Quadratus Lumborum and its role in Low Back Pain
The majority of Low Back Pain is classed as non-specific, meaning there is no known specific pathology as to the cause of the pain.
I see such cases on a daily basis, after ruling out potential red flags or neural implications, I go straight to one muscle I know will most likely be implicated – Quadratus Lumborum (QL).
The QL is a deep muscle located in the lower back, it attaches to the 12th rib; the transverse processes of the lumbar spine, and the pelvis (posterior iliac crest). It aids with inspiration during breathing along with allowing the spine to extend and flex laterally (side to side). It is a postural muscle that gets notoriously tight and overactive in many people. It is the muscle many practitioner’s consider the main cause of low back pain.
Low back pain is more often than not of muscular origin. Trigger points within the QL muscle can cause severe pain, sometimes leading to complete failure to weight bear in an upright position.
Image reference: David G. Simons, Janet G. Travell, Lois S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual
Symptoms of QL implicated Low Back Pain
Persistent deep aching pain, normally at rest and often in an unsupported upright position (sitting or standing).
Difficulty bending forward
Pain bending to the opposite side
Difficulty climbing stairs
Pain when rolling over in bed
Difficulty when rising from a chair
Pain when coughing or sneezing
Referred pain
Active trigger points can refer pain to other areas in the body including:
Pain to the outside of the hip – this is often misdiagnosed as trochanteric bursitis. Placing pressure onto the lateral hip can cause immense pain.
Pain into the gluteal muscles and down the thigh, mimicking sciatic pain.
Pain at the front of the upper thigh which is often described as a lightening bolt pain
Deep, aching pain in the sacroiliac region
Pain to the front of the abdomen
Pain to the groin
Image reference: David G. Simons, Janet G. Travell, Lois S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual
Causes
Trigger points in the QL can arise from overload and overuse of the muscle. Repetitive movements including gardening, lifting heavy items, golf, walking or running on a slant or uneven surface can be contributors. They can also be a result of one leg being slightly shorter than the other. A sudden quick movement such as lifting a heavy item or trauma from a car accident can also cause trigger points.
Treatment
Acute pain caused by the QL responds well to myofascial therapy but once the pain becomes chronic, (3months plus), myofascial therapy may not be as successful by itself.
Chronic low back pain often leads to myofascial pain syndrome (ongoing muscle pain), as well as articular dysfunction within the lumbar spine.
If articular dysfunction is involved it can be hard to differentiate between the two as both conditions share similarities in their presentations.
Treatment involves assessing postural positions and asymmetries, along with any lower limb-length inequality. Myofascial therapy (trigger point therapy, dry needling, stretching), and strengthening of associated muscles is also recommended.
Self-treatment can include heat to the area followed myofascial release using a spiky ball followed by specific QL stretches.