Trigger Point Therapy - Treating the QL
Treating the QL - Dr. Jonathan Kuttner
Trigger Points in the QL are known by some as the "masters" of lower back pain!
(Latin quadratus, squared; lumbus, loin)
Whilst the quadratus lumborum (QL) is a small muscle it plays a vital role in body mechanics enabling us to maintain our upright posture.
Trigger points in the QL are almost always associated with acute low back pain complaints, especially those cases where the pain is so severe that the client cannot stand.
QL trigger points are also often associated with sciatica-type symptoms and hip pain.
Quadratus Lumborum - Common Trigger Point Sites
ORIGIN
Posterior part of iliac crest. Iliolumbar ligament.
INSERTION
Medial part of lower border of 12th rib. Transverse processes of upper four lumbar vertebrae (L1–L4).
ACTION
Laterally exes vertebral column. Fixes 12th rib during deep respiration (e.g. helps stabilize diaphragm for singers exercising voice control). Helps extend lumbar part of vertebral column, and gives it lateral stability.
NERVE
Ventral rami of the subcostal nerve and upper three or four lumbar nerves, T12, L1, 2, 3.
BASIC FUNCTIONAL MOVEMENT
Example: bending sideways from sitting to pick up an object from the floor.
TRIGGER POINT REFERRED PAIN PATTERNS
Several “zones” of pain at: lower abdomen, sacroiliac joint (upper pole), lower buttock, upper hip, and greater trochanter.
Referred Pain Patterns - Deep
Referred Pain Patterns - Superficial
INDICATIONS
Renal tubular acidosis, discogenic list scoliosis, mechanical low back pain, walking stick/cast for fracture, hip and buttock pain, greater trochanteric pain (on sleep), pain turning in bed, pain standing upright, persistent deep lower backache at rest, pain on coughing and sneezing (Valsalva’s maneuver), pain on sexual intercourse, patient presents with a functional list to one side, may be associated with acute low back pain and radiations into leg(s), post kidney stone treatment, sciatica.
CAUSES
Disc problems in lower back, or facet or spinal joint issues (such as degeneration, sacroiliac joint issues, and spondylolisthesis or spondylolysis in lumbar spine), repetitive strain, gardening, putting on shoes/socks while standing, housework, occupational positions, soft mattress, trauma, weak abdominals, short leg on one side (PSLE).
DIFFERENTIAL DIAGNOSIS
Sacroiliitis. Bursitis of hip. Radiculopathy (lumbar). Disc pain (lumbar). Ligamentous
pain (iliolumbar/lumbosacral). Spondylosis. Spondyloarthropathy. Stenosis (spinal). Spondylolisthesis. Rib dysfunction (lower).
CONNECTIONS
Gluteus medius/minimus/maximus, TFL, pyramidalis, iliopsoas, pelvic oor, sciatica, hernia, testicular/ scrotal, transversus abdominis, external oblique, diaphragm.
QL Trigger Points - Stretching is a key part of the treatment protocol
GENERAL ADVICE TO CLIENTS
Correct any leg length discrepancy. Change mattress. Occupational advice (mechanical). Hobbies (gardening). Strengthen abdominal (core) stability. Avoid leaning on one leg. Take care when twisting. Emotional component.
Links
Find a Trigger Point Professional in your area
Treating Erector Spinae Trigger Points
Dry Needling for Trigger Points
Certify as a Trigger Point Therapist
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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