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.