By Glenn Henson, Clinical Therapist at Psoas Massage + Bodywork Janet Travell, MD (Founder of Trigger Point Therapy), had good reason to name the Quadratus Lumborum (QL) the "Joker of Low Back Pain" in her landmark book on myofascial pain. This small muscle that attaches the crest of the pelvis to the lumbar spine and bottom rib is often at the root of chronic low back pain and stiffness. Because of its tendency to hike up (or raise up) the pelvis when aggravated, it can have widespread postural effects on the body. A tight QL could cause one or all of the following:
- The appearance of having one leg shorter than the other.
- Induced scoliotic patterns in the spine.
- Crippling pain when trigger point activity is also present - extremely common with chronic cases of a "hiked up" hip.
Symptoms and Causes
In my experience when someone comes in for treatment saying, " I threw my back out again," the QL is almost always involved. These clients will often complain of ongoing stiffness in the low back with periodic bouts of intense pain that can be debilitating. The pain is usually along the crest of the ilium, referring strongly into the sacroiliac joint and deep into the buttocks. Secondary trigger points often form in the buttocks, referring pain down the leg, inducing sciatic-like symptoms. Episodes are usually brought on by either new physical activity or a seemingly innocuous movement like bending over to pick up a pencil. Loading the muscle while picking something up with a slight side-bend could also bring on an attack.
When I get a more detailed history from the people who have this type of pain, I hear varied stories. Sometimes there's a chronic hamstring issue on one side, or a plantar fasciitis problem in one foot (runners and triathletes), or one shoulder seems to always be bothering them (office workers). Some have been told by their medical professionals that it may be because they have one leg shorter than the other. Common among these clients are complaints of a vague sense of being off balance or feeling disconnected from the ground, and the pain is often described as sharp or pointed.
Do You Have a Leg-Length Discrepancy?
An easy self-test for an apparent leg length discrepancy is to lie down flat on your back and rotate your feet inwards. The big toes should meet in the middle and block any further rotation. If you find that one foot rotates in and completely misses the other toe it indicates that one leg appears to be shorter. While there is a percentage of the population that in fact have bone length discrepancies in the pelvis, femur or tibia, they are in the minority. Most discrepancies are attributable to compensations in the body due to pain or tension.
The reality is that these are all symptoms of the pelvis being uneven and the body adapting to it. This is a common phenomena and underscores the importance of a stable, even pelvis. If the descriptions above are also your experience with low back pain, then regular bodywork can keep the symptoms in check. It can even out the pelvis and legs, and for many people, eliminate the problem altogether.
Using a combination of Direct Myofascial Release, Neuromuscular therapy and Active Release Technique, clients have had great success in releasing chronic spasms, deactivating or greatly reducing trigger point activity and returning the pelvis to a more neutral position - creating more balance in the body. Clients are often surprised at how quickly an apparent leg length discrepancy can be "fixed." Rotations and pelvic tilts can be more complex to resolve and often require multiple treatments.
When I work with clients, I often discuss perpetuating pain factors like desk ergonomics, how long you sit for and how you sleep. Changing some of these habits is often the difference between temporary and permanent change in your pain frequency. Likewise, I usually provide clients with homework--gentle movement re-education patterns that clients find very soothing to perform. You can do these on your own and retrain your body's neurological system to accept new positions. My aim is to create balance, set the stage for your healing, and give you the tools and knowledge to manage your pain or eliminate it.
You can eliminate these frequent bouts of low back pain. While no treatment can be guaranteed, proper bodywork will help. If this description fits you, call the studio today to book an appointment at 415.227.0331.