What is the Quadratus Lumborum?
A) The muscle that connects the hip to the ribs, earning it the nickname “hip hiker”
B) A deep muscle of the lower back and frequent culprit in back and hip pain
C) Part of the posterior wall of the abdominal cavity
D) A boring old square (quadratus lumBORum)
Did you think it was all of the above? Nope! It’s A through C. There’s nothing boring about the QL. Lumborum refers, of course, to the lumbar spine (and not to boredom). Quadratus refers to the shape of the muscle. Though it is made up of bands of fibers overlaid at slightly different angles as depicted above, it appears on the whole to be quadrilateral, a squat, square muscle that helps form the posterior wall of the abdominal cavity and that connects hips to ribs, assisting with lumbar extension and lateral flexion, hip hiking, stabilizing the lower back and twelfth rib.
Why Should You Care?
The Quadratus Lumborum is a common culprit in non-specific low back pain. Low back pain is one of the top reasons people come for massage (and one of the top reasons people miss work), and there’s some research out there that suggests that massage therapy can be an effective way to treat lower back pain. Working the QL can help your back feel better and get you back to work. Good stuff!
What Makes the QL Exciting?
Like a compelling love interest, the QL is deep, but accessible. Though it is located beneath several layers of paraspinal muscles, it is lateral at its outer edge, coyly peeking out from under more superficial muscles. I’m anthropomorphizing a little, but there is something cool about deep muscles that can be accessed directly during massage. As with sliding under the scapula to address subscapularis or dipping under pec major to reach pec minor, working on the quadratus lumborum reminds me how easily we can reach what doesn’t, at a glance, seem readily palpable. My favorite approach to quadratus lumborum is to find the lateral border, its edge dropping off into softer tissues, and to sink in from the side. Sidelying position is excellent for accessing this muscle and leaning in, but prone works, too, a slow drag of fingertips easing into the layers of the back, finding what’s deep, and releasing.
I also like to access QL from sidelying. We weren’t taught much sidelying in school and I figured out the lateral to medial sink into QL was really effective for a lot of my clients. Much more than just rubbing, rubbing, rubbing on the back.
I love the lateral to medial sink-in!