Treating QL Pain: Myotherapy Solutions for Chronic Lower Back Issues
Author: Jerry Song
The quadratus lumborum (QL) is often called the “hip-hiker muscle,” playing a significant role in core stability and movement. Despite its small size, dysfunction in the QL can cause considerable discomfort, manifesting as low back pain, hip pain, or even referred pain patterns that mimic other conditions.
Anatomy and Function of the Quadratus Lumborum
The QL is a deep muscle located in the lower back, forming part of the posterior abdominal wall. It runs from the iliac crest (top of the pelvis) to the 12th rib and lumbar vertebrae (L1–L4).
Primary Functions:
- Lateral Flexion of the Spine: The QL bends the torso sideways.
- Stabilisation of the Spine and Ribcage: It plays a key role in maintaining posture, especially during movements like walking or lifting.
- Elevation of the Hip: In unilateral contraction, it lifts one side of the pelvis (hence the name “hip-hiker muscle”).
- Assistance with Breathing: The QL helps stabilise the ribcage during deep inhalation.
Given its involvement in both movement and stability, the QL can easily become overworked or strained, leading to pain and dysfunction.
Common Trigger Points in the QL
Trigger points in the QL are notorious for causing referred pain patterns, which can be mistaken for other conditions.
Trigger Point Locations:
- Deep within the muscle, along the posterior iliac crest.
- Near the attachments on the lumbar vertebrae or the 12th rib.
Referred Pain Patterns:
- Low Back Pain: A dull ache or sharp pain along the lower back.
- Hip and Gluteal Pain: Radiating pain around the pelvis and buttocks.
- Thigh Pain: Discomfort can extend to the upper outer thigh.
- Pain During Breathing: Trigger points near the rib attachment may cause pain when taking deep breaths.
Who Is Most Susceptible to QL Issues?
Certain activities, occupations, and lifestyles put some demographics at higher risk for QL dysfunction:
- Office Workers and Desk Sitters
- Prolonged sitting can lead to QL shortening and tightness, especially if posture is poor.
- Manual Labourers
- Repetitive bending, lifting, or twisting places strain on the QL.
- Athletes
- Sports involving asymmetrical movements (e.g., tennis, golf) or repetitive impact (e.g., running) can overwork the QL.
- Parents and Caregivers
- Frequently carrying children on one side of the body can overactivate the QL.
- Individuals with Leg Length Discrepancies
- Unequal leg lengths can lead to chronic QL compensation to maintain balance.
- People with Poor Core Stability
- Weak abdominal muscles force the QL to take on extra stabilising responsibilities, leading to overload.
Myotherapy Treatments for the QL
Myotherapy offers a range of effective techniques to treat QL-related pain and dysfunction.
- Trigger Point Therapy
- Direct pressure is applied to deactivate trigger points and relieve referred pain.
- Dry Needling
- Inserting fine needles into QL trigger points promotes relaxation, reduces pain, and restores muscle function.
- Myofascial Release
- Gentle, sustained pressure targets the fascia surrounding the QL, relieving tension and improving mobility.
- Deep Tissue Massage
- Focused techniques are used to release deep-seated tension in the QL and surrounding muscles.
- Stretching and Mobility Work
- Guided stretching helps lengthen the QL and improve range of motion.
- Example: Side-Bending Stretch – While standing, reach one arm overhead and lean to the opposite side.
- Pelvic Stability Exercises
- Strengthening the core reduces the QL’s workload, preventing future strain.
- Heat and Ice Therapy
- Heat can relax the QL, while ice can reduce inflammation after overuse or injury.
- Postural Correction
- Myotherapists can identify and address postural imbalances contributing to QL dysfunction.
Self-Care Tips for QL Health
To minimise QL tension and discomfort, incorporate these self-care strategies:
- Maintain Proper Posture: Sit and stand with a neutral spine, avoiding slouching or excessive arching of the back.
- Take Movement Breaks: Avoid prolonged sitting by standing up and stretching every 30 minutes.
- Strengthen Core Muscles: Exercises like planks and bridges help reduce QL overcompensation.
- Stretch Regularly: Stretch the QL and surrounding muscles to maintain flexibility.
- Use Ergonomic Lifting Techniques: Bend at the knees and engage the core when lifting heavy objects.
- Avoid Asymmetrical Activities: Distribute weight evenly when carrying bags or children.
Example case study
A patient (M, 56) presented with a history of chronic lower back pain that goes deep into the top of the hip. Symptoms were exacerbated by activities such as gardening and performing mechanical work on his cars. The patient reported some improvement after changing his mattress but noted that his predominantly sedentary work lifestyle significantly aggravated his discomfort.
Upon examination, the patient displayed:
- Hypertonicity in the right quadratus lumborum (QL) and lumbar/thoracic erector spinae group (Lx/Tx ESG).
- Pain referral patterns consistent with QL dysfunction, exacerbated by prolonged sitting and repetitive physical tasks.
After a Myotherapy treatment that included myofascial cupping, deep tissue massage, and trigger point therapy, the patient reported a noticeable improvement in lumbar range of motion, and reduced tenderness in previously sensitive areas.
This case underscores the importance of addressing the quadratus lumborum (QL) and surrounding muscles in managing chronic lower back pain. The patient’s sedentary lifestyle and physically demanding hobbies likely contributed to overuse and strain in the QL, leading to persistent discomfort.
The quadratus lumborum muscle is a vital stabiliser and mover, but when overworked or strained, it can lead to persistent pain and dysfunction in the low back, hips, and even the ribs. While we’ve focused on the QL in this article, it’s also important to note that in most cases, pain arises from multiple contributing factors, including other muscles, joints, and overall movement patterns. For this reason, it’s always best to seek a proper assessment from an experienced therapist to identify the root cause of the issue and develop an effective treatment and self-care plan.
If you or someone you know are dealing with a QL condition, musculoskeletal pain, or even myofascial trigger points, book an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain. Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.
