Quadratus Lumborum: Pain & Trigger Points

The quadratus lumborum is a muscle that runs from the back of your hip along the lumbar spine to your ribs.

Besides the gluteus medius, it is probably the most often overlooked muscle when it comes to low back pain and pain in the sacroiliac joint.

The muscle causes problems when it is tense or carries trigger points. A self-massage is the method of choice here.

The most convenient aspect about a self-massage is the fact that you can perform it anytime and anywhere.

1. Pain patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

In the case of tensions, the muscle usually is sensitive to pressure, although the pain isn’t referred to other areas.

However, if trigger points are present in the quadratus lumborum, they usually react sensitively to pressure and can refer pain to other regions.

Especially to the area of the abdomen, lateral upper thighs, hips and buttocks.

Pain triggered by this muscle is often perceived as very deep-seated and can be so severe that you wake up screaming at night as the pain becomes unbearable for a few moments.

It is important to note that especially in the case of back pain, the intensity of the pain is almost never related to the seriousness of the problem.

This means that even if your pain seems immeasurable, it is not necessarily a sign of serious disease!

Illustration of the pain patterns

quadratus-lumborum-triggerpunkt
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quadratus-lumborum-schmerzen-
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1.2 Symptoms and ailments

In addition to the pain described above, tensions in the quadratus lumborum are often accompanied by movement limitations.

Since the muscle mainly has a stabilizing function on your spine, all upper body movements can become so painful that you can hardly perform them.

While sitting and walking is often severely limited and painful, though possible, it is inconceivable to bend forward or turn sideways.

The only positions that provide relief are the step positioning and lying with flexed knees.

However, I have developed a quick help that allows you to cover at least short distances walking.

This will help you to continue with your normal life until you have freed your quadratus lumborum from its tensions and trigger points.

Often the pain is so immobilizing that you have to move on all fours.

In this position, the muscle does not have to do any stabilization work and therefore causes you little or no pain.

1.3 Differential Diagnoses

The kind of pain related to the following diagnosis may be very similar to these caused by trigger points in the quadratus lumborum.

That’s why they’re differential diagnoses. You should note that the following diagnoses and trigger points are NOT mutually exclusive, thus can coexist, and sometimes favor each other.

  • Inflammation of the bursa at the trochanter major
  • Disc protrusion
  • Sciatica

Due to its frequency, I would like to go into the sciatica in more detail.

Sciatica and S1 Radiculopathy

Trigger points in the quadratus lumborum can cause satellite trigger points in the gluteus minimus, which can lead to pain in the supply area of the sciatic nerve and thus transmit pain into your leg.

This pain is very quickly attributed to S1 radiculopathy, i.e. irritation/damage of the nerve root in the S1 region or spinal stenosis (abnormal narrowing of the spinal canal).

Radiculopathy is associated with motor and sensory failure and must be verified or proven by a neurologist using specific tests.

The result of a spinal stenosis should also be properly verifiable, for example by an imaging procedure.

In any case, it makes sense to check the gluteus minimus for sensitivity of pressure and, if necessary, to massage it. Of course, along with the quadratus lumborum.

In the vast majority, this should eliminate the pain.

2. Attachment Points

As mentioned earlier, the muscle runs from your hip through your lumbar spine to your lowest (12th) rib. Below you will find the exact Latin names and the innervation of the muscle.

Origin

  • Crista iliaca

Insertion

  • 12th rib & rib processes of the 1st – 4th lumbar vertebrae

Innervation

  • The muscle is innervated by the nervus subcostalis.

3. Function

In general, the muscle provides stabilization of the lumbar spine and is therefore active when sitting, walking or standing. It also contributes to forced exhalation – e.g. coughing – by increasing the pressure in the abdomen.

However, it has a few more functions. It’s necessary to distinguish whether the muscle is only active on one side of the body or whether both sides are working.

Unilateral contraction

A one-sided contraction can lead to the following movements or provides the following functions:

  • Limitation of movement or of stabilization during the lateral inclination/lateral flexion of the spine
  • Side flexion to the same/ispilateral side
  • Moving the hip upwards – Example: When you “crawl down” from a bed or high seat alternately moving with your left and right buttocks.

Bilateral contraction

  • A bilateral contraction leads to a backward bend or extension of your spine.
wirbelsäule-lateralflexion
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Lateral flexion

wirbelsäule-extension
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Backward bend/Extension

4. Quadratus Lumborum – Trigger Point Activation

The muscle is usually acutely and/or chronically overloaded and, as a result, develops tensions and/or trigger points. In addition, anatomical “problems” can also be responsible. However, this is rarely the case.

Acute overloads

In particular everyday movements represent triggering factors:

  • Getting up from a deep chair
  • Lifting a heavy object
  • Long work with bent back – for example gardening
  • Getting up from bed
  • Hair washing in the sink or above the bathtub

I would like to point out that these examples usually are only are the final straw, putting temporarily strain on the already tense muscle. In general, these everyday movements should not cause any problems.

However, if the muscle is weak due to a inactive lifestyle, it is also more sensitive and less resilient. In the course of time, even everyday movements can overload the muscle.

Additionally, emotional stress, whether conscious or unconscious, has a huge impact on the tension of your quadratus lumborum.

But also sports can lead to problems in this muscle, especially if it is carried out very one-sidedly and if no balancing movements / activities are performed.

Basically, all sports can be mentioned here, as the muscle must constantly stabilize the spine.

The same activities and movements should be listed for chronic overloads as for acute overloads. However, you should know that these should not actually exist as such.

The quadratus lumborum is designed for continuous work and should not cause any problems to anyone.

However, in many persons it is too weak and burdened by emotional load. This is why it tenses up easily and as a result causes problems.

Massage the muscle regularly until you find no more tensions and then slowly start strengthening exercises.

If you then continue with the exercises in combination with regular relaxing exercises, there is a big chance your back pain will go away!

Anatomical “problems”

All circumstances that force the lumbar spine in some way into a slight lateral flexion have to be mentioned. This permanently approximates/shortens the muscle and it is only a matter of time before tensions and trigger points develop.

The most common examples are probably leg length differences and scoliosis.

However, I would like to note that a strong tension of the quadratus lumborum can pull the spine into a lateral flexion and thus manifest a functional scoliosis. This is especially true in cases of mild scoliosis.

5. Palpation

You will certainly not feel the quadratus lumborum or be able to distinguish it from the surrounding muscles. However, this no problem, as in the next chapter I will show you where to exert pressure, how to examine the muscle and how to massage it.

6. Self-massage of the Quadratus lumborum

For the self-massage of the quadratus lumborum, I really recommend a massage stick. Either the Trigger Fairy to very narrow and sensitive people or the Body Back Buddy, to everyone else.

Unfortunately, without a massage stick it won’t be possible to perform an optimal massage on this muscle, which is one of the most common muscles causing back pain.

Nevertheless, I will also show you how to massage it without a stick, so you will have at least the option to do so.

For the massage, please lie on the floor on your back. Your knees are flexed, feet on the ground.

6.1 Self-massage with the Trigger Fairy

  • Place the Trigger Fairy under your back and examine the area directly next to your spine from your hip up to your lowest rib for painful points.
  • Do this by pressing the stick into the muscles.
  • Vary a lot with the direction of the pressure.
  • Apply it upwards and also from the side.
  • Usually, the best way to reach the most painful parts of the quadratus lumborum is to exert pressure from sideways, i.e. in the direction of your spine.

Once you find a painful point, you have three choices:

  • Keep the pressure upright for 10, 20 or even 30 seconds and concentrate on the most painful part of the spot.
  • Massage from shortly before to just after the point by gently moving the Trigger Fairy.
  • Hold the pressure and move your hips up and down repeatedly. That means, you’re moving your hip toward your shoulder. This causes the quadratus lumborum to contract. The muscle can be loosened by the simultaneous pressure on the muscle.

6.2 Self-massage with your thumbs

You can also massage the muscle with your fingers. However, this option is not optimal because of the following points.

  • You cannot exert that much pressure.
  • The massage quickly tires the fingers.

To massage the muscle with your fingers, use the thumb technique. The massage is performed as described above.

Exemplary positions for self-massage

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Pressure from „behind“.

quadratus-lumborum-hexenschuss-selbsthilfe
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Pressure from the "side“

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. The Lower Extremities. Baltimore, MD: Williams & Wilkins, 1993. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print