Trigger points in the quadratus lumborum (QL) are notorious for pain in the lower back, top of the hip, and buttocks that often extend down into the upper thigh. What is not as commonly known is that trigger points (TrPs) in 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 you move, cough or 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. 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.

Quadratus Lumborum Referred Pain Pattern
Contents of Article


    Where is the quadratus lumborum muscle?

    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

    Looking for detailed muscle anatomy? The Quadratus Lumborum Muscle 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 felt in the lower back, where the muscle connects to the top of the hip bone. The pain extends 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 down into the top of the thigh, the pelvic and groin areas.


    • 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

    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)

    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. 

    What Causes Trigger Points To Develop?

    Two of the main 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. You may have been born with a shorter leg or it can 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

    TWD Recommends

    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.
    The Casper Sleep Essential is firm but has enough softness to provide support. It is recommended to those who like a firm but not hard mattress.
    The Snuggle-Pedic Mattress is not as firm as the Casper, but provides needed support. Recommended for those who need support but prefer a softer feel.

    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, 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 contributes to back pain and 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 movements at the waist are problematic for the QL muscle.
    • Horseback riding on a whole is good for strengthing back muscles. However, it is still 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 Recommends

    Cureve Hot Cold Pack can be used for warm and cold treatments. It is recommended that you use cold packs for injuries, swelling, and after a TrP treatment. Use a warm treatment when the muscle is tight and needs to relax.

    Quadratus Lumborum Trigger 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 TrPs' locations 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. The balls are used by placing the ball between you and the wall. The ball applies pressure to the TrP. You gently roll the ball around to massage the muscle. The Kieba Massage Lacrosse Balls are the right size and hardness to get the job done.

    The other tool often used is the Thera Cane Massager. The Thera Cane is used on the QL muscle 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 deactivate trigger points fully QL muscles respond best to 2-3 treatments of 1-2 minutes spread throughout the day.

    Using Cold and Heat for QL Back Pain

    Heat on muscle aches and pains feel good. Heat packs are your friend and your worst enemy! Heat treatments reduce your pain and stiffness, so more is better, right? Sorry, but the answer is no. Heat does promote relaxation, but it can also cause inflammation in the area, which is a primary contributor to muscle 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 tops, no longer.

    The best treatment course is to alternate between hot and cold treatments. I know you think ice treatments are torture because it is just so darn cold. The secret to a cold pack treatment is to endure the first 1-2 minutes, after which you will be surprised. It will start to feel good. The next secret to a cold pack treatment is to leave it on for 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 trigger point treatments for 20 minutes. After at least an hour passes, 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 because if you apply the alternate treatment too soon, it will reduce the benefit of treatment.

    Support and Compression

    Heat does promote relaxation, but it can also cause inflammation in the area, which is a primary contributor to muscle pain. The compression provided by the brace supports the lower back, reducing pain and increasing mobility. To fully support the QL muscle, the brace band should be wide and have side straps to easily adjust the amount of compression.

    TWD Recommends

    If you have low back pain or need abdominal support, the Professional's Choice Back Brace will help reduce your pain and stiffness. The waist wrap and 2 side straps are easily adjusted and provide support compression to the low back and abdomen. It is the only low back brace TWD recommends. It works!

    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 you must continue treatment until the TrPs are deactivated. Once the TrPs are deactivated, you cannot feel the knot, and the area around the trigger point does not produce pain when pressed.

    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 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.

    TWD Recommends

    Doctors and physical therapists often recommend TENS to relax muscles and ease the pain. The Belifu TENS Unit Muscle Stimulator is an excellent choice for treating back and hip pain.

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

    • Sprain/strain of lower back muscles
    • 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
    • Liver disease
    • 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:

    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
    • Gluteus medius
    • Gluteus minimus
    • Spinalis muscles
    • Longissimus muscles
    • Iliocostalis muscles