In my private practice, I will often see clients who have a Quadratus Lumborum (QL) muscle that is in spasm, or is very tight. Many times, they will tell me that they are trying to retrain their QL so that it doesn’t spasm, however, they are struggling – which is why they booked with me.
Let’s dig in.
The QL connects from the pelvis to the lowest rib and to the upper four lumbar vertebrae.
It performs 4 primary movements:
• Ipsilateral lumbar flexion or side bending – the left QL moves the left ribs to the left hip.
• Lumbar extension – when contracting bilaterally the QL’s move the lumbar spine into a back bend.
• Fixes 12th rib during forced exhalation
• Elevates the ilium to which it attaches – the left QL moves the ilium toward ribs on the left side.
There is one more action of the QL which you won’t find in anatomy books.
I call it “The King of Compensation”!
Exploring the King of Compensation
When function goes awry in the spine and hips, it is remarkable what the QL is capable of. For example, when the erectors spinae become weak and/or when the hip rotators, hip abductors and/or hip adductors become weak or inhibited, or simply aren’t functioning as they should, the QL often kicks in with its superhero cape and stands strongly (for a moment or two), declaring that “yes, I will act as erector spinae, hip abductors, rotators and adductors”. REALLY!
This way of compensation “helps” for a short time. . . but not really because the QL is doing a job that it wasn’t designed to do. And, in short order it becomes tight, experiences reduced blood flow, develops trigger points, and may start to spasm. Feeling uncomfortable, people will often find their way to active release, IMS, massage, manual adujstments, or specific stretching of the QL, however, while the gains are often effective and good, the solution is short term…the problem isn’t actually being solved, it is just being temporarily relieved.
What to do?
When you are working with someone who is complaining about their QL, or has been diagnosed with a QL issue, consider the following:
- Become curious about the person. Be mindful that you aren't overly focused on them as a body with a QL issue.
- Notice if there is hip hiking - you can really see this when they are on their back and are crossing ankle to knee in preparation for "figure 4" aka "thread the needle". As they lifted their right leg, rotated that right leg in the hip socket and placed their right ankle on the left knee was the movement pure and precise or did the pelvis shift? Often this shift is the right hip slides to the right ribs. Even a little shift is a big deal.
- Notice if they are flaring their ribs, or conversely, holding their ribs very firmly when twisting or back bending, or when raising their arms overhead.
- Is there a tendency for them to slump - whether a kyphotic slump, or a "shrinking" slump where everything is smushing downward compressing the lumbar spine and heavy into the pelvis.
Also consider what many academics and therapists are saying about the QL:
• when femur movement in the pelvis is limited or when the abductors and/or adductors of the hips become inhibited or weak, or are not firing as they should, the QL can become overworked.
• there is a relationship between kyphosis in sitting and a tight or overworked QL.
My over 20 years of experience has shown me how simple improvements of hip function and shoulder function create remarkable gains to allow the QL to pack its superhero cape and just “be”. If I can help someone move without being rigid and firm in the ribs, and instead assist them to move only as far as their ribs are quiet and their abdominals are not rigid, the changes are quick. When I can help them move with an easy breath, not a overdone “belly” or forced “ujjayi” breath, the changes are even quicker still. When I can help them move a joint the way the joint is meant to move without added tension elsewhere, the changes in motor control and coordination are quicker still. From that place we can build stamina and strength.
The summary is, that while a QL issue is quite literally a pain in the back, it doesn’t have to be long lasting if we look at why the muscle wants to kick in and compensate to get a job done.
Remember my old adage, “The pain is not where the problem is.”
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Have fun exploring,