Pain in the lower back, in the sacrum, buttocks and hip area, on the lateral surface of the pelvis and in the lower abdomen, which intensifies when sneezing and coughing, can occur as a result of problems with the quadratus lumborum muscle.
Quadratus Lumborum Anatomy
The quadratus lumborum muscle is a deep muscle of the lower back. Above it are the latissimus dorsi, the serratus posterior inferior and the iliocostalis muscles.
The quadratus lumborum muscle is a complex muscle in its structure, which consists of three groups of fibers.
The first group of vertical fibers forms the most powerful part of the muscle. At the top, they are attached to the inner half of the 12th rib, and at the bottom – to the iliac crest.
The second group of muscle fibers is oriented in an oblique direction. At the top, these muscle fibers are attached to the spine, and at the bottom – to the ilium.
The third group of oblique lumbocostal fibers is attached at the top to the 12th rib, and at the bottom – to most or all of the transverse processes of the lumbar vertebrae.
The size, shape, and development of these muscle groups can vary greatly between individuals. Note the illustration of the quadratus lumborum muscle on the left and right in two different individuals.
Quadratus Lumborum Trigger Points
The quadratus lumborum muscle has four tension sites or trigger points.
The first and second trigger points are more superficial and closer to the lateral edge of the muscle,
while the third and fourth trigger points are deeper and closer to the spine.
The first trigger point is located just below the twelfth rib and causes pain along the iliac crest, which sometimes extends further into the lower abdomen and groin.
The second trigger point is located near the iliac crest and refers pain to the hip joint and along the outer surface of the upper thigh. The pain in the hip joint can be so intense that the person cannot lie on their side and put weight on the leg on the affected side. The pain intensifies when trying to stand up straight or when walking.
The third trigger point is located in the area of the transverse process of the third lumbar vertebra and causes pain in the sacroiliac joint.
The fourth trigger point is located in the area of the transverse processes of the fourth-fifth vertebrae and reflects pain to the lower parts of the buttock.
Sometimes reflected pain from the third and fourth trigger points can go along the anterior surface of the thigh to the patella area, as well as to the testicles and scrotum.
Quadratus Lumborum Pain Syndrome
When there are problems with the quadratus lumborum muscle, the pain is most often dull, but with movement it can transform into a sharp and even cutting pain. Acute and sudden onset of quadratus lumborum pain syndrome very often leads to urgent problems. For example, a person makes a bed and makes an awkward movement that activates trigger points and literally falls to the floor from pain. In this state, he cannot independently rise to a vertical position and is forced to move on all fours.
Most often, trigger points are activated when simultaneously bending forward and to the side, for example, when trying to pick up an object from the floor. The heavier the object, the greater the likelihood of pain. Problems with the quadratus lumborum muscle can also be observed with muscle injury, for example, with a fall or a car accident. Forced exhalation caused by coughing or sneezing can cause a sharp increase in pain. The pain intensifies when hitting a golf ball with a club or a tennis ball with a racket.
The quadratus lumborum muscle is considered the most common myogenic source of back discomfort. In his study, Good showed that out of 500 cases of back pain in military personnel, the quadratus lumborum muscle was affected in 32% of cases.
The simplest and most accessible method of relieving pain and trigger points at home is strong mechanical action on trigger points followed by muscle stretching.
Quadratus Lumborum Self-Massage
As we already know, the quadratus lumborum muscle is deep and in order to have a strong massage effect on it, it is necessary to first relax the more superficial muscle layers. Take a large massage roller or a two-liter bottle filled with warm water. Get down on the floor, place the massage tool under the right lumbar region. Lean on your right hand and slowly massage the muscles located between the lower ribs and the ischium for several minutes. Work only on soft tissues and in no case exert a strong massage effect on the spinous processes of the vertebrae. Do the same exercise in the other direction, slowly massaging the lower back area for several minutes.
After this, take a large or small massage ball and begin working on the right lower back again. It is more convenient to do this on a large massage ball with a diameter of 12 centimeters, especially if you have a large body. Perform massage movements up and down, right and left, clockwise and counterclockwise. If you find an area of increased muscle tension that causes increased discomfort, stay there for 30-60 seconds. Breathe smoothly through your nose and try to relax the muscles in this position. If the pain becomes very intense and insurmountable discomfort occurs in the lying position, work with a massage ball near the wall, adjusting the force of impact on the problematic area of the muscle. Be sure to repeat this exercise in the other direction.
The muscle area located along the spine can also be massaged on double massage balls with a diameter of 12 and 8 centimeters. Get down on the floor, place a double ball with a diameter of 12 centimeters under the lower back. Leaning on your hands and feet, move your body back and forth for several minutes.
Then take a double massage ball with a diameter of 8 centimeters and repeat the same exercise. Keep in mind that a small double massage ball has a more intense effect on the muscles. So if you’re having trouble doing this exercise on the floor, start near a wall. Press the double ball against the wall, slowly bend your knees, and then straighten your legs again, massaging the muscles on either side of your spine.
To massage the muscle, you can use the help of a massage therapist or a friend. Lie on your stomach and have your assistant first warm up the skin and muscles with light stroking movements in the direction from the pelvic bone to the ribs. Then use your fingers and hands to knead the muscle more deeply. For even greater impact on the muscle, you can use your elbow.
If you have found trigger points that cause increased pain, press on them for 30-60 seconds. Breathe smoothly and deeply, trying to relax the muscles. The quadratus lumborum muscle massage can also be done in a side-lying position. To do this, place a pillow under your lower back, lie on it, bend your legs at the knees and also place a pillow between them. Move one hand behind your head. If you are working on a massage table or couch, grab the edge of the table or couch with your hand. In this position, you can affect the quadratus lumborum muscle from a different angle. During the massage, avoid pressing on bones and joints, do not massage the area where there is unbearable pain or severe inflammation. Be sure to massage the opposite quadratus lumborum muscle.
After mechanical action on the trigger points, it is necessary to stretch the muscle.
Quadratus Lumborum Function
In the first part of the article, we figured out that the quadratus lumborum muscle consists of three groups of muscle fibers located at different angles. To understand what exercises can achieve muscle stretching, let’s look at what main functions the quadratus lumborum muscle performs in the human body.
The quadratus lumborum muscle stabilizes the lumbar spine, and also participates in breathing and especially in forced exhalation, stabilizing the 12th rib.
With a fixed pelvis, the quadratus lumborum muscle performs a lateral tilt of the torso, and with a fixed chest, it performs a one-sided lift of the pelvis.
Bilateral contraction of the quadratus lumborum muscle extends the lumbar spine.
Based on the analysis of functions, all exercises in which the torso is tilted laterally or tilted forward will stretch the quadratus lumborum.
Quadratus Lumborum Stretch
The lateral torso bend can be performed in a standing position. Place your feet hip-width apart or wider. Slowly inhale and stretch your left arm upward. Slowly exhale and stretch your left arm to the right, trying to stretch the left side of your body. Keep your legs straight, rest your right arm on your right leg and do not tilt your pelvis forward or backward.
With each slow exhalation through your nose, try to make the lateral bend even deeper. Reach your physiological limit and hold the final position for one minute. Then slowly inhale and return to the starting position and exhale and lower your left arm. After that, inhale and stretch your right arm upward and exhale slowly and stretch your right arm to the left, stretching the right side of your body. Deepen the stretch with each exhalation and hold the final position for one minute. Then slowly, inhaling, return to the starting position and exhaling, lower your right arm. This is one cycle of the exercise. To achieve better results, do two more cycles.
A similar exercise can be done while sitting on the floor. Straighten your legs in front of you, keeping your feet together or spread wide. You can also cross your legs. Place your right hand on the side of your pelvis. Take a deep breath and stretch your left arm up. As you exhale, lean to the right, stretching the left side of your body. Deepen the degree of stretching with each natural exhalation. You should also bend your right arm at the elbow and lean on your forearm.
This will help to stretch the quadratus lumborum even more intensely. Hold the final position for 1 minute and then repeat the exercise on the other side.
If you have very problematic quadratus lumborum muscles, do a side bend of the body, kneeling or lying on your back. You can also gently stretch your quadratus lumborum by lying on a table or couch with one leg hanging off the end. It is important that the surface you are lying on has good support and does not tip over when you shift your center of gravity.
Leaning your torso forward will help stretch both muscles at once at a different angle. In a standing position, place your feet hip-width apart, bend your legs slightly at the knees. Rest your hands on your hips and, exhaling slowly through your nose, lean forward. Relax your neck, feel the stretch in your muscles and hold the position for one minute.
Then place your hands on your hips again, straighten your arms, relieving the load from the quadratus lumborum muscle and, inhaling, slowly return to the starting position. You can repeat this exercise 2 more times.
A similar exercise can be done while sitting. Bend your legs slightly at the knees and grab your shins or feet with your hands. Inhale slowly and look up, and, exhaling slowly, lean your torso forward toward your legs and hold the final position for one minute.
You can also stretch your quadratus lumborum muscles while sitting on a chair. Bend forward, grab your left shin with your right hand and, exhaling, turn your torso to the side. Inhale and lift your left arm up. As you exhale, stretch your left arm forward and feel the stretch in your muscles. Hold the final position for one minute.
Inhale softly and slowly return to the starting position. Repeat the exercise on the other side
After any forward bends, you must do one of the exercises aimed at extending the spine in the lumbar region. For example, you can do a gluteal bridge while lying on your back. Bend your knees and place your feet hip-width apart. Place your hands behind your head. Inhale slowly and lift your pelvis up. Hold the final position for one minute and then lower your pelvis to the floor with a slow exhalation.
There are a number of exercises in yoga practice that help to intensively stretch the quadratus lumborum muscle. One of the most effective exercises is parivrtta janu sirsasana. This asana combines a lateral bend of the body with a forward bend of the body. Sit on the floor and straighten your legs. Bend your right leg at the knee and bring the heel of your right foot closer to the perineum. Grab your right knee with your left hand and turn your body. Inhale and stretch your right arm up. Exhale and stretch your right hand towards your left foot. Hold the final position for one minute.
Then, with an inhale, slowly return to the starting position and repeat the exercise in the other direction. As a result of regularly performing this exercise, over time you will be able to grab your foot with your hand and achieve the maximum degree of stretching of the quadratus lumborum muscle.
The right and left quadratus lumborum muscles are closely connected to each other and are antagonists to each other, that is, muscles that perform the opposite function. For example, when you bend your body to the side, one quadratus lumborum muscle is stretched, while the other, on the contrary, contracts. The more intensely you stretch one muscle, the more intensely the other is activated. This can lead to overloading the contracted muscle and activation of trigger points with the development of characteristic pain. Therefore, at the beginning of therapeutic work, exercises should be done very gently and not go to extreme positions. Also, at first, preference should be given to simpler and more passive exercises, such as side bends while standing, sitting or lying, as well as bends of the body toward the legs while sitting. As the condition of the muscle improves and the level of training increases, you can add more complex exercises to your regular home practice that promote intense stretching of the quadratus lumborum muscle on one side of the body and intense tension on the other.
Lower Back Pain Relief and Helpful Tips
Chronic overload of the quadratus lumborum muscles can be caused by skeletal asymmetries, especially unequal length of the lower limbs, a decrease in the size of one half of the pelvis, or shortening of the shoulders. As a result, pain can persist for many years. These asymmetries can be objectively determined using X-rays, computed tomography, or magnetic resonance imaging. To correct these conditions, you need the help of an orthopedist.
To avoid sudden muscle overload and lightning-fast pain, wear socks, knee-highs, trousers, or a skirt while sitting or leaning against a wall. Avoid long-term stereotypical loads, such as gardening, cleaning the floor, carrying heavy objects, or running on an inclined surface or on an uneven beach surface.
Do not sleep on soft mattresses, since lying on your side will constantly strain the quadratus lumborum muscle on one side. To relieve tension from the muscle, place a pillow under your legs below your knees. When sleeping on your back, place a small pillow or blanket under your knees.
Avoid long-term forward bending of the body, such as when working at a computer or driving a car.
Strengthen your abdominal muscles, as they are the muscles that perform the opposite function to the quadratus lumborum. Their weakness leads to chronic overload of the quadratus lumborum.
If there is no damage to the leg muscles and knee joints, then you should lift objects from the floor by bending your knees and keeping your torso straight. If you have problematic quadratus lumborum muscles, avoid unnecessary bending, especially with a twist of the body. For example, make your bed on your knees, rather than bending over the bed.
Brush your teeth strictly vertically, avoid bending over the sink, and when rinsing your mouth, you need to lean on the sink with your free hand.
Never stand up straight from a chair. To avoid strong muscle contraction, first move your pelvis to the edge of the chair. Next, rotate your torso to the side and place one foot under the front edge of the chair. Stand up, resting your hands on your thighs and keeping your torso straight. To sit on a chair without straining your quadratus lumborum, reverse the sequence. Place your feet together at the edge of the chair and rotate your torso at a 45-degree angle. Rest your hands on your thighs and sit on the front edge of the chair with your back straight. Then rotate your torso to a neutral position and move your pelvis back, taking a comfortable position.
If you are suddenly caught off guard by a sharp pain from your quadratus lumborum trigger points, such as in the middle of the road, you can give yourself a quick fix to keep moving. Pinch the skin over the muscle area several times. Then place your hands on your iliac crests and press down with your hands, thereby relieving the quadratus lumborum.
The quadratus lumborum is rarely affected by trigger points in isolation and is very often combined with problematic iliopsoas and iliocostalis muscles, latissimus dorsi, gluteus medius and others.
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