Issue link: https://www.massageandbodyworkdigital.com/i/398416
The two QLs work as a team, along with the iliopsoas, lumbar paraspinals, and multiple ligaments, in stabilizing the lumbar spine. Distress in this fundamental stabilizer can have devastating effects, like a hurricane blowing through the body. Any movement can be painful, including urination and defecation. The pain may be excruciating in any position that increases weight bearing and requires stabilization of the lumbar spine. Rolling onto either side from a supine position is painful and difficult; coughing and sneezing can be agonizing. Bending forward, twisting, and sneezing or coughing at the same time can throw the quadratus lumborum into spasm. Even if it's not a full-blown hurricane, an irritated quadratus lumborum can blow an ill wind of persistent aching pain and gradual loss of lower-back and pelvic flexibility, range of motion, and vitality. Nature has given the QL the power to do its job of stabilization with an intricate and interlacing fiber arrangement. The most lateral fibers, which are the easiest to palpate, are the nearly vertical iliocostal fibers. The iliolumbar fibers span diagonally from the ilium and iliolumbar ligament to the transverse processes of L1–L4. The diagonal lumbocostal fibers attach to the 12th rib and the lumbar transverse processes. Keep this complex fiber arrangement in mind as you work the QL. Trigger points are often found in both QLs and refer pain in a horizontal pattern across the lumbar spine. Trigger points also refer to the SI joint, upper sacral region, greater trochanter and lateral thigh, groin, obliques, and buttocks. An improperly functioning QL will affect all the hip/lower-back muscles, and secondary trigger points may develop in the gluteus medius and minimus, piriformis, and iliopsoas. Activation of trigger points or dysfunction of the QL can be brought on by numerous factors—a short list includes pregnancy, car accidents, weak and/or incorrectly trained abdominal muscles, and short upper arms (elbows that do not reach the iliac crest and cannot reach the armrests in most chairs; the client tends to lean to one side, placing an eccentric load on the opposite quadratus lumborum). Of course, poor posture is the biggest culprit. Often, however, the client is valiantly trying to improve his posture, but is prevented from doing so by twisted, tangled, locked- short, or locked-long myofascial structures. Another cause, as with any other stabilizing muscle, is ligaments that have weakened with age and/or injury. As we age, the QL gets recruited to stabilize even more, leaving it prone to injury. Because of its attachment at the 12th rib, the QL plays a vital role in respiration. Keep in mind that the iliopsoas has an attachment right next door at T12. If the iliopsoas is locked short near its T12 attachment, it pulls down and slightly rotates the spine away from that side (contralaterally), producing an additional load on the QL. I've often found that this 12th rib attachment can be the most difficult to fully release. Often full of scar tissue, it has lost its suppleness, inhibiting dynamic and responsive movement of the rib cage. 84 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4 The QL can become an emotional and energetic dumping site for our unmet needs, frustrations, anger, and grief around issues of support. Quadratus lumborum trigger- point referral patterns.