Quadratus Lumborum and Back Pain
I have written about a number of the “lightning rod” muscles such as the piriformis, psoas, and transverse abdominis. I refer to them as “lightning rods” because they attract attention. Sometimes this is for good reason, after all, everyone should know about his or her psoas. However, every problem related to the core shouldn’t be thrown onto the back of the psoas or the transverse abdominis for that matter. Just like every pain in your butt is not the piriformis, every pain in your back is certainly not the quadratus lumborum.
The quadratus lumborum is often referred to as the QL. It is most commonly associated with pain in the back and that makes sense because the QL is located in the lower part of your back on either side of your spine.
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Anatomy of QL
Let’s start by talking about the anatomy of this muscle and what its functions are. As I mentioned, it’s located in the lower back. Specifically it is on either side of the lumbar spine between the lowest rib and the top of the pelvis. The technical attachments are the iliac crest, the transverse processes of the lumbar vertebrae 1 – 4, and the medial half of the 12th rib.
The muscle itself is relatively thin and sometimes has an additional layer of muscle to it. A google search of images will show lots of variation.
When both sides of the muscle contract simultaneously, it causes the lumbar spine to go into extension. If one side contracts it either pulls the rib cage down to assist in lateral flexion (side bending) or it lifts one side of the pelvis up in what is known as hip-hiking.
Additionally, this muscle is also used in respiration to help stabilize or move the lowest rib. It works in conjunction with the psoas for creating an anterior pelvic tilt. And it helps stabilize the lumbar spine along with the transverse abdominis (they share fascial attachments) and function with other “core” muscles.
The QL usually gets blamed when there is back pain. It’s totally possible that it is the culprit in cases of back pain. Of course, muscles tend to work together and interact dynamically with each other. Even if your QL is acting up, it’s very possible that it’s really telling you to look at an even larger problem. It may even be involved in the larger problem I wrote about in “Gluteal and Psoas Relationship for Yogis.”
Perhaps the most common larger problem is that the erector spinae muscle is not working as hard as it needs to or is even over worked. If the erectors of the spine work overtime stabilizing the spine in say sitting at a desk, the muscles become dysfunctional over time and the QL has to pick up some of its slack.
If it seems like the QL is acting up, I would always suggest looking at one particular muscle in the erector spinae group of muscles. I often find the most lateral muscle of this group, iliocostalis lumborum, is the one that gets mixed up with the QL the most. Not just functionally but literally. If someone were to put their finger on the edge of this muscle, they may very well assume that it is the QL that they are on. Its fibers lie on top of where the main part of the QL is. It is often not happy when people have overdone their backbending in the lower back.
It may also be worth having a look at the trigger points from the iliocostalis lumborum and those associated with the QL. Both of these muscles have trigger points that refer into the gluteal and piriformis region. This is a possible connection with the Gluteal and Psoas article previously mentioned.
Postures to Activate and Stretch It
All yoga postures that cause us to have an extended and hyperextended spine will shorten the QL (and ilicostalis). Poses where we are in a prone position such as shalabasana are the clearest to activate the QL as well as the erector spinae group of muscles because we are working against gravity to create the hyperextension in our spine.
Postures such as wheel can have the muscle shortened but in a different way. In backbends the arms and legs also generate forces that put us into a backbend. It’s not all created by the literal muscles that hyperextend the spine.
To stretch the QL forward bending can be one way of getting after it but it is more effective to do side bending. Parighasana comes to mind as the one of the most clear and consistent ways to stretch the QL. Having said that, alignment will matter in a yoga posture like this to get as much of the QL as possible. I suggest that you play with the amount of twist that you do when turning your body sideways. You may find different angles get at it in more or less effective ways for you.
Other options are a simple head to knee posture with the knee taken back further than “normal” will bring about a nice stretch through these tissues. Triangle pose, depending on how you do may also do the trick. You’ll find that your obliques will also get a stretch in these postures. See if you can differentiate the sensations.
Is It Weak or Not?
It will often be suggested that a muscle is weak when it acts up and causes pain and therefore needs to be strengthened. Remember, muscles can be weak because they are too tight. One way for this to happen is long sustained contractions that reduce the blood flow to the tissues. This is a very common scenario in a variety of muscles but especially here with the QL. Sitting for long periods of time without moving can reduce the flow of blood to this muscle and its neighbors.
When blood flow is reduced, the muscle finds itself having a harder time accomplishing basic physiological functions including removing waste products that would naturally be removed with blood flow. In addition to this, oxygen is essential to tissues remaining healthy. With a lack of blood flow, there is less oxygenation to the muscles and a compounding effect to its dysfunction.
At this point the muscle gets tight and weak. In my view this is the wrong time to simply try and strengthen the muscle even though doing so should increase the amount of blood flow to it. Personally I lean toward stretching the tissue first for a period of time and then adding strengthening techniques later.
Patterns in this area of the body are complicated. I encourage you to do research in your body as well as seeking out someone who can more objectively help you understand your pattern more clearly.
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David answers a question about how to strengthen the tensor fascia latae. He explains how the tensor fascia latae works in balance with other muscles in the body and reminds us that strengthening is not always the answer.