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Quadratus
lumborum (low back, hip, groin pain)
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Pain Referral Zone
Quadratus lumborum originates on the transverse processes of the lumbar
vertebrae and the last rib and inserts on the iliac crest of the pelvis. Its
principal function is usually said to be "hiking" or raising the hip,
or proximating the ribcage and pelvis on either side. Trigger points in
quadratus lumborum typically refer into the low back, hips, buttocks and groin.
It is one of the chief culprits in low back pain syndromes. It operates in close
conjunction with the lumbar paraspinal muscles, which are closer to the surface;
if there are problems in one, there are usually problems with the other. See
below.
Translation: Translation: "Quadratus lumborum"
means "the rectangular muscle of the loins." It attaches to your
lowest rib, the sides of the vertebrae in your lower back, and the top of your
pelvis. Its job is to raise your hip, but it also coordinates between the upper
half and the lower half of your body. Trigger points in this muscle can cause
pain in your lower back, your hips, your buttocks and even around into your
groin. It's one of the main causes of low back pain. See below.
Observations
on Quadratus Lumborum
 Have
you ever wondered about that virtual absence of skeletal structures around your
waist? Above the waist the heart and lungs, and to a certain degree the liver
and kidneys, are enclosed and protected by the rib cage. Below the waist the
reproductive system is snugly tucked into the pelvis. But between those two
areas there are no bones to be found but a few vertebrae; it seems very
vulnerable.
But that soft, vulnerable region is what gives the torso its flexibility.
Because the skeleton is largely interrupted there, we can bend and twist in all
directions, rather than looking and acting like the Tin Man or a mechanical toy.
The trade-off of vulnerability is probably worth it.
But
there's another advantage. In the film and TV industries, there is a device
called Steadicam. When a camera is mounted on Steadicam, it can be used by a
skilled operator without a tripod in such a way that the bounces and jolts of
his movements are not transferred to the camera, and the picture remains steady.
It works a little like the shock absorbers in a car, by absorbing sudden
movements.
Quadratus lumborum has a similar function. A year or two ago I treated a man for
quadratus lumborum pain whose job was to videotape kayak expeditions on a river
in West Virginia. When he's working, his lower body is sitting in a tiny, light
vessel that is constantly moving with the sometimes violent motions of the
water, while his upper body has to keep the camera steady. His quadratus
lumborum had been working overtime to do that job, and was now registering a
complaint.
We don't all have to use video cameras, but our systems of vision and balance
are located in our heads, and our arms and hands often have work to do that
mustn't be disturbed by what our legs and hips are doing. In reverse, we often
need to stand still while engaging in vigorous activity with our upper bodies
and arms and hands. It's the job of quadratus lumborum to mediate between the
two sections, making sure that the movements of one do not interfere with the
movements of the other.
They have help, of course. The intercostal muscles between the ribs, the rectus
abdominis and abdominal obliques, the serratus posterior inferior and serratus
anterior, and many other muscles, contribute to the cause of flexibility and
stability. But it is a rare case of low back pain that does not involve the
quadratus lumborum, which refers even around to the front of the lower torso to
the abdomen and the groin, and we would do well to give it some attention.
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