The quadratus lumborum or QL is a muscle that lies deep in your lower back. The QL attaches along the top of your pelvic bone (the iliac crest) and extends upward to attach to the lowest rib and along the transverse processes of lumbar vertebra one through four. This muscle is the deepest back muscle which means it lies below other muscles and fascial layers.

The QL is considered a core muscle and a postural muscle. It has several functions. Its attachments on the spine and pelvis suggest it may extend the spine and laterally tilt the pelvis though it is likely that the QL assists other muscles in these functions more than it performs them independently. Its attachment on the 12th rib helps stabilize the diaphragm to allow for better inspiration. It also helps maintain frontal plane stabilization of the pelvis.

QUADRATUS LUMBORUM SYNDROME

As you can see, the QL has its hand in many different functions of the spine, pelvis and ribcage. Because of its location in the lower back, problems with the QL muscle can lead to lower back or buttock pain. It is always prudent for your therapist to examine the QL muscle if you are experiencing low back pain. Pain or postural dysfunction caused by the QL muscle is known as quadratus lumborum syndrome. Signs and symptoms of QL syndrome include

• Low back pain that is deep and achy
• Pain that worsens in sitting or standing
• Pain when coming up to stand
• Pain with bending forward or leaning away from the involved QL muscle
• Pain with coughing or sneezing
• Tightness of the QL muscle
• Overactivity of the QL muscle

Active trigger points in the QL muscles which can refer symptoms to other locations:

• Outside of the hip
• Buttocks and posterior thigh (mimicking sciatic pain)
• Front of the upper thigh
• Groin
• Abdomen
• Sacroiliac joint region

WHAT CAUSES QL SYNDROME?

QL syndrome can have many causes. An acute or traumatic event like lifting something very heavy, falling or getting into a car accident can lead to the development of active trigger points and overactivity in the QL muscle. This can persist for quite some time if not addressed. Additionally, repetitive motions that stress the QL can also lead to QL syndrome. These activities could be walking or running on a slant or uneven surface, repetitive bending such as during gardening or at work or repetitive lifting. Additionally, anatomical variations such as a leg length discrepancy can lead to QL syndrome.

If you decide to work with a physical therapist to help with your Quadratus Lumborum issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your back PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR THE QUADRATUS LUMBORUM

Physical therapists are movement specialists trained to evaluate and treat musculoskeletal conditions like QL syndrome. While my team of therapists and I will always create an individualized treatment plan just for you, below are some common treatment strategies and techniques to address QL syndrome:

Myofascial release techniques are often utilized to address dysfunction in the QL muscle as well as nearby muscles and fascia. The longer you have dealt with QL syndrome, the more likely it is that other muscles and fascia will need treatment as well

Trigger point release through dry needling or manual therapy may be prescribed to treat active trigger points. This can improve both localized pain as well as referred pain and reduce overactivity in the QL muscle

Spinal mobilization to improve the movement of spinal segments is often recommended due to the stiffness or hypomobility that can arise in response to tight and overactive QL muscles

Muscle stretching to lengthen over shortened muscles can help with improved postural control and pain reduction

Muscle strengthening and motor control exercises are important to adequately support the QL muscle, spine and rib cage during exercise and activities of daily living

QL syndrome can be a significant cause of low back pain but it is important to rule out other causes such as disc herniation or nerve compression. As part of a comprehensive examination our team of therapists will look for red flags that indicate referral to a physician is necessary as well as look for other potential causes of low back pain.

Living with low back pain can take a toll on your mental and physical health. Our team of therapists would love to help you feel better. If you are living with QL muscle pain or curious if your low back pain could be caused by QL syndrome, call Evolve Physical Therapy today to schedule your initial evaluation.