it is important to continue treatment until the TrPs are deactivated, meaning you cannot feel the knot and the area around the trigger point does not produce pain when pressed.

Sombra Warm Therapy Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint over-use and stiffness, and arthritis. (Not sold in stores)

Interesting facts:

  • Known as the ‘hip hiker’ muscle’ because it is the muscle that raises the hip.
  • Pain from the quadratus lumborum can be paralyzing. It brings a sharp stabbing knife-like pain to the lower back area. Turning over in bed and trying to stand from a sitting position can almost bring tears to the eyes.
  • The quadratus lumborum muscle allows 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.

Quadratus Lumborum muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

  • Trochanteric bursitis
  • S1 nerve compression
  • Degenerative disc disease
  • Stenosis
  • Sciatica
  • Cauda equina syndrome
  • Ankylosing Spondylitis
  • Scoliosis,
  • Diverticulosis
  • Endometriosis
  • Uterine Fibroids
  • Uterine Prolapse
  • Pelvic Inflammatory Disease
  • Prostatitis
  • Kidney Infection
  • Kidney stones
  • Bladder Pain and Infection
  • Urinary tract infection
  • T10 T11 T12 Radiculopathy
  • L1 L2 L3 L4 or L5 Radiculopathy

Other muscles that should be considered and examined:


Satellite trigger points associated with the quadratus lumborum muscle:

Trigger points in the QL muscle almost guarantee that there will TrPs in the gluteus medius and gluteus minimus muscles which will need to be treated. Other muscles that you should check:

  • Iliopsoas
  • Thoracolumbar paraspinals
  • Piriformis
  • Iliocostalis

Relax While Easing Your Pain and Stiffness

Heated Massage Pad to relieve back pain.
You’re tired, your lower back and hips are stiff and hurt. All you want to do is lie down and be able to relax.

The Snailax Vibrating Massage Mat With Heat is made for those times. The mat features a full-body vibrating massage and has multiple settings for massage and heat. The remote allows you to adjust settings with a push of a button. A wonderful way to ease aches and pains in the back, hips, and legs at the end of the day! 69 inches (5′ 9″) long.

Other muscles with similar pain patterns:

The Oblique Muscles

Iliopsoas Muscles

Donna Martin

Massage Therapist Owner: thewellnessdigest.com Twelve years of experience working with clients with chronic pain, post injury pain, and post surgery pain. Muscle dysfunction is often overlooked but can hold the key to many pain conditions.

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