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Massage Aha!

Professional therapeutic massage therapy in Kansas City, MO by Aaron Harris, BCTMB

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The Quadratus Lumborum (QL) Muscle

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The Quadratus Lumborum (QL) muscle can be tricky for your massage therapist to reach.

The QLs are located deep in the abdomen, but oddly enough, causes a majority of low back pain. Stretching from the posterior ilium (the large round bone at the top of your hip), along the lumbar spine, the QL ends on the twelfth (last) rib. There is one on each side of your body.

The Quadratus Lumborum Muscle
Located deep in the abdomen, the QL is the “hip hiker.”

The majority of the Quadratus Lumborum is deep to the Psoas and the Erectors, making only the lateral (outside) edge accessible to manipulation by a therapist.

What Does the Quadratus Lumborum Muscle Do?

When engaging just one of these muscles, the QL laterally tilts the pelvis, giving it the nickname “hip hiker.” If you lift your hip up towards your shoulder, that’s lateral tilt.

Similarly, if you flex your torso to the side, you are using the Quadratus Lumborum on that side.

As a pair, the QL muscles help stabilize the last rib, especially when breathing forcefully.

Why Does My QL Hurt?

Prolonged periods of sitting keep these muscles contracted which can lead to a loss of circulation and the development of adhesions, or knots. Often the QL muscles help maintain your posture if your lower back muscles are weak. Over time, this also leads to overuse, spasms, and muscle fatigue.

In patients with kyphosis, an abnormal rounded curvature of the spine, their body weight is shifted forward, placing more pressure on the QLs, the lower back, and other structures further up the body.

Scoliosis, an abnormal lateral curve of the spine (picture an “S” shape), will often involve a weakened or fatigued Quadratus Lumborum.

Trigger Points

There are a few main trigger point locations in Quadratus Lumborum.

The uppermost point refers pain to the SacroIliac (SI) joint and the lateral hip.

Quadratus Lumborum Upper Trigger Point
A trigger point in the uppermost part of the QL (marked by X) refers pain along the lateral thigh and over the SI joint.

The middle points are responsible for pain directly over the SI joint.

Quadratus Lumborum Middle Trigger Points
The middle trigger points of Quadratus Lumborum (marked by X) refers pain over the SI joint and posterior thigh (marked in blue).

The lowest points refer pain into the buttock on the same side.

Quadratus Lumborum Lower Trigger Point
A common trigger point in the lower part of the Quadratus Lumborum (marked by X) refers pain to the buttock (marked in blue).

The trigger points that refer pain over to the sacrum are often misdiagnosed as SI joint dysfunction.

Some patients report a “jolting pain” to the front of the thigh from trigger points deep in the QL.

Massage for the Quadratus Lumborum

As you can see from the illustrations, reaching the QL takes patience and is often best achieved by a side-lying position. Deep tissue techniques are best to “sink” down past other muscles to address trigger points along the lateral edge. In particularly thin clients, it may be possible to access the QL by sinking in through the abdomen, however, many find this to be quite uncomfortable.

When you see me for issues with your QL, I will send you home with several stretching exercises designed to help strengthen and relax this notoriously difficult muscle.

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