Low Back Pain and Trigger Points
Active trigger points can be found in the Quadratus Lumborum muscle. These trigger points are always on the top of my list when it comes to acute low back pain complaints, especially those cases where the pain is so severe that the client cannot stand.
The quadratus lumborum (QL) trigger points also play a prominent role in chronic low back pain cases as well, becoming a key player in the subsequent onset of sciatica symptoms and hip pain complications.
The Quadratus Lumborum Muscle
The quadratus lumborum (QL) muscle group is actually a small abdominal muscle, that sits behind your main back muscles, the Erector Spinae. But this small and somewhat hidden muscle group plays such a prominent role in normal body mechanics that without its functioning the upright posture of the human being is impossible to maintain.
The Trail Guide to the Body, below, shows an excellent description of where you will find the QL muscle
The primary muscle that works in opposition the the QL, is the QL, situated on the other side. As one muscle contracts, the other will relax. If one muscle develops trigger point activity, the muscle on the other side will become overloaded and develop trigger points as well. From a clinical perspective, this means that the therapist should always address the trigger points in both the left and right QL muscles, even if the pain is limited only to one side.
What Causes Quadratus Lumborum Trigger Points?
The following factors may activate or reactivate trigger points in the QL muscle:
- Any activity that involves bending and twisting at the waist, such as reaching for an object on the floor, can overload the QL muscle.
- Lifting heavy or awkward objects, such as a TV, especially if it involves twisting at the waist.
- Bending over to put on pants, especially if their foot becomes entangled in the pants and they lose their balance.
- Automobile accidents.
- A genetically short leg that causes a lateral tilt in pelvis, or walking or running on a sloping surface (side of the road), may predispose the QL muscles to overload and trigger point activity.
- A soft bed that sags like a hammock, or a Tempurpedic mattress, may activate or reactivate QL trigger points by placing the muscle in a shortened or stretched position for an extended period.
Quadratus Lumborum Symptoms & Findings
The signs and symptoms associated with active quadratus lumborum trigger points are as follows:
- Severe, deep, aching low back pain during movement or rest, and in nearly any position, but worse in the upright posture of standing or sitting.
- A sharp, knifelike pain when moving the hips/pelvis is common.
- Client’s will attempt to support and stabilize their upper body with their hands. This bracing with the hands occurs during walking and sitting, and is the hallmark sign of active QL trigger points.
- Coughing and sneezing can creating episodes of agonizing pain as the muscle contracts to stabilize the rib cage.
- Clients may be forced to crawl on their hands and knees to the bathroom when getting out of bed in the morning.
- Clients will be unable to roll to either side when laying in a face-up position.
- The pain from untreated QL trigger points may progress to involve the groin, genitalia, and sciatica symptoms.
- The low back pain from QL trigger points may also transform into severe hip pain over time that resembles trochanteric bursitis.
- A common postural distortion with QL trigger points is an elevated hip crest on the painful side.
Stretching your QL can help prevent and ease a painful low back. try these one below.
With thanks to Dr Laura Perry.
An excellent Blog from Dr Laura Perry of The Institute of Trigger Point Therapy, Housten, Texas. For the full post please see http://www.triggerpointtherapist.com/blog/quadratus-lumborum-trigger-points/ql-trigger-points-masters-low-back-pain/