Quadratus lumborum and back pain

Quadratus lumborum (QL) trigger points can play a prominent role in chronic low back pain.

The quadratus lumborum muscle

The quadratus lumborum muscle has a small and somewhat hidden muscle group that plays such a prominent role in normal body mechanics that without its functioning the upright posture of the human being is impossible to maintain.

  • The iliocostal fibres (shown below in blue) attach on the iliac crest and run vertically upward to attach to the 12th rib.
  • The iliolumbar fibres (shown below in green) attach on the iliac crest and run diagonally upward and medially to attach to the tranverse processes of the lumbar vertebrae (L1 to L4)
  • The lumbocostal fibers (shown below in red) attach on the lumbar vertebrae and run diagonally upward and laterally to attach to the 12th rib.

The most important biomechanical consideration with the QL muscle relates to the guy-wire fibre arrangement discussed above. The primary antagonist to each QL muscle is the opposing QL muscle on the other side of the body. Thus, if one muscle develops trigger point activity, the muscle on the other side will become overloaded and develop trigger points as well.

The quadratus lumborum trigger points

As shown in the diagrams above, there are four potential trigger points in the QL muscle:

  • The upper QL trigger point is found just lateral to where the lumbar paraspinal muscles and the 12th rib meet. Note: this trigger point lies underneath the paraspinal muscle mass in this region.
  • The lower QL trigger point lies deep in the region where the paraspinal muscles meet the hip crest (iliac crest).
  • The middle or deep QL trigger points lie closer to the spine than the superior or lower trigger points, next to the 3rd and 4th  lumbar vertebrae.
  • Typically, all four trigger points in this muscle present simultaneously.

Quadratus lumborum pain

The referred pain from the QL trigger points is usually described as an intense, deep ache, but it may also have a sharp, knife-like quality at times, particularly during movement. The distribution of the referred pain is as follows:

  • The upper trigger point (shown to right in blue) refers pain to the flank region of the low back, along the crest of the hip, and around the front to the upper groin region. It may also refer pain to the sacroiliac (SI) joint.
  • The lower trigger point (shown to right in red)  refers pain and tenderness to the hip joint region, making laying on that side too painful during sleep.
  • The middle trigger points (shown above in green) refer pain and tenderness strongly to the SI joint and lower buttock regions. Occasionally, these trigger points may refer a sharp, electrical pain to the front of the thigh.

Quadratus lumborum symptoms and findings

The signs and symptoms associated with active QL trigger points are as follows:

  • Severe, deep, aching low back pain during movement or rest, and in a sharp, knife-like pain when moving the hips/pelvis is common.
  • One attempts to support and stabilize the upper body with the hands. This bracing with the hands occurs during walking and sitting, and is the hallmark sign of active QL trigger points.
  • Coughing and sneezing can creating episodes of agonising pain as the muscle contracts to stabilise the rib cage.
  • Forced to crawl on hands and knees to the bathroom when getting out of bed in the morning.
  • Unable to roll to either side when laying in a face-up position.
  • The pain from untreated QL trigger points may progress to involve the groin, genitalia, and sciatic symptoms.
  • The low back pain from QL trigger points may also transform into severe hip pain over time that resembles trochanteric bursitis.
  • A common postural distortion with QL trigger points is an elevated hip crest on the painful side.

What causes quadratus lumborum trigger points? 

The following factors may activate or reactivate trigger points in the QL muscle:

  • Any activity that involves bending and/or twisting at the waist, such as reaching for an object on the floor, can overload the QL muscle.
  • Lifting heavy or awkward objects, such as a TV, especially if it involves twisting at the waist.
  • Bending over to put on pants, especially if the foot becomes entangled in the pants and they lose their balance
  • Car accidents.
  • A structurally short leg that causes a lateral tilt in pelvis, or walking or running on a sloping surface (side of the road), may predispose the QL muscles to overload and trigger point activity.
  • A soft bed that sags like a hammock may activate or reactivate QL trigger points by placing the muscle in a shortened or stretched position for an extended period.

Associated trigger points

The effective treatment of the QL trigger points will also require addressing associated trigger points in other muscle groups as well as correcting lumbopelvic or spinal dysfunction. In acute cases of low back pain, the therapist should include the gluteus medius trigger points in their treatment routine. In chronic cases, the gluteus medius trigger points, gluteus minimus trigger points, gluteus maximus trigger points, and piriformis trigger points will need to be addressed by the therapist.

The quadratus lumborum-gluteus medius/minimus connection

The referred pain from the upper QL trigger point is projected to the gluteus medius and gluteus minimus muscles, and therefore can activate trigger points in these muscle groups (termed satellite trigger points).

The relationship between the trigger points in these muscle groups is so strong, that palpation on the QL trigger points can produce the referred pain associated with the gluteus medius and minimus trigger points.

The quadratus lumborum-gluteus maximus/piriformis connection

Referred pain from the middle or deep QL trigger points may also activate satellite trigger points in the gluteus maximus and piriformis muscles.

The quadratus lumborum-iliopsoas connection

One other trigger point that can be associated with QL trigger point activity is the trigger point in the iliopsoas muscle group. Because both of these muscle groups share a similar function, stabilising the lumbar spine, trigger point induced weakness in one of the muscle groups tends to overload the other muscle group and cause secondary trigger points to develop within it.

Brain scans shows stress can sabotage your diet

As anyone who has ever downed a litre of ice cream after a bad day at the office knows, the stresses of everyday life can sabotage self-control when it comes to diet. But why?

When people are under stress, even at modest levels, tasty food wins out over healthier options because the brain’s signal for taste is “louder” than the intention to eat healthy, according to a new study published in the journal Neuron.

The small neuroscience study of 51 people asked them to choose between foods while they had fMRI brain scans, to see how the decision-making process affected their brains.

Participants were chosen because they expressed interest in maintaining a healthy lifestyle but admitted they sometimes made unhealthy food choices. Researchers aimed to assess how moderate levels of stress, like those encountered in daily life, would affect what people choose to eat, especially when the options were real and not hypothetical; the participants had to eat one of the foods they selected following the test.

Researchers approached the study with the idea that a delicious but less healthy food was an immediate reward, whereas a healthier food is a long-term reward because while it may not be as enjoyable to eat now, it benefits lifetime wellness.

Before they began, the participants were asked to rank the foods as tasty or healthy so that researchers knew their individual taste preferences and could make contrasting pairs based on those rankings.

Then participants were split into two groups: 29 of them were put under the mild stress of having to submerge their hand in an ice-water bath while being videotaped in the lab before the test; the other 22 were the control group.

Brain activity was monitored in an fMRI machine while participants were shown pairs of pictures of different foods and asked to choose between them. In some cases, the healthier food was outlined in a white frame to indicate that it was “recommended,” to see if participants would be more likely to choose it.

fMRI image shows areas of the ventral striatum (upper) and amygdala (lower). Stressed participants’ food choices were more affected by short-term taste reward and they encoded taste more strongly in portions of the amygdala and ventral striatum.

The fMRI images showed three different regions of the brain were activated and the relationships between the regions changed during the time participants had to select foods.

Those who experienced the stress of the ice-water bath went for the tasty food choices more often than healthy ones, especially when the difference between the foods was greatest.

“Stress participants are struggling most and are most likely to fail when their temptation gets really, really high in terms of taste,” said Maier. “If two items are rather close together in terms of taste, then they would rather go with the healthier one.”

Current theories connect cortisol, a hormone which increases with stress, to the problem of stress eating. In this study, it showed only a partial link to food choices for people who were part of the stress group.

The way to get around this wiring for choosing what tastes good over what’s healthier, is planning. If you know you have a stressful day and you come home, sooner or later you will make the trip to your kitchen cupboard and get that snack. Instead, you can just not buy it in the first place and not tempt yourself.

Reference:

Maier, S. U., et al., Acute Stress Impairs Self-Control in Goal-Directed Choice by Altering Multiple Functional Connections within the Brain’s Decision Circuits. Neuron, 2015. 87 (3): p. 621-31.

The benefits of inflavonoid intensive care

Inflavonoid Intensive Care is a unique formula to relieve acute inflammation, developed after long studies and research by a team of health care experts which includes scientists, researchers, and naturopaths.

Inflammation is characterised by pain, heat and swelling.

Positive benefits of controlling chronic inflammation:

  • Digestive health
  • Improved immobility
  • Reducing pain caused by arthritis
  • Improved health and vitality

Positive outcomes of Inflavonoid Intensive Care:

  • As affective as NSAIDs
  • Gut friendly
  • Liver friendly
  • Safe for long term use

The ingredients in Inflavonoid Intensive Care work at various points within the inflammatory cascade to decrease inflammation and pain via the following:

  • Boswellia prevents 5-lipoxygenase (5-LOX).
  • White willow bark prevents prostaglandin synthesis by inhibiting cyclo-oxygenase (COX-2) mediated prostaglandin release shown in vitro.
  • Ginger suppresses prostaglandin synthesis through inhibition of COX and LOX.
  • Quercetin prevents the activation of NF-ƙB demonstrated in vitro studies.
  • Volatile oils, naturally found in BCM-95™ Turmeric, contribute to its effect.

These oils show antiinflammatory activity with ability to stick to the nuclear receptor, perisome proliferator-activated receptor γ (PPARγ), prevent prostaglandin E2 (PGE2) production and prevent inducible nitric oxide production during the inflammation process. To maximise the benefits of Inflavonoid Intensive Care, a unique extract of boswellia, turmeric, and ginger are added.

Inflavonoid Intensive Care is for people who experience strain, a high work load or stress, inflammation and pain. Taking Inflavonoid Intensive Care daily will reduce inflammation and pain. It can also help to boost energy and help following intense exercise or “weekended warrior syndrome”.

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