Quadratus Lumborum Trigger Points

Introduction

The quadratus lumborum (QL) is a deep lower back muscle responsible for spinal stability, lateral bending, and hip movement. When trigger points develop in this muscle, they can cause lower back pain, hip tightness, and difficulty standing upright, often mimicking sciatica, kidney pain, or SI joint dysfunction.

Name and Area

  • Name: Quadratus Lumborum (QL)

  • Area: Located deep in the lower back, running from the iliac crest (pelvis) to the lumbar vertebrae and lower ribs.

Indications

Quadratus lumborum trigger points may contribute to:

  • Lower Back Pain That Feels Like a Deep Ache or Stiffness (Mistaken for a Disc Injury or Muscle Strain)

  • Pain That Extends to the Hip and Pelvis (Can Mimic SI Joint Dysfunction or Hip Bursitis)

  • Sharp Pain When Bending or Twisting the Spine (Common in Golfers, Tennis Players, and Office Workers)

  • Pain That Increases with Standing for Long Periods or Walking on Uneven Terrain

  • Pain or Stiffness When Transitioning from Sitting to Standing (Can Feel Like the Back Is "Locked")

  • Difficulty Maintaining an Upright Posture (Can Cause Leaning to One Side or an Uneven Gait)

Pain from this muscle is often mistaken for lumbar disc herniation, SI joint dysfunction, or kidney-related pain.

Muscle Action

  • Laterally Flexes the Spine: Bends the torso sideways, important for maintaining balance.

  • Extends the Spine: Helps keep the spine upright and stable.

  • Assists in Hip Elevation: Lifts the hip when walking or stepping (important for hip hiking in gait mechanics).

The quadratus lumborum is crucial for core strength, postural stability, and lower back function.

Signs and Symptoms

Individuals with quadratus lumborum trigger points often report:

  • Dull, Aching Pain in the Lower Back or Near the Waistline

  • Pain That Spreads to the Hip or Upper Buttocks (Can Mimic Sciatica or Hip Pain)

  • Sharp Pain When Bending to the Side or Rotating the Spine

  • Pain or Stiffness in the Lower Back After Sleeping or Sitting for Long Periods

  • Pain That Worsens with Walking on Uneven Ground or Carrying a Heavy Bag on One Side

  • Pelvic Imbalance or Uneven Posture (Can Cause One Hip to Appear Higher Than the Other)

Pain worsens with prolonged sitting, standing, or asymmetrical movements.

Perpetuating Factors

Common causes of quadratus lumborum trigger points include:

  • Prolonged Sitting with Poor Posture (Common in Office Workers, Truck Drivers, and Cyclists)

  • Lifting Heavy Objects Without Proper Core Activation (Common in Weightlifters and Laborers)

  • Walking or Running on Uneven Terrain (Can Lead to Asymmetrical Pelvic Loading and Hip Hiking)

  • Leg Length Discrepancy or Pelvic Imbalance (Forces One Side of the QL to Overwork for Stability)

  • Chronic Stress or Emotional Tension (Can Cause Increased Lower Back and Core Tightness)

Trigger Point Referral Pattern

Trigger points in the quadratus lumborum refer pain to:

  • The lower back and waist area (Can Mimic Kidney Pain or Lumbar Strain)

  • The hip and upper glute region (Mistaken for SI Joint Dysfunction or Sciatica)

  • The front of the hip and groin (Can Resemble Hip Flexor Tightness or Oblique Muscle Strain)

Pain from this muscle is often confused with lumbar spine issues, hip joint dysfunction, or kidney disorders.

Differential Diagnosis

Quadratus lumborum trigger points may be mistaken for:

  • Lumbar Disc Herniation (Lower Back Pain That Radiates Down the Leg, Worsens with Sitting or Bending Forward)

  • SI Joint Dysfunction (Pain in the Lower Back and Buttocks, Worsens with Standing on One Leg or Walking)

  • Kidney Stones or Infection (Pain in the Flank, Can Be Accompanied by Urinary Symptoms)

  • Hip Bursitis (Lateral Hip Pain, Worse with Sleeping on the Affected Side or Walking Long Distances)

  • Oblique Muscle Strain (Pain in the Side of the Torso, Worsens with Twisting Movements)

A thorough spinal, hip, and core assessment is necessary to rule out these conditions.

Associated Trigger Points

Quadratus lumborum trigger points often co-exist with:

  • Iliopsoas (Deep Hip and Lower Back Pain, Can Contribute to Postural Dysfunction and Anterior Pelvic Tilt)

  • Gluteus Medius and Minimus (Outer Hip and Buttock Pain, Affects Pelvic Stability and Walking Mechanics)

  • Latissimus Dorsi (Thoracic and Lower Back Pain, Common in Overhead Movements)

  • Erector Spinae (Lower Back and Core Pain, Can Contribute to Postural Fatigue and Stiffness)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Quadratus Lumborum Iliac crest, transverse processes of L1–L4 12th rib, transverse processes of L1–L4 Ventral rami of spinal nerves (T12–L4)

The quadratus lumborum is innervated by the ventral rami of spinal nerves (T12–L4), which also control core stability, lateral bending, and lumbar spine support.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the lower back, waist, and upper hip.

  • Resisted Side Bending Testing: Assess pain and weakness when bending the torso sideways against resistance.

  • Gait and Postural Analysis: Look for hip hiking, uneven weight distribution, or lumbar misalignment.

  • Leg Length and Pelvic Alignment Testing: Rule out structural imbalances contributing to QL tightness.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the quadratus lumborum, reducing lower back tightness and improving spinal mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the lower back and upper pelvis.

  • Massage Therapy: Helps improve circulation and reduce muscle tension in the lumbar region.

Stretching

  • Side Stretch Against a Wall: Stand and gently lean sideways to stretch the QL.

  • Child’s Pose with Side Bend: Helps lengthen the QL and relieve tension.

Strengthening Exercises

  • Side Planks: Strengthens the QL and obliques for better lumbar stability.

  • Bird-Dog Exercise: Improves core activation and reduces strain on the lower back.

  • Glute Bridges: Helps engage the posterior chain and counterbalance QL tightness.

Postural and Movement Adjustments

  • Avoid Prolonged Sitting Without Lumbar Support (Take Standing Breaks Every 30–60 Minutes)

  • Ensure Proper Walking Mechanics (Engage the Core and Avoid Excessive Hip Hiking)

  • Incorporate Dynamic Core Stability Drills (Prevents Excessive QL Activation and Improves Hip Mobility)

Conclusion

The quadratus lumborum plays a crucial role in spinal support, postural stability, and lateral movement, but trigger points in this muscle can cause significant lower back, hip, and pelvic pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic lower back dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.