Quadratus Lumborum Stretch
Lie on a flat, elevated surface. If it's a bed, remove the covers first for a firmer surface.
Place a pillow (or stack 2) on the edge of the long side of the bed, with the shorter side of the pillow(s) on the edge of the side of the bed.
Lie on the edge long side of the bed, facing the inside of the bed, with your waist on the pillow.
- Lift the knee that’s on the bed up so that your leg is bent.
- Keeping your top leg straight, slowly and gently bring it backwards and dangle it off the side of the bed (behind and below you).
Reach up over your head with your top arm.
Reach straight out on the bed with your bottom arm to keep you from falling backwards off the bed.
You should feel a stretch in your quadratus lumborum ("QL") and/or oblique on the top side. Alternatively, you may feel a stretch in your ITB and/or intercostals (rib muscles) on the top side.
At first, do NOT left your pelvis roll backwards (toward your dangling leg). Your pelvis and back should be totally vertical, not rotated. Once you’re more experienced with the stretch you can vary the degree you allow your pelvis to rotate backwards in order to stretch others muscles.
Vary the angle with which you lie on the bed.
- The more pillows you stack underneath your waist, the greater the stretch.
The quadratus lumborum muscles, together with the illiopsoas, are a common cause of lower back pain. However, before you convince yourself that the quadratus lumborum is the source of your back pain and commit to stretching your quadratus lumborum every day, you should consider whether your psoas muscle might be causing your lower back pain. Read the floota.com articles on (1) testing your psoas for dysfunction (2) stretching out your psoas and (3) "desk jockeys" (detailing the negative effects on your body of sitting for 16 hours a day 365 days a year).
What does the quadratus lumborum do? The quadratus lumborum muscle does three things: (1) the quadratus lumborum assists in rotating your torse, (2) the quadratus lumborum assists in lateral flexion of your torso (i.e., side-bending, as when, for example, performing a side plank exercise or kettlebell windmill exercise), and (3) when your left and right quadratus lumborum muscles contract at the same time, they assist in back extension (i.e., straightening your back, as when, for example, you stand up, or perform a good morning lift).
Gradual Pain Onset. Because most people sit for 90% of the day, their quadratus lumborum muscles are short, tight, and overused. If you have back pain that is only on one side of your lower back, there’s a good chance it’s the quadratus lumborum on that side. If (1) you have a quadratus lumborum muscle that’s causing you pain only on one side and (2) no obvious injury initiated the pain (e.g., a fall), your pain could be coming from your everyday sitting habits. For example, if, for some reason, you like to cross your legs when you sit, and you frequently only cross them one way (e.g., always right over left), this means there are unequal forces on your back. To keep you sitting up, one of your quadratus lumborum muscles is then engaged. Some people have a tendency, when they cross their legs while sitting, to shift their weight onto the butt cheek of the uncrossed leg. For example, crossing your left leg over your right means you lean slightly to the right, with, say, 70% of your weight on your right sit-bone, 30% on your left. This isn’t a problem, unless you do it for 12-14 hours a day, every day (like most of us do when we’re sitting). If this is habitual, that means one of your quadratus lumborum muscles is doing most of the work all day while you sit.
Sudden Pain Onset. Alternatively, some experience a sudden onset of pain on one side of the lower back. For example, maybe 20 minutes after doing something like gardening or taking the groceries out of the car, you may experience pain in your quadratus lumborum. When you twist your torso, the quadratus lumborum on the side you’re twisting towards contracts, along with the erector spinae and internal obliques on the same side, and the external obliques on the opposite side. If you are not standing straight up when you twist, but rather you are leaning over and twisting at the same time, this puts your quadratus lumborum on the side you’re twisting towards on double duty. You are asking your quadratus lumborum to both (1) rotate your torso and (2) extend your back (keep it upright) while (3) in a mechanically disadvantageous position (assuming you’ve allowed your lower back to arch forward, as most people do when bending over).
What to do? So what do you do if you have quadratus lumborum pain? First of all, lie down and have someone rub your lower back on one side and then the other, to check for tenderness. The problem is, there are several structures down there, and the quadratus lumborum is the deepest (it’s below other muscles, like the erector spinae). To massage the quadratus lumborum, you have to kind of come in from the side, rubbing up and down relative to the spine (i.e., parallel to the spine).
Short Term: Heat. If indeed one of your quadratus lumborum muscles is causing you pain and you’ve determined the quadratus lumborum pain is due to habitual overuse you need to address the habitual overuse first. Get a lumbar support pillow and use it until your quadratus lumborum is better. Next, use a heating pad on your quadratus lumborum. You can get an electric heating pad for $15 USD, and most of them come with a felt pad nowadays that can be soaked in water and placed in the satchel to provide moist heat, which is much more conductive. One of my physical therapists said that just using a heating pad without a small wet towel between it and your skin is less useful in that it doesn’t conduct as much heat to the muscle as when the skin is moist.
Longer Term: Stretching and Soft Tissue Work. Next, stretch your quadratus lumborum to get it supple again. Recovery could take weeks of daily quadratus lumborum stretching. If, after stretching the quadratus lumborum for weeks, the quadratus lumborum is still tender and sore, either you didn’t correct the habitual misuse of it and are reinjuring it daily, or you have some sort of myofascial problem with it (i.e., “knots” or “adhesions” in the audratus lumborum muscle itself). In this case, you need to go to someone who can do some brand of myofascial rehabilitation (sometimes called “stressage”) like A.R.T. (Active Release Technique) before stretching will be much good.
Prevention: Posture, Lifting Technique, and Strength. Once the quadratus lumborum pain is gone, the quadratus lumborum pain will return unless you (A) stop sitting all day, get a lumbar support pillow, and vary your posture as you sit, (B) strengthen your quadratus lumborum such that it can handle the demands you place on it, and/or (C) stop misusing your back when you lift objects. To strengthen your quadratus lumborum do anaerobic exercise specifically for the quadratus lumborum muscles (once they no longer hurt). For example side-bends on a stability ball, side-planks, and kettlebell windmills. As for misusing your quadratus lumborum, you need to learn to lift objects properly by not relying solely on your lower back. Lift heavy objects by squatting way down and using your legs and butt to stand back up, keeping your lower back engaged and straight the whole time. Lift lighter objects the same way, or by using the golfer’s pickup, planting one leg and allowing the other to lift off the ground behind you as you lean over.
- Shirley A. Sahrmann, Diagnosis and Treatment of Movement Impairment Syndromes 51-74 (2002).
- Carolyn Kisner & Lynn Allen Colby,Therapeutic Exercise: Foundations and Techniques 465 (5th Ed., 2007).
- Quadratus lumborum muscle @ Wikipedia.
- Quadratus Lumborum @ Exrx.