Freeing the Quadratus Lumborum

By Peggy Lamb

The short, thick quadratus lumborum (QL) is a wonder of a muscle. While the iliopsoas initiates walking, the QL provides powerful stability so we can walk. Some researchers believe complete bilateral paralysis of the quadratus lumborum would make walking impossible, even with braces. This magnificent muscle is an essential component in the bedrock of our bipedal freedom, and plays a major role in low-back health. Since low-back pain is the second most common reason for visits to the doctor’s office (upper-respiratory infections are first), understanding how to free a dysfunctional QL is of vital importance to any bodyworker.

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.

An Emotional Muscle
As infants, we go through a series of fascinating neurological changes as we advance through the stages of movement development. Two movements are inherent in each stage: pushing and reaching. The push must precede and support the reach; otherwise the reach becomes a fall. For example, when an infant learns to walk, she must push down hard into her little feet before a stable, vertical reach can occur. I think of the quadratus lumborum as a “push” muscle, which translates to qualities such as resourcefulness, stability, confidence, personal power, strength, and how supported we feel both internally and externally.
The QL is a bridge tissue between the upper and lower body. It can become an emotional and energetic dumping site for our unmet needs, frustrations, anger, and grief around issues of support. It stores energies and emotions that need to flow through the pelvis, down the legs, and out the feet, instead of stagnating in our core. Unloading the QL and the spine by lying on the floor or on the ground has biomechanical benefits and delivers a powerful kinesthetic message of support: We can let down into a generous and abundant Mother Earth.
Remember, the sturdy QL is one of the structures that stabilize the pelvis and lumbar spine so we can walk. The health of this muscle contributes to our ability to move forward in life with power and ease, both literally and metaphorically. Feeling trapped in a soul-numbing job or an unfulfilling relationship are two examples of energetic/emotional disturbances that could manifest in a locked quadratus lumborum.
Problems in the QL can also surface when we offer too much support to others and neglect ourselves. This hardy muscle has much to do with our personal sense of power. It reveals how good we are at taking care of ourselves in all aspects of our lives, and how often we ask for help when we need it. When we’re in the victim vibe, we collapse and compress our vertebrae. In that situation, the QL shortens, losing its robust flexibility and strength.

Muscle Swimming to Release the QL
We can release the stalwart QL using an approach I call “muscle swimming.” Muscle swimming uses physiology to facilitate release of myofascial structures, allowing the therapist to work smarter and the client to have co-ownership of the session. You can use the following two strategies of muscle swimming in your work with the QL.

Pin and Rock
Our first encounter with a stressed myofascial unit should be gentle and nonthreatening. Passively shorten the muscle, gently pin it with multiple fingers for a broad, dispersed pressure, and add a slow, rhythmic rocking of the joint. Rocking stimulates a parasympathetic response. Be patient—wait for the tissue to soften and yield before moving to the Pin and Move protocol. Come back to this Pin and Rock maneuver when you sense guarding in your client.
Pin and Move
When you meet an area of dense fascia, trigger points, tender points, or just plain snarly tissue, integrate active movement. Active movement engages the brain by involving the central nervous system, creating longer-lasting results. Fascial layers and actin and myosin myofibrils glide across each other as the muscle goes through its shortened, neutral, and stretched states.
1. Place the muscle in a shortened state.
2. Pin the area at the first barrier you encounter. If it’s a trigger point or tender point, use one finger, or appropriate tool for specificity, and work it from an oblique angle of 45 degrees.
3. Have your client perform a movement. Start with the main action the muscle performs, for example, flexion, abduction, extension, etc. Movement should be done at a slow to medium tempo. Two movement patterns I find helpful are the Pelvic Tilt and the Running Man.
4. Have client repeat the movement four to five times.
5. Ask, “Is there any change?” Using this language instead of “Is it better?” gives your client permission to tell the truth. If the clients says the area feels better, your next question is, “How much better?” If your client reports at least a 50 percent change for the better, then move to another area and repeat the above steps.
6. If your client reports no change, you have three options:
• Add resistance to the current movement pattern. This loads the muscle and recruits more fibers, allowing you to swim through the tissue; 10–20 percent of resistance is usually all that is needed.
• Try another movement pattern. This is where the work gets interesting; the trial and error of experimenting with different movements and levels of resistance develops our skills and intuition.
• Ask your client for input. She may feel an urge to move the area in a certain way.

Side-Lying Palpation
The side-lying position offers the most advantages for precise deep-tissue work on the quadratus lumborum.
Place a small, rolled towel under the client’s waist, and, if possible, place the client’s top arm behind her head on the table. This will elevate the rib cage, allowing even more space for you to work. If your client’s shoulder won’t tolerate that position, place that arm on the table and support it with a pillow. Another pillow should go between the client’s knees/thighs.
Find the iliac crest and the 12th rib, and then place your fingers halfway between those bony landmarks. Move your fingers about ¼- to ½-inch posterior and gently press toward the table. You will be on the most lateral layer of the QL. Have your client hike her hip to verify your position. You should feel the QL shorten under your fingers. Keep in mind you should be pressing deep to the erector spinae.

Step 1: Warm the Tissue
We’ll use the Pin and Rock technique to prepare the QL for deeper work. Place two or three fingers of your uphill hand on the belly of the QL, using gentle pressure. Place your downhill hand on your client’s hip. Maintain moderate pressure on the QL as you slowly rock your client’s hips forward and back. The hand on the QL is still; the working hand is the rocking hand. Instruct your client to breathe deeply. Do this until you feel the QL begin to soften.
After the central part of the QL softens, angle your fingers to the iliac crest and continue to pin and rock. Once you feel that section soften, repeat with your fingers angled to the 12th rib. Since we’re working in a small area, angling the fingers usually suffices to connect with these attachments.

Step 2: Warm the Deeper Layers
After the attachments have softened, return your fingers to the central section of the muscle, continue to pin and rock, and feel if you can soften and warm the deeper layers of the muscle where it attaches to lumbar vertebrae 1–4. It’s essential that you take the time to warm these deeper layers. Many therapists just release the superficial fibers, which is good, but not good enough.

Step 3: Pin and Move
Once the tissue is warm and receptive, it’s time to release knots, adhesions, and trigger points with our Pin and Move technique. When you feel a knot, adhesion, or trigger point, gently pin the area while the client does active movement.
Two suitable movement patterns are pelvic tilts and a maneuver I call Running Man. When using one of these, teach your client the movement pattern using passive movement. Do it for her several times, then have her do the movement four or five times. Hip hikes and lateral flexion of the spine are two other possible movement patterns.
Pelvic Tilt: Sidelying with both knees bent, the client should tuck the tailbone under in a posterior tilt of the pelvis, then back again in an anterior tilt. Repeat four to five times while working the tissue.
Running Man: This maneuver involves thigh flexion and extension. Even though the QL is not directly involved, the iliac crest shifts during these movements when done in a side-lying position, engaging the QL.
1. Ask the client to slowly slide the top leg toward the chest, keeping the entire leg in contact with the table. The thigh does not need to come into full flexion. Whatever the client can do without straining is fine. The bottom leg should be comfortable, with a small degree of flexion at the thigh and knee.
2. Have her slowly slide the top leg into extension.
3. Lift that leg about one inch above the bottom leg and place it behind the bottom leg.
4. Repeat the above steps three to five times while working the tissue.

Step 4: QL Stretch
Stretch the high ilium side. The client lies on the side opposite the side to be stretched, and moves her body to the edge of the table. Guide the top leg to hang off the edge of the table. The knee needs to clear the table; sometimes it takes a bit of trial and error to achieve this while maintaining the client’s alignment. If you’re having trouble getting the knee to clear the table, ask her to scoot her upper body away from you and her rear end toward you. Stabilize the pelvis with your body to prevent rotation or over-arching of the lower back. A towel under the client’s waist can help with positioning and increase the stretch. To use a proprioceptive neuromuscular facilitation (PNF) strategy, have the client push up to engage and shorten the QL, using light effort. Have her hold the contraction for 8–10 seconds. You can then feel if the tissue can stretch farther. Repeat the PNF two more times. PNF techniques are especially good for re-educating the stretch reflex and reducing its signaling on tissue that has an especially short resting length.
Gently press down on the femur (less intense) or the calf (more intense) of the leg being stretched with your downhill hand. The client’s upper arm must be above the ribs, reaching up toward her head. With your uphill hand, traction the iliac crest away from the ribs. Hold for 15–30 seconds.
Move your upper hand to the rib case and traction it away from the pelvis, while maintaining the pressure on the femur or calf. Hold for 15–30 seconds.
To bring the client out of the stretch, lift her leg back onto the table so she does not engage the muscle.

A Stepping Stone to Freedom
Freeing the QL is a valuable skill for every manual therapist’s toolbox. Let this article be your stepping stone to developing a finely honed and exquisite skill set for working with, and freeing, this wonder of a muscle.

Peggy Lamb is the author of The Core of the Matter: Releasing the Iliopsoas and Quadratus Lumborum, Releasing the Rotator Cuff, and Stretch Your Clients!. An educator and bodyworker for more than 25 years, she brings her eclectic and extensive background into her teaching for an interesting and enlightening learning experience. She teaches her techniques nationally and internationally to massage therapists, physical therapists, and occupational therapists. Visit her website at or email her at

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