The quadratus lumborum muscle is a small flat quadrilateral shaped muscle found in the low back region. This muscle consists of superficial fibers and deep fibers.
The QL originates on the inferior aspect of the 12th rib and the tips of the lumbar TVPs, and runs in an inferolateral direction to attach onto the iliac crest. The quadratus lumborum muscle laterally flexes the vertebral column. It also acts to fixate the 12th rib during inspiration.
figure 1• the Quadratus Lumborum muscle.
• Medial ½ of the inferior border of the 12th rib
• Tips of the lumbar Transverse Processes (TVPs)
• Iliolumbar ligament
• Internal lip of the iliac crest
• Lateral Flexion of the vertebral column (when acting unilaterally)
• Extension of the vertebral column (when acting bilaterally)
• Fixation of the 12th rib during inspiration
Caution: make sure to assess carefully the structures in the iliolumbar and sacral region of the spine prior to performing the following techniques. Also, ensure that the tissue has been adequately warmed up before performing any deep techniques or stretches.
1. MUSCLE STRIPPING TO QUADRATUS LUMBORUM
• Objective: To reduce and potentially eliminate contractures and adhesions commonly found in the QL muscles. Contractures and adhesions in the QL can result with chronic repetitive strain injuries and overuse injuries (such as frequent bending/lifting with improper biomechanics), the chronic stage of healing after traumatic muscle strains (e.g., athletic low back injuries), and other traumatic injuries that cause damage to the muscle or other structures in the iliolumbar region of the back (such as “Slip and Fall” accidents or Motor Vehicle Accidents).
• Positioning: Have your client lying prone, in a relaxed state. Stand at the side of the table opposite the muscle you are treating.
• Technique: Reach over with both hands to the lateral aspect of your client’s torso, just superior to the iliac crest. Hook your fingers onto the iliac crest, and then perform a deep stripping technique towards you (medially) along the superior border of the iliac crest until you feel the QL at about the midway point of the iliac crest. Continue your stripping technique in a superomedial direction along the lateral fibers of the QL until your reach the bottom of the 12th rib.
Figure 2 – Muscle Stripping performed on the QL muscle.
*This technique can be enhanced by placing your client into a bowed position before performing the stripping technique. By bowing your client to the contrilateral side (i.e. contrilaterally flexing both the torso and the legs), the QL muscle will be lengthened, and this technique will become very effective in addressing contractures, adhesions, and trigger points in your client’s QL.
2. ISCHEMIC COMPRESSION TO QL
• Objective: To release trigger points (hyperirritable bands within the muscle belly) in the Deep fibers of the Quadratus Lumborum.
• Trigger points can occur in muscles due to injury (to the muscle itself or to other structures in the region), or due to overuse. They are a source of local as well as referred pain, and they reduce the flexibility, strength, and overall functionality of the muscle.
• Positioning: Ask your client to lie prone on the table. To perform this ischemic compression technique, stand at the side of the table, on the opposite side of the muscle you are treating.
• Technique: First, palpate along the muscle to find the trigger point in the QL. To locate a trigger point, palpate the muscle to feel for a taut band or a twitch response in the muscle belly. A common location of QL trigger point is in the muscle belly around the level of the 4th or 5th lumbar TVP.
• Once you have located the trigger point, apply an ischemic compression by gradually applying a thumb pressure to the trigger point (see figure 3 • Although it is not demonstrated in the image, it is always a good idea to apply the pressure with both thumbs, as this will help to prevent overuse injuries to the joints and muscles in your hands).
• Your client will likely feel referred pain in the posterior aspect of the sacrum, and at the ischial tuberosity. Keep in communication with your client, checking to ensure that you are staying within the limits of his pain tolerance. Hold this technique for approximately 20 seconds to 1 minute, until your client tells you the pain has diminished, or until you feel the muscle fibers begin to relax under your pressure.
• Once you feel this release, gradually release your pressure. Then apply a few effleurage strokes to flush out the area, and follow up with a passive stretch to the muscle.
Figure 3 – Ischemic compression to the QL muscle.
3. STRETCH TO THE QUADRATUS LUMBORUM:
Objective: To lengthen the quadratus lumborum muscle fibers.
• This stretch will work to reduce pain in the muscle caused by trigger points as well as by muscle tension. A properly applied muscle stretch will also improve the flexibility, strength, and overall functionality of the QL muscle by reducing contractures and adhesions. (NB • If scar tissue in the muscle has been treated with friction techniques, a passive stretch following the friction techniques can also help to functionally realign the scar tissue so that the muscle can function in a more efficient manner).
• **Stretches are most effectively performed after the muscle has been adequately warmed up with massage and/or properly administered hydrotherapy.
• Have your client lying prone. As this is a passive technique, your client’s muscles should be fully relaxed.
• To stretch the QL muscle fibers, you must first open up the space between the iliac crest and the twelfth rib by putting your client into a contrilaterally bowed position. You can do so by first asking your client to contrilaterally side flex the torso, and then place your clients legs into a contrilaterally side flexed position as well. (see figure 4). To further stretch the QL, take hold of your client’s ipsilateral ankle, oscillate for approximately 5 seconds, and then traction the leg inferiorly and hold for approximately 30 seconds. This traction will bing the iliac crest inferiorly, further opening the space between the iliac crest and the 12th rib.
• Make sure to perform this stretch in a gentle, sustained manner, always staying within your client’s pain tolerance. If your client feels pain, then you have gone too far with the stretch. Also, check in with your client during the stretch to ensure that he is breathing properly. After holding this stretch for approximately 30 seconds, gradually release it by releasing your inferior traction on the leg, and then return your client’s torso and legs back to a neutral position. Repeat this stretch a total of 3 times.
figure 4 • The therapist performs a stretch to the QL muscle fibers.
The techniques highlighted in this article are courtesy of…
The Massage Students Video Guide • Video 1: The Torso
(By: www.RMTstudents.com… The #1 Online Study Centre for Massage Students).
Dwayne Gray, RMT, is president of RMTstudents.com Inc. He is a 2003 Graduate of the 2,200-hour Massage Therapy program at ICT Kikkawa College in Toronto. Dwayne has certified in Active Release Techniques, Hot Stone Massage, Ultrasound Therapy, TENS, and IFC Therapy. He has owned a successful sports injury clinic in Burlington, Ontario, managed the world’s largest team of Registered Massage Therapists under one roof (50) with the Brydson Group, in Toronto, and now independently performs injury rehab treatments in Pickering, ON, while continuing to work to build RMTstudents.com for massage students. He can be contacted through www.RMTstudents.com.