The Quadratus Lumborum: Location, Function & Treatment
Dr. Angel Rivera
The quadratus lumborum, or QL, is a lower back major muscle that attaches to the iliac crest, or top of one of the pelvic bones, and then runs down to attach on either side of your spine. It functions as an extensor for your torso when you want to raise your torso from a supine position, such as in sitting up from laying down or bending over. For example, if you were in a chair with your arms crossed and you wanted to stand up, the quadratus lumborum would help you by extending your hips back so you can straighten out. The quadratus lumborum also stabilizes the sacral region, or lower back near the pelvis, of the spine during movement. In this article, we will discuss what it is, its function, what happens when you hurt it, and how to prevent an injury.
The quadratus lumborum, with "quadras" meaning square and "lumbus" meaning loin, is a muscle that starts with fibers that go into the iliolumbar ligament and then go across the iliac crest of the pelvis and along the lower border of the twelfth rib. It also attaches to the iliac fascia on both sides, as well as to all three parts of the quadratus lumborum. The QL starts at the L5-S1 lumbar vertebrae of your spine and finishes at the T12 spinal segment.
Its function is to stabilize your torso when you are standing or sitting upright by acting on your hip joint. It also helps you bend your torso forward and assists with the rotation of the pelvis. It does this by pulling on the lowest ribs and vertebrae. For example, if you are just standing, the quadratus lumborum holds your pelvis at an even level. If you are running, the quadratus lumborum allows you to bend forward at the hips without arching your lower back in compensation. When lifting heavy objects, the quadratus lumborum works with other muscles in the area by helping lift and stabilize one side of the pelvis at a time.
The quadratus lumborum is supplied with nerves by the T12 and L01 nerve roots of your spinal cord. Which means that it is a lower back muscle which also affects the sacral region. These two areas are closely related in terms of their biomechanics and interactions with other muscles. The quadratus lumborum is a deep muscle, meaning that it lies just below the surface of other muscles. If you were to look at your hip from behind and trace down on either side until you reach the top of your pelvis, this would be where the quadratus lumborum attaches.
A list of other muscles near the quadratus lumborum include the iliacus, quadratus femoris, psoas major and minor, and obturator externus. Some of the major nerves near the quadratus lumborum include the tibial nerve, femoral nerve, and the obturator.
An injury or strain to the QL is actually pretty common, particularly in athletes who do repetitive movements with their torso such as gymnastics and rowing. Injuries can happen due to overuse from poor posture, an awkward or heavy load, or sudden movement. In addition to QL pain from injury, other causes can include poor posture from repetitive movements such as painting ceilings and playing the piano. Also, an awkward position when lifting something too heavy requires you to twist your body while bending forward with a straight back, such as picking up a box that is too big or a sudden movement such as falling to the ground onto your side can all cause injury to your quadratus lumborum.
Common QL injuries include a strain or tear in the muscle fibers from overuse or heavy lifting that puts an intense amount of stress on this important muscle. It can also cause bursitis, which is an inflammation of the bursa in the quadratus lumborum that puts pressure on the muscle and causes a lot of pain. This can be caused by arthritis or developing fatty tissue within your QL from being overweight.
A common cause of quadratus lumborum discomfort is an abdominal hernia, which happens when intestines slip through a muscle tear or rupture. This causes pain that may extend into the quadratus lumborum muscle, and can be associated with bowel problems like constipation.
Symptoms of quadratus lumborum injury include lower back pain that starts on one side and then spreads across the lower spine, hip pain if it is an acute injury, abdominal pain, and pain in the quadratus lumborum muscle itself. It may cause you to lose control of your bowels or bladder if it is a severe injury, but this should only be temporary as function returns with proper treatment.
Can quadratus lumborum pain cause complications?
If quadratus lumborum pain goes untreated, it can cause even more problems. For example, quadratus lumborum pain may lead to a pinched nerve in the lower back or compression of your spinal cord due to pressure on the nerves from an inflamed muscle. Your quadratus lumborum could also pull away from its origins and attach somewhere else along your spine if it is still in spasm, or it could even rupture. This can lead to more serious problems with your spinal cord and nerves which you definitely don’t want.
A QL strain or tear is diagnosed with a physical exam and imaging. That means that your doctor will ask you where it hurts, how long the pain has been going on, what makes the pain hurt worse, and if there have been any recent injuries including falls to the ground or heavy lifting accidents. If you have recently been in a car accident or done anything that caused your QL to be overused, this could also lead to quadratus lumborum pain. Imaging including X-rays and MRIs can rule out any other causes for QL pain such as tumors or herniated discs in the lower spine.
How do you treat quadratus lumborum pain?
Treatment for quadratus lumborum pain depends on how severe it is and what caused your quadratus lumborum to be injured or strained. If there was a recent injury such as falling onto your side, then rest and ice will help the pain to heal. Applying an ice pack or cold compress to the area for twenty minutes at a time can reduce inflammation and swelling that puts pressure on your quadratus lumborum, which then reduces your QL pain. In severe cases where you cannot get out of bed due to QL pain, your doctor may prescribe a muscle relaxant such as Flexeril to help quadratus lumborum muscles to heal. Local injections to the quadratus lumborum block, which is a fascial plane block where local anaesthetics can be injected and also called the ultrasound-guided quadratus lumborum block, can be done to help relax nerves, specifically in the thoracolumbar fascia.
Stretching and practicing yoga are excellent quadratus lumborum pain treatments if you are at risk of injuring your quadratus lumborum. These are both low-impact exercises that will strengthen the QL muscles without putting any additional stress on them or making it worse, but be careful not to do anything too strenuous right away when you are in QL pain. If you injure your quadratus lumborum once, it is very likely that the same area will become injured again if you put too much pressure on it before it has fully healed.
Acupuncture therapy is another quadratus lumborum pain treatment that can help your QL to heal. This therapy involves using needles, heat, or electrical currents to stimulate certain parts of the body and increase blood flow which helps muscles to repair themselves more quickly. Acupuncture is used for all sorts of injuries including QL strains and tears.
If quadratus lumborum pain is severe enough and has not gone away on its own with rest, ice packs, stretching, acupuncture therapy, muscle relaxers like Flexeril, anti-inflammatory medication such as ibuprofen, and therapy exercises, then surgery may be an option for the injury. This is a last-resort treatment that should only be done when all other options have been exhausted and the chronic pain continues to persist despite trying every pain treatment available.
The best quadratus lumborum injury prevention is to avoid injuring your QL in the first place. This means practicing yoga or doing some light stretching before doing any exercise or physical activity that can put pressure on the muscle. It also means avoiding heavy lifting, especially in the gym when you are not sure how much weight is tolerable without hurting your quadratus lumborum. Before exercising with quadratus lumborum pain or using weights for resistance training, talk with a personal trainer to make sure the pain does not get worse.
Avoid any heavy lifting that involves turning or twisting the torso, which puts pressure on quadratus lumborum muscles and can cause them to become strained or even tear. That means avoiding certain exercises, if possible, including squats with weights, lunges, pushups, pull-ups or chin-ups, crunches, or any other exercises that require you to twist your torso.
The quadratus lumborum is a muscle in the back that attaches to your lower ribs and spine. Pain in this muscle occurs when this muscle becomes injured or strained due to strenuous activity, heavy lifting, falls onto your side, etc. Treatments for injuring your QL vary depending on how severely it has been injured and quadratus lumborum pain may be resolved in time without treatment. If the injury is severe, there are injuries that require surgery as a last resort. Injury prevention is important to avoid putting too much strain on your QL during exercise or physical activity so yoga or stretching before physical exercises is recommended. If you have any more questions or believe you have injured your quadratus lumborum, please see your healthcare provider.
References, Research and Sources