Lower Back Pain: The Quadratus Lumborum
October 4th, 2016| Dr. Matthew DiLallo DC, MA, CSCS
Lower back pain can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Learn how we can attack the Quadratus Lumborum to combat lower back pain.
Low Back Pain: The Quadratus Lumborum Muscle:
The Quadratus Lumborum (QL) is a deep muscle that runs on both sides of the lower back. The muscle begins on the lowest rib and the nearby vertebra, and connects to the top of the hip crests. The QL is responsible for stabilizing the lower back while upright, and also has a role in side bending. Either one or both of the QL muscles can tighten and close the distance between the rib and the hip crest. This compresses the affected side of the spine and everything in its path, which includes the discs, joints, and nerves.
The QLs pick up the slack when the lower fibers of the erector spinae are weak or inhibited (as they often are in the case of habitual seated computer use and/or the use of a lower back support in a chair). Given this disadvantage, the constant contraction while seated can overuse the QLs, resulting in muscle fatigue, trigger points, and lower back pain.
How important is the QL?
Research (Knapp 1978) suggests that paralysis of the QL makes walking impossible, even with braces. The QL works with the contralateral (opposite) gluteus medius muscle when you’re walking. So if you’re walking with a heavy briefcase in your right hand, the left QL and right gluteus medius are firing hard to maintain correct posture and gait. Also, when you throw or kick explosively, the QL must fire hard to maintain the correct torso position and provide the spinal stability to transfer power throughout your body. So without a properly functioning QL, you are setting yourself up for trouble.
Releasing the QL:
Prior to starting a strengthening program, we need to get rid of any residual muscle spasm or hyper-tonic/tight tissue tone that we may have in the QL and the surrounding musculature. There are a variety of methods we can utilize accomplish this.
- Chiropractic Adjustment to the joints that the QL attaches to, Lower Thoracic, Lumbar and Pelvis. Resetting and releasing the pressure in a joint neurologically releases and relaxes the tension in the muscles that attach to those joints.
- Active Release Technique or other trigger point methods. Research suggests that direct pressure (approx. 2 mins) into a trigger point or tonic/spastic muscle will cause the tissue to release its spasm and restore normal tone in the tissue.
Strengthening the QL:
Much like a computer we need both hardware and software that runs correctly for the computer to function properly. Now that we have reset the hardware (bones, joints, and soft tissues) we need to ensure that the software (how we move) is functioning properly so we don’t damage the hardware again.
From a training standpoint, research from Dr. Stuart McGill demonstrates that it’s best to strengthen the QL with static exercises in order to preserve the intervertebral discs. Bending to the side, especially under load, is very stressful to the discs so that movement should be avoided. Also of note, the QL responds better to endurance exercises vs heavy loads since its primary role is to provide lumbar stability.
Enter Weighted Carries:
Carrying a load is an essential human activity, and there is no lack of opportunity to do this all around us. Loaded carries can be done anywhere, with any manner of odd objects. When performed unilaterally, weighted carries are a fantastic way to train trunk stability, specifically anti-lateral flexion, hip stability, grip strength and even shoulder stability. They do an amazing job of “activating” the rotator cuff through a process called irradiation. When you squeeze something as hard as you can, the rotator cuff turns on, and as a result the shoulder “packs” itself. So not only are carries great for strengthening the QL and trunk musculature, but they also double as an effective shoulder rehabilitation tool. Some of our favorite weighted carry variations are:
1) Suitcase Carry:
2) Figure 8 Suitcase Carry:
3) Front Loaded Carry:
4) Front Rack and Overhead Combo:
It should be noted that the QL is only one muscle in an entire subset of muscles and fascia that contribute to low back and hip stabilization. This is only one little part in the grand scheme of human movement. Should you have any further questions or would like to schedule an appointment please call our office at 561-402-4701!