Quadratus lumborum (QL)
Spanning the gap between our 12th rib and the top of our pelvis, QL effectively joins the upper and lower body together. It is a deep back muscle but can also be thought of as a posterior abdominal muscle!
Where is it?
If you stand like Peter Pan with your hands on your hips, your thumbs will be sitting over the lateral portion of QL.
QL attaches to the bottom rib, the transverse processes (sticky-out bits) of the first four lumbar vertebrae (L1-L4) and the posterior iliac crest.
In the back of the body it is overlaid by the erector spinae muscles and the thoracolumbar fascia.
In the front of the body it is overlaid by psoas major and minor.
What does it do?
QL can work unilaterally (one side at a time) or bilaterally (both sides together) and the movements vary accordingly:
Unilaterally – lifting the pelvis towards the rib (hip hitch) and bringing the ribs towards the pelvis (side bend) will use the QL muscle on that side of the body. Back extension/standing upright will also involve QL on one or both sides of the body
Bilaterally – QL stabilizes/anchors the bottom ribs during deep inhalation/exhalation (eg for singers using diaphragmatic breathing techniques)
Movements that rely on QL:
Certain sports or exercises rely heavily on QL strength and may therefore create overuse issues. Examples will usually include one-sided flexion with rotation – think of a tennis serve, a golf swing or any throwing sport (eg. cricket or javelin)
Similarly, repetitive working patterns can create over-use issues – plastering, construction work, gardening, etc.
In everyday life we might also rely on QL, perhaps more than it likes?! Think about repetitive ball tossing for the dog, carrying a child on one hip, teaching a movement class and only demonstrating on one side of the body, etc.
QL can also be involved in static situations! For example, sitting unevenly will effectively create a hip hitch on one side (eg. feet tucked up to one side of the body, a car seat of office chair where the hips are not supported in a level position, or even just that we lean more weight onto one sit bone than the other…)
How do you know if QL is unhappy?
Usually you will notice some low back pain or tightness, which might refer up to the ribs or down over the hips.
It might feel tighter on one side when you do a side bend or a hip rolling movement.
You might find it hard to soften and lengthen your low back (eg. when trying to tilt the pelvis forward and back)
What can you do about it?
Book a massage would be an obvious answer, because it can specifically get skilled hands onto the affected area. Massage can be used to release any potential trigger points, which will in turn improve your movement function and reduce on-going issues. Let me know if I can help!
In terms of self-care, try to identify the movements or positions which are keeping your QL ‘stuck’ because changing those factors will likely get to the source of the problem. You might also like to join a Pilates or Yoga class which addresses general movement patterns through the torso and gives you a chance to notice how your body is moving, or not!
I am a big fan of trigger point release work (you probably already knew that!).
You can find some TP release ideas here from Jill Miller and a great blog post on the topic here from Neil Asher Education (this is aimed at therapists but you’ll find some useful stuff here to use at home too).
I hope this all gives you a better understanding about what’s happening in the back of your waist, what might be aggravating it and what you might do to help it.
Next time we’re working here on the massage table or in class you’ll know why we’re there!