Getting to the heart of the QL

Case study:

I recently had a client coming to see me once a month for the past 6 weeks with a problem in her low back and hips. I could see clearly that her QL (quadratis lumborum), erector spinae were completely burnt out from being in a constant state of contraction and in addition, her glute med’s weren’t working at all. I knew I could help with the first phase of healing by releasing and relaxing the Ql’s, erector spinae and corresponding trigger points in the piriformis and psoas.

I also knew that unless she either changes what she does everyday (which happened to be sitting at a desk all day long) or she learned exercises that would re-train her muscles out of their habit, meaning learning to consciously relax muscles that are in constant contraction while learning to fire muscles that no longer know how to fire, she would never get lasting results from my work.

As suspected, each time she came in, she felt better for a week or so after, but we always went back to square one. After 2 times of this, I started recommending that she see Cassidy at The Body Gallery. Cassidy retrains your body from the inside out how to get back in balance and the results are lasting! I can speed up the process by encouraging and reminding your muscles that they should be relaxed and also encourage nerve passageways to fire again through trigger point therapy. This is how Cassidy and I work so effectively together.  She has seen Cassidy just two times now and is already noticing changes in her body and the reduced pain is lasting longer.  

I know it’s much more exciting to think that laying on a massage table with an amazing bodyworker can correct  all the crazy things we expect from our body on daily basis rather than having to do some work from the inside out for lasting effects, but it’s simply dillusional….sorry!

Educational moment: One of the most common rebutles when I tell a client a certain muscle is weak and proceed to find that the same muscle is incredibly tight, is “How can it be so tight if it’s weak and I’m not using it?” This article is a great explanation of how a muscle like the QL can actually be weak and tight at the same time. It’s also a great explanation as to the work that Cassidy and I do are so complementary to each other and essential to the whole healing process.

Quadratis Lumborum:

 

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“The quadratus lumborum, or QL, is a common source of lower back pain. Because the QL connects the pelvis to the spine and is therefore capable of extending the lower back when contracting bilaterally, the two QLs pick up the slack, as it were, when the lower fibers of the erector spinae are weak or inhibited (as they often are in the case of habitual seated computer use and/or the use of a lower back support in a chair). Given their comparable mechanical disadvantage, constant contraction while seated can overuse the QLs, resulting in muscle fatigue. A constantly contracted QL, like any other muscle, will experience decreased blood flow, and, in time, adhesions in the muscle and fascia may develop, the end point of which is muscle spasm.

The experience of “productive pain” or pleasure by a patient upon palpation of the QL is indicative of such a condition.

Hip abduction is performed primarily by the hip abductors (glut medius and minimus). When the glut med/min are weak or inhibited, the TFL or QL will compensate by becoming the prime mover. The most impaired movement pattern of hip abduction is when the QL initiates the movement, which results in hip hiking during swing phase of gait. Hip hiking places excessive side-bending compressive stresses on the lumbar segments. Thus, a tight QL may be another hidden cause of low back pain (Janda 1987).

When the hip adductors are tight or hypertonic, their antagonist (gluteus medius) may experience reciprocal inhibition. The gluteus medius will become weak and inhibited. This in turn may cause hypertonicity of ipsilateral QL. Chronic hypertonicity of QL tends to cause low back pain due to its ability to create compressive stress on lumbar segment.

Current studies show that application of heat or ice, massage, and estim will not leave long-term benefits. Careful assessment of muscular imbalances and movement impairments by a therapist is recommended in order to address the underlying issues mentioned (you need Cassidy for this).

While stretching and strengthening the QL are indicated for unilateral lower back pain, heat or ice applications as well as massage should be considered as part of any comprehensive rehabilitation regimen”  (You need Jennifer for this).

 

Resources:

http://en.wikipedia.org/wiki/Quadratus_lumborum_muscle

 

Photo Credit:

http://www.visiblebody.com/index.html

 

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One thought on “Getting to the heart of the QL

  1. Great article! We work great together when it comes to this issue! It’s important to find the balance between strength and release.

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