Low back pain causes: Quadratus lumborum muscle

Back pain, Back surgery, Buttock pain, Groin pain, Hip pain, Low back pain, Muscle information / Friday, October 16th, 2009

This is a series on low back pain. If you missed the summary of causes, go back to Part 1.

Of all the muscles that cause low back pain, the quadratus lumborum is probably chief among them. This little muscle is under all the other low back muscles attaching to the bottom rib, the top of the hip, and to all of the lumbar vertebrae and the disc spaces between them. It’s so hidden that massage therapists rarely get to it. The clearest view I’ve seen was on a cadaver from the inside with the abdominal contents removed.


The actions of the quadratus lumborum are to hike your hip up, do side-bending and backward extension (arching your back). It is important for walking and breathing. It functions as a low back stabilizer when you bend forward or to the side. You can’t sit up or stand straight without using the QL because it holds the spine still in any upright posture.

The importance of the QL wasn’t understood until Travell and Simons published their ground-breaking medical text in 1991 on Myofascial Pain and Dysfunction: The Trigger Point Manual. They devoted almost sixty pages to this neglected muscle. Surprising to the back surgeons was the news that this muscle can be the cause of a failed low back surgery and pseudo-disc syndromes.

Now we know that when it harbors Trigger Points, the quadratus lumborum can refer pain all over the low back area across the sacrum and into the hips and buttock. It also can refer across the top of the hip bone, into the upper thigh over the hip joint (trochanter of the femur) and around into the abdomen, groin (even to the testicles) and down the front of the thigh in a narrow shocking bolt of pain.

The effects of spasms and Trigger Points in the quadratus lumborum can be devastating, rendering a person incapable of getting up from a bed or chair or from a crawling position and unable to cough or sneeze. You remember that ad about the person who fell and couldn’t get up? That was probably due to the quadratus lumborum.

This is probably the muscle I treat most frequently in my Neuromuscular Therapy center near Boston.

2 Replies to “Low back pain causes: Quadratus lumborum muscle”

  1. My husband has lived with CONSTANT spasms of the quadratus lumborum on the left side for two years. It is so spasms so severly, they cannot reach it by trigger point injections. He was completely healthy and fit until this happened, now he is practically debilitated. He has to take long acting and short acting hydrocodone and muscle relaxers do nothing for him. Currently he is going to massage and PT several times a week. He cannot sit or stand still. He does get a little relief if he lays on his right side. It is so very sad and he is so depressed. HELP!!

    1. Has anyone checked him for a leg length discrepancy, hemipelvic asymmetry or scoliosis? Sounds like an underlying structural imbalance perpetuating his symptoms.

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