I have had many conversations with my patients lately about the quadratus lumborum, commonly known as the QL. In many cases, these patients have suffered from chronic low back pain without a specific injury. This muscle has multiple functions and can be the source of low-level, chronic low back discomfort if overused, tight, and/or weak. Releasing and re-training the QL can be very successful in finally getting rid of low back pain. 

I am a bit of an anatomy nerd, as are most PTs I know. So I thought I would take the opportunity here to share some information about this fascinating muscle with all of you! I strongly believe that knowledge is power. The more we understand our anatomy and physiology the less fear we will have if we one day are dealing with an injury or diagnosis. 

The quadratus lumborum is found on both sides of the lumbar spine and attaches into the pelvis and the 12th rib. It is a deep muscle and very close to our kidneys and intestines. If irritated badly enough, this muscle can affect our digestive health. In this blog, however, we will be looking at the QL from a movement perspective.

The function of the QL is mainly as a stabilizer or “postural muscle”. It is a primary stabilizer of the low back when sitting so if you are someone who sits a lot for work and you also experience low back pain, the QL is most likely involved. The QL also helps to stabilize the pelvis when standing, walking, or running. It functions to laterally tilt the pelvis and to side bend and extend the spine. It is considered a “core muscle” because it has similar attachments to that of the other abdominal muscles and helps to form the posterior wall of our abdominals. And since it has an attachment on the 12th rib, it also plays a role in breathing. That is a lot of work for one muscle!

Since the QL is so closely integrated with the surrounding muscle groups (i.e. abdominals, erector spinae, and gluteals) it often becomes an issue when one of those groups is either weak or injured. In that case, the QL will work overtime to compensate for the injured or weak muscles. This can lead to excessive tightness in the QL and the formation of abnormal bands of tissue, known as trigger points.

If you have been treated at Outlast, it is likely that you have heard of trigger points. Most people know these areas of irritability as “knots”. Trigger points can refer pain into other areas of the body, similar to how diseased visceral organs can refer pain into other areas of the body. The QL has a referral pattern into the same sided hip and tailbone. See the photo below. Many people will describe QL pain as a pain in the tailbone, center of the buttocks, or a pain that “wraps around” their hip. 

If any of this sounds like you, do not fear, there are many things that you can do on your own to address a cranky QL. The first step is to determine if your QL is tight. Try the following stretch. In a half kneel position (left knee down on the ground and your right leg up), reach your left hand overhead and side-bend your trunk towards your right side. Check out this video if you are having trouble figuring out the position. If this feels like a big stretch between your lateral ribs and pelvis or if you are having pain in that area, then you most likely have tight or poorly functioning QLs. If you can find some comfort in this position, this a good stretch to work on with some deep breathing in order to begin opening up and releasing your QL. You can also work on foam rolling this area. 

In order to avoid continued issues with the QL, you want to make sure that you have a good foundation of strength in your abdominals, low back and gluteals. Some good exercises to focus on to improve strength in these areas are bridge variations (elevated bridges with feet on a bench, single leg bridge, single leg elevated bridges, etc), low back extension exercises (supermans, banded pull throughs, GHD lumbar extensions, etc), and abdominal stabilization exercises (bird dogs, plank bird dogs, side plank lifts, etc). As I mentioned earlier, the QL is active as a postural stabilizer when we are sitting, so to limit QL overuse, try to avoid sitting for long periods of uninterrupted time. Get up and move around, stretch your back for a few minutes, maybe even work from a standing position whenever possible. 

There are also some specific exercises you can do to help re-train the QL to function properly. These exercises should be incorporated once the pain level is at a minimum. One of my favorite QL exercises is a suitcase hold march. For this exercise, you will hold a heavy dumbbell or kettlebell by your side in one hand. You then will slowly perform an alternating march without allowing your trunk to sway. This works on the stabilizing function of your QL.

In physical therapy, there are many techniques we as PTs can do to help release tension in this area and help to retrain the QL to restore proper function. If you have tried the above techniques and are still struggling with chronic low back pain, do yourself a favor and schedule a PT appointment. We are here to help you help yourself!

Shannon Hall, PT, DPT

https://www.ncbi.nlm.nih.gov/books/NBK535407/

https://www.gregoryangell.com/online/yo-ga-articles/quadratus-lumborum-marathon-runner-muscles/