Low Back Pain: Why Can't I Break Through It?
While there are many causes of LB pain, as well as a number of presentations, today’s focus will be on the Quadratus Lumborum (QL), a stabilizing muscle for the lumbar, or lower spine. While there are injuries that can cause spasms in the QL, one thing we often see is low back pain that results from repetitive or mechanical origins.
This muscle has several attachments: it goes from the 12th rib to the top of the posterior hip bone, as well as to the transverse processes of the first four lumbar vertebrae.
The QL is involved in a number of movements:
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Side bending, when one side contracts and the other lengthens;
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Repetitive twisting, one sided lifting, sports such as golf, tennis, and pickleball;
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It helps to raise the hip when lifting a leg and standing on one foot;
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It assists in lumbar extension to keep the body upright while back bending;
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The 12th rib attachment allows the diaphragm to descend to inflate the lungs during inhalation;
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It helps stabilize the lumbar spine, pelvis, and lumbosacral junction during walking, standing, and carrying uneven loads.
When the QL is very tight on one side we can see referred pain that goes down into the gluteal region (buttocks), the SI joint, and the top of the hip bone (iliac crest). Occasionally, it can radiate to the groin or the top of the femur.
If one side is chronically tight, the pelvis on that side will be pulled upward creating asymmetry in the low back and SI joints. If there is structural imbalance or an injury that changes the gait, it can cause secondary compensation in the surrounding muscles and pain into the hip and buttocks.
Weakness of the gluteus medius or abdominal muscles result in an overworking of the QL to stabilize the pelvis and spine. When overworked, or due to habitual patterns, micro-tears can occur leading to protective spasms that lock up the lower back. Activities or habits such as:
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Slouching or leaning to one side while driving;
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Repeatedly sitting on one side of a couch which tips the pelvis to one side, shortening the other side;
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Always crossing one leg over the other when sitting;
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Always sleeping on the same side;
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Frequently sitting on one foot.
What You Can Do:
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Pay attention to your posture and any habitual patterns of sitting, driving, etc.. We can’t make changes to things we are not aware of.
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Stop crossing legs and sitting on one foot. When sleeping on your side, put a pillow between your knees to balance the hips and lower back.
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Do regular lateral stretches to prevent and treat tightness, especially important if you engage in twisting sports. Some examples from yoga are Triangle and Extended Side Angle pose.
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While driving, place your left foot on the foot rest instead of having the foot flat on the floor, and move the seat forward to avoid overextending the right hip.
Acupuncture is a great way to address the tightness and imbalances and to release any trigger points in the lower back and SI joint.