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Hidden Roots of Lower Back Pain: Quadratus Lumborum

Lower back pain is one of the most common reasons someone seeks out acupuncture, oftentimes after trying other approaches. Direct massage to the lumbar region is frequently used to relieve lower back pain. Although this will often alleviate symptoms for some people, there may be some who do not see improvement or frequently have recurring symptoms.

Two muscles deep in the abdomen that are often overlooked when treating the lower back are the iliopsoas and the quadratus lumborum. The iliopsoas is the largest hip flexor in the body and is the only muscle that connects the spine to the legs. Quadratus lumborum is the deepest abdominal muscle and attaches the lumbar spine to the lower ribs and hips. Trigger points in both of these muscles can mimic sciatica, referring pain into the groin, hips, glutes, and legs. In this mini-series we will look at the anatomy of both muscles and how you can massage and stretch them at home to help relieve lower back pain.

Now, let’s take a look at the anatomy of the quadratus lumborum muscle:

The quadratus lumborum attaches to the top of the iliac crest (your hip bone), the bottom of the 12th rib, and the transverse processes of the first four lumbar vertebrae. It helps in laterally tilting the pelvis, laterally flexing the vertebral column, and supports the 12th rib during forced exhalation, such as coughing and sneezing.

Indications of a Tight Quadratus Lumborum

The most common symptom of a tight quadratus lumborum is lower back pain. You may also have pain in the following areas:

  • Crest of the hip

  • Front/upper groin region

  • Sacroiliac joint

  • Hip joint

  • Buttocks

You might experience the most pain during the following times:

  • During the upright posture of standing or sitting

  • Difficulty getting out of bed in the morning

  • Bending and twisting at the waist

  • Lifting heavy objects

  • Coughing and sneezing

You might have a tight quadratus lumborum if you:

  • Have one leg shorter than the other or one hip higher than the other

  • Have scoliosis

  • Torso seems to lean to one side

  • Frequently stand with all your weight on one leg

  • Have difficulty rolling over while lying down

  • Brace yourself during sitting or walking

Stretching Quadratus Lumborum

Follow these steps to isolate and stretch your quadratus lumborum

  1. You can stretch the QL muscle in a seated or standing position.

  2. Imagine a string pulling the top of your head up toward the ceiling.

  3. With your spine straight, lift your right arm up, pull your shoulder back to open up the chest, then lean over to your left side. You can place your left hand on the ground, or along your thigh, for support.

  4. Lean over as far as is comfortable for your body.

  5. From here, imagine another string pulling upward from the side of your lower ribs. You can even gently push your right hip out to the side to feel more of the stretch in your waist.

  6. Repeat on the opposite side.

For a deeper stretch, try incorporating a hamstring stretch

  1. Sit on the ground with your legs stretched out in a wide-V.

  2. Bend your right knee and tuck your foot up against your left leg.

  3. Imagine a string pulling the top of your head up toward the ceiling.

  4. With your spine straight, lift your right arm up, pull your shoulder back to open up the chest, then lean over to your left side, reaching for the toes on your left foot with both hands.

  5. Lean over as far as is comfortable for your body, allowing gravity to draw you down into a deep stretch.

  6. Repeat on the opposite side.

Self-Massaging the Quadratus Lumborum

  1. Locate the quadratus lumborum by reaching behind to your lower back and place your fingers on your spine. Slide your fingers out to the side until they slide off the band of muscles that run along the sides of your spine. If you press into the space your fingers fall into it should feel tender. That’s how you’ll know you’re on the right spot.

  2. Position a small ball or foam roller against a wall or on the floor in this crevice.

  3. Roll around in this space from the lower ribs down to the hips until you find a tender spot. Hold in this position until the discomfort dissipates. Continue massaging this area as long as it feels comfortable to you.

Strengthening the Quadratus Lumborum

Side planks and weighted side bends will strengthen the quadratus lumborum. When doing these exercises, be sure to engage your core to help stabilize the pelvis and lower back in order to protect your back from strain or injury.


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