Are you getting back spasms after a long day at the driving range?  How about a sharp pain in the low back after putting in some miles on the bicycle or taking a deep breath after a hard bout of exercise?  Both of those could be symptoms of quadratus lumborum pain. In this article, you’ll learn how to manage quadratus lumborum pain with exercises & stretches from beginning to end.

 

GET TO KNOW THE QUADRATUS LUMBORUM

The first thing to know about the quadratus lumborum is where the muscle is found in the body.  The quadratus lumborum (QL) is a large muscle located on the posterior (back) side of the trunk and abdominal wall with a left and right side QL. If you were looking at your friend’s back, you would notice the spine runs up and down in the middle of the back.  The QL muscle is located laterally on each side of the spine. Near the bottom of the spine, the quadratus lumborum attaches to the 12th rib, the transverse processes of the lumbar spine, and the iliac crest (this can vary just like the piriformis).  The main anchor for the quadratus lumborum is the iliac crest. The iliac is the long, curved bone, that is part of the bony pelvis.

 

Quadratus Lumborum Muscle

The quadratus lumborum is a deep trunk muscle. That means it is located below other muscles. In the case of the quadratus lumborum, it is found under the lats and paraspinals. The quadratus lumborum primarily helps to make a side bend and extension motion of the low back.

 

WHAT CAN CAUSE QUADRATUS LUMBORUM PAIN?

The quadratus lumborum can become problematic in two ways:

 

• First, the quadratus lumborum can become extremely hyperactive causing it to go into a ‘guarding’ state. This can be a result of overuse with a specific activity, the QL compensating for a weakness elsewhere, or simply doing too much too soon of something new that your body isn’t used to. Remember, the QL muscle contributes to the specific motions of same-side trunk side bend, rotation, and extension of the trunk to one side. When moving in and out of trunk positions that either flex or stretch the QL in a hyperactive state, this can trigger symptoms of significant low back tightness, soreness, and even back spasms. This is probably the case for people after playing too much golf for the first time or shoveling snow for hours on end.

 

• Another way the quadratus lumborum can become injured is by becoming extremely lengthened causing a strain. When this happens, the QL muscle has gone past its maximum length and is overstretched causing microtears in the muscle fibers, hence a muscle strain. Symptoms of a quadratus lumborum strain will cause the low back to feel like there is a sharp or tugging sensation occurring in the low back with movement or even breathing. This is probably the case for people that swing a golf club or a bat viciously too hard and strain their QL!

 

Get Rid of Your Quadratus Lumborum Pain With Our Program!

The Low Back Rehab Program is a step-by-step program developed Doctors of Physical Therapy and Strength & Conditioning Specialists to strengthen and protect your low back. No matter how many times you have dealt with low back issues, NOW is the time to build a strong and robust low back versus when you’re dealing with another flare-up! We teach you how to take control of your own low back issues, on your own time!

 

HOW DO I REHABILITATE MY QUADRATUS LUMBORUM?

In the early phases of rehab for quadratus lumborum pain, it is important to focus on both mobility and stability.  Focusing on mobility and stability is important, whether you have low back pain caused by the quadratus lumborum, or not. By focusing on gentle mobility, you’ll be promoting moving the QL muscle through its entire length while ideally not causing sharp pain or triggering back spasms. Definitely check out the video above as Mike takes you through his back-pain routine that promotes gentle mobility! But as we said, there are still benefits to doing stability exercises as well! It may sound counter-intuitive, but actually doing trunk stability exercises focused on other muscles (not just the QL) can promote reciprocal inhibition of the QL muscle AKA getting it to relax, which will make trunk and low back movement less painful. Another theory is you can actually work the QL muscle with light stability exercises with ideally minimal to no pain and achieve a contraction-relaxation reaction to the muscle. By targeting the quadratus lumborum with stability exercises, the muscle will ideally contract and then relax secondary to normal physiological processes of muscles working and a healthy amount of fatigue! This can help to eliminate the vicious cycle of QL muscle guarding, back spasms, or other triggers to your low back pain and promote more pain-free quality movement!

 

 

HOW DO I STRETCH THE QUADRATUS LUMBORUM?

To increase the mobility of the quadratus lumborum muscle, you will want to bend your trunk in the opposite direction of the side you are experiencing pain/symptoms on and ideally lean forward to what you can tolerate.

SEATED QUADRATUS LUMBORUM STRETCH

Sample Low Back Rehab Program Exercise Video

In the seated quadratus lumborum stretch, you will position yourself to the side of the seat until your almost off the edge. Extend the leg out in front of you, allowing the weight of the body to even out and straighten the side of the torso.  Stretch the quadratus lumborum by reaching your arm overhead and bend the trunk away from the side.

 

STANDING QUADRATUS LUMBORUM STRETCH

Again, the real key is to side-bend away, rotate away, and bend forward to maximally stretch the QL muscle!

 

FLOOR QUADRATUS LUMBORUM STRETCH

This one is a bit more advanced, however, when performed correctly it works like magic! Getting into the 90/90 position helps to anchor the pelvic, which remember is a big anchor point for the quadratus luborum. Getting the trunk bending and rotating away with this movement is a great way to help move the QL through its full range of motion!

 

QUADRATUS LUMBORUM STABILITY EXERCISES

Stability exercises will help to activate the QL muscle and jump-start the healing process with the added, delayed benefit of promoting pain-free trunk and low back movements. Ideal exercises to start with should be low-level trunk/core exercises that focus on working the QL muscle at an ideal length for the healing muscle fibers, not ‘too short or too long’. These types of stability exercises also help to increase the endurance of the QL muscle fibers, which will help you perform the activities and things you love to do as long as you’d like without back pain or spasms!

Carry – Suitcase, Unilateral, In Place

Sample Low Back Rehab Program Exercise Video

The QL muscle is designed to help stabilize the trunk and the pelvis. By doing loaded unilateral exercises in a standing position and balancing on one foot, you’re going to challenge trunk and pelvic stability. This is hands down one of my favorite quadratus lumborum rehab exercises!

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HOW DO I STRENGTHEN MY QUADRATUS LUMBORUM?

Once your low back is feeling better, you can add in more progressive trunk and core stabilization exercises! Below are a few of our favorites

TABLETOP KNEE DROP

Sample Low Back Rehab Program Exercise Video

• HOW: Start by lying on your back with your knees bent and your feet flat on the ground. Bring your knees together and up towards your chest creating a “L” with your hips and lower legs.  Your arms should be out to your side. Let your knees drop to one side, slowly. Use your core to let them fall down and to bring them back up.  Alternate going to both sides. 

 

• FEEL: You should feel your core muscles working and also a stretch in your lower back.

 

• COMPENSATION: Keep your knees together and straight up from your hips.  Keep your upper back and shoulder blades on the ground as you rotate.

 

TRUNK ROTATION – BAND

LISTEN: HOW TO MANAGE YOUR OWN BACK PAIN!

 

SIDE LYING OBLIQUE LEG LIFT

While you are performing most of these exercises, you might be wondering whether you are isolating the quadratus lumborum muscle versus engaging the obliques, abs, and other ‘core’ muscles. Do not over think it. Muscles of the body simply do not work in isolation. As much as we’ve provided some quadratus lumborum specific exercises, it is extremely important to understand you’re always working more than just your QL, and it’s better off that way! Strengthening the muscles that assist the quadratus lumborum and perform similar motions is beneficial. Check out this article below to learn about how the ‘sling’ muscles work together.

 

READ: OBLIQUE SLING EXERCISE PROGRESSIONS AND ASSESSMENT

 

STANDING SIDE CRUNCH – DUMBBELL

Remember, the QL connects to the trunk and the pelvis! This exercise is different because now you’re moving the trunk versus moving the pelvis and lower body in the last exercise (oblique leg lift). Being able to resist motion (anti-movement exercises that are common core stabilization exercises) and dynamically create motion are both important ingredients to a successful rehab plan, something that [P]Rehab always considers with programming!

 

GETTING BACK TO WHAT MAY HAVE INJURED YOU IN THE FIRST PLACE

Finally, you will want to add some power exercises back into your programming. By adding these Rainbow Medball Slams into your workout, you will be able to make sure that the quadratus lumborum is able to generate enough force to help you perform your sport or activity at your absolute best.

RAINBOW MEDBALL SLAMS – ALTERNATING

Start with the medball at about hip height.  Swing the medball all the way up, drawing a rainbow over your head, and then slam the medball down on the opposite side you started from.

Whether it is a golf swing, a tennis swing, or a baseball swing, you will be ready to make an impact! Check out this article on excellent medicine ball exercises!

 

CLOSING THOUGHTS

Key takeaways for quadratus lumborum rehabilitation:

• Focusing on mobility and stability is important, whether you have pain caused by the quadratus lumborum, or not. QL exercises are a common theme in low back rehab

 

• Muscles of the body do not work in isolation, this includes the QL, so strengthening the muscles that assist the quadratus lumborum is important and basically unavoidable!

 

• Before returning to a sport like golf, be sure to add in some power strengthening exercises to protect your quadratus lumborum and your back

 

Take Control of Your Low Back Pain!

The low back is the centerpiece to our movement foundation and is the most adaptable and resilient area of the movement system. Since it takes on so many responsibilities it can at times become overwhelmed and request a change be made. Those requests tend to say: “Can you use your hips more?” and “Can you build up more core strength for this activity?” After this program, your back will be happy to know that these requests have been attended to!

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.