QUADRATUS LUMBORUM
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Copyright © Alastair McLoughlin 2015 Revised © Alastair McLoughlin 2019 and 2022
The right of Alastair McLoughlin to be identified as the original Designer, Developer and Author of the Work has been asserted by him in accordance with the Copyright, Design and Patents Act 1998.
All rights reserved. No part of this text may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover, or reprinted in any physical or electronic manner without the written consent of the author.
The ideas and concepts explored within this text are those of the author. For educational purposes only.
No diagnosis is being offered nor any cure promised by the application of this information.
Alastair McLoughlin cannot be held responsible for any injury arising from the application of this work by the practitioner to any third party however caused.
This work is not a substitute for medical attention. Please seek your physician’s advice if in doubt.
INDICATIONS FOR USE- Low back pain
- Restricted trunk rotation
- Restricted side bending (lateral flexion)
- Restricted flexion or extension of the spine
- Leg length difference
- Pelvic balancing.
- Sacro-iliac joint dysfunction
- Uneven shoulder height
- Tenderness in the area lateral to the kidneys
- Tissue tension of the QL
- Stiffness and tension through the lumbar area adjacent to the spine
CAUTIONS OR CONTRAINDICATIONS If there is severe pain in the lumbar area exclude the possibility of kidney infection or disease.
Refer for medical diagnosis if you are unsure about any undiagnosed medical condition.
Position of the patient:Patient is laying prone on the treatment table.
Use of a face hole is optional but preferable to avoid tension in the lower back which might occur when the head position is facing left or right.
Assessment:With the client standing check for uneven shoulder height.
When the client is laying prone check for tenderness or tissue tension on the Quadratus Lumborum - lateral to the Erector Spinae in the lumbar region between the 12th rib and the posterior iliac crest.
This sequence shows you the position of QL - lateral to Erector Spinae and is clearly identifiable by palpation.
Check both sides for a comparison of tissue tension.
Assessment takes just a few seconds to complete but is repeated in the video presentation from different angles purely for educational purposes.
Application of the AoB procedure:Treat both sides.
The work is performed using three or four ‘movements’ using both hands simultaneously, moving in opposite directions as shown.
Note the change in the use of fingers and thumbs when treating left or right sides of the body.
The instructions here are for a left side QL problem.
Moves on both sides of the body will be shown in the video presentation.
Standing to the left of the client and facing their lumbar region, place the first finger of your left hand immediately inferior to the last floating rib.
At the same time place the thumb of your right hand on the lateral aspect of the crest of the ilium.
With finger and thumb in the correct location make an AoB move laterally with your finger (along the edge of the 12th rib) and at the same time make a medial move with your thumb (along the edge of the crest of the ilium).
When that first move is complete, and where the finger and thumb come to rest, reposition your finger slightly laterally and your thumb slightly medially.
Now perform those AoB opposing moves once again - the left first finger travelling laterally and the right thumb travelling medially.
Reposition your finger and thumb once again - a little more laterally with your finger and more medially with your thumb.
By now your finger should be quite lateral of the QL - near the outer side of the body whilst the thumb should be quite medial - almost at the lumbar vertebrae.
After a minute or two pause you can re-check the tissue tension in QL and there should be a palpable difference - resulting in a more relaxed lumbar region.
Repeat this sequence on the opposite QL noting the changes of use for first finger and thumb in each three move sequence.
After a minute or two pause, and check for changes in tissue tension.
Help the patient to a seated position:Pause and check the client experiences no dizziness or light-headedness.
If they are dizzy or light headed then wait for a minute or two to allow that feeling to clear itself.
Only then may the client step down from the couch (a) placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.
If the client continues to be dizzy after waiting two minutes (b) then lay them in a foetal position, cover them with a blanket and wait for the dizziness to pass.
Return them to a seated position and check any dizziness has subsided.
Then ask get them to stand - placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.
The client may need to sit for a few moments before dressing and leaving your office.
How it works:Quadratus Lumborum attaches to the 12th rib and posterior iliac spine of the pelvis.
Therefore it isn’t difficult to imagine that if one QL has more tension than the opposing side an unevenness in shoulder height is easy to occur.
These release moves, performed in opposing directions, make for a quick and effective release of the lumbar area.
As QL also attaches to the transverse processes of all the lumbar vertebrae.
Therefore, release of tension in the area can have a beneficial effect on mobility for the lumbar area.
