Back pain – The Quadratus Lumborum muscle and its trigger points

Last week, I experienced some terrible stomach and back pain that lasted for 10 days. No doctors could find what it was. We all thought it was the gall bladder or the kidneys but my results were great and I eat so healthy that I couldn’t possibly avoid to eat even less fat than I already do. So after being in pain for so long I tuned in to myself and started looking on-line for answers. And it’s when it hit me – I should know better as a massage therapist – it is in fact my QL that’s so tight that it’s causing me terrible pain, pain that so intense that it is pulsating and radiating in my entire abdomen! I massaged myself with a tennis ball and found these very nasty sore spot (trigger points) where I applied more pressure while rolling gently on the ball. And OMG what a pain I experienced! But it was that ‘good pain’, when you know you are right and that somehow the pressure release so many years of tight muscles. It was an amazing learning curve for me: go back in myself and heal myself with an open-mind. I was in so much pain and because it was located in the abdomen mostly I thought it was something completely different than an inflamed trigger point!

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The QL muscle is renowned for being the prime cause of lower back pain. He brings the hips up and is important for balancing postural distortion. It is located deep into the abdomen and runs from the iliac crest to the 12th rib. It is close to many structures such as the kidneys, the colon and the diaphragm, as well as nerves, abdominal muscles and the spine. Needless to say that if this muscle doesn’t work properly, a lot of problems could occur.

This muscle acts as a prime mover, a postural muscle and a respiratory muscle. Some people with back pain also experience discomfort when breathing because a cranky QL resists elevation of the rib cage, and cramps up when pulling it down firmly on exhalation. Imagine the sense of relief when this is resolved!

Overuse and strain of the quadratus lumborum are one of the major causes for chronic pain in the lower back. One typical cause is the habit of sitting at the desk using a reclined seat, which releases the intrinsic back muscles and weakens them in the long term. The weak back muscles must now be compensated by the quadratus lumborum leading to painful tension and stiffening of the muscle. Other causes can be direct damage or any type of imbalance of the pelvis or spine which forces the quadratus lumborum to stabilize them. An example of that type of imbalance is unequal leg lengths.

If the gluteal muscle is weakened or overused (particularly the gluteus medius), the QL will be excessively recruited in order to stabilize the pelvis. That is one of my weakest point: after carrying two babies and running, my glute muscles are just constantly sore. I experience pain in the hips sometime and massaging those areas is extremely painful. It is a good sign that my QL is being put under a lot of strain already… so working on those weak areas will relieve, eventually, some of the pressure put on my QL.

Very often, one side of our body is weaker. On that side, having problems with the QL will most likely lead to chronic pain and tensions in the mid and upper back and in time it will affect further down the kinetic chain (i.e. hip, knee, shoulder, neck and head). Other causes of problems can be accidents, shorter leg, overuse or poor posture.

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In these pictures, you can see the trigger points (X) and the related areas of pain (in red)

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You can release the trigger points of the QL as I mentioned above: by using a tennis ball. I do it on the floor but you can do it by leaning onto the wall. Locate the area by by finding the bottom rib and then going just beneath it, pushing down, in and 45d upwards. Roll the ball over this area until you find an area of tenderness. Trust me, you’ll know when you are there! Hold there for about 20s and do this as much as you can, up to 10 times a day. It won’t release straight away so keep on doing it. Once you feel amazing and that something as changed, you know you have done something good for you!

You can too, off course, book a massage with me. It is always better as I can really assess the problems you are experiencing and work on a deeper level in related areas as well.

Always do a gentle stretch afterwards, as seen on the pictures below.

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Take care of your back, it works so hard for you, days and nights!

 

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