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Quadratus lumborum pain referral zone:
Quadratus lumborum (low back, hip, groin pain):



 

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: "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.

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.
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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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