Quadratus lumborum and back pain
I’ve 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, which makes sense because the QL is located in the lower part of your back on either side of your spine.
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 to create an anterior pelvic tilt. And, it helps stabilize the lumbar spine along with the transverse abdominis. They share fascial attachments and function together with other “core” muscles.
Back pain and quadratus
The QL usually gets blamed when there is back pain. And, 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 also possible that it’s really telling you to look at a larger problem. It may even be involved in the larger problem I wrote about in “Gluteal and Psoas Relationship for Yogis.”
Are the erector spinae involved?
Perhaps the most common larger problem is that the erector spinae muscles are not working in an ideal way. They may not be working as hard as they should be, or they could be over worked. If the erectors of the spine work overtime stabilizing the spine when sitting at a desk, for example, 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 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. And, I don’t mean just functionally, but also 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.
Postures to activate and stretch it
All yoga postures that extend or hyperextend the spine also shorten the QL and ilicostalis. Poses where we are in a prone position such as shalabasana are the most direct ways that we activate the QL as well as the erector spinae group of muscles. This is because we are working against gravity to create the hyperextension in our spine.
Postures such as wheel can shorten the muscle, but it happens 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 muscles that hyperextend the spine.
We stretch the QL when forward bending somewhat, 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.
Another option is a simple head to knee posture with the knee taken back further than “normal”. This will bring about a nice stretch through these tissues. Triangle pose, depending on how you do it, 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’s often suggested that a muscle is weak when it acts up and causes pain. And therefore I often get the question: what 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 has 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 maintaining healthy tissues. 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 technique later.
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Hi David, I have read various articles on Psoas and Quadratus Lumborum but nowhere found both to be an issue for back pain. How come? Why cant both muscles be responsible for back pain when both are attached to lumbars and pelvic? Almost both muscles get stretched or contracted in yoga postures – whether forward bend, backward bend or side bends. Have you written any article showing the relationship between the two? Or would you like to recommend any? regards, Umesh
I correct myself, after some foam rolling, more than my ITB I think my gluteus minimus was more unhappy
Every time I do bicycle my QL contracts, but I experience it later in the day at night.
long time ago I was told I have one hip higher and rotated, explaining my shorter leg (1 cm shorter, not much for the bug painful symptoms he he)
any advice to strengthen (not sure what else I could strengthen, ive done so much core that I have a 6-pack) or take care of the over use?
I recently had a hysterectomy and have been experiencingsit bone and tailbone pain? Been to chiropractic care, massage, pain pills no help. I do have a old fracture in tailbone but this new pain is different and started 2 weeks after surgery?any idea’s and where can i find a clinic like yours