I must admit I have thought about writing an article like this about the Quadratus Lumborum (QL) and Psoas muscles for a very long time but have avoided it, for I was afraid it would take me too far down the rabbit hole of confusion and contradictory conclusions that make absolutely no sense. However, I have come across problems with this muscle several times recently when working with various people with hip problems or those that have tried to execute the complex multi-joint exercises I have been using a lot and thought I should try to explain why this happens, and more importantly what you can do about it. To make this easier to understand and also minimize the length of the article I have split this into two parts with part one about the QL and part two about the psoas. They really work together to create stability of the spine during movement although they are often misunderstood and trained as prime moving muscles. The QL helps form the lateral stabilizing system needed for walking and single leg stance whereas the psoas allows the hip to flex without damaging the spine. There is no doubting they are very unique muscles and when you understand their purpose it is easier to determine what exercises work best and how to prevent problems from occurring.

The QL is very prone to shortening and becoming a tight over-working muscle and is often exposed to injury and pain as a reaction to dysfunction occurring elsewhere in the body, usually weakness with the pelvis, hips, and feet. This is a common problem often seen with people who have a lateral pelvic tilt, scoliosis or those suffering with sacroiliac joint dysfunction and extension related back pain. In all of these cases there is a common denominator at large with weak glutes and hip stiffness.

Trigger point release is often used successfully with muscles that are short and tight in other areas of the body but this is very difficult to do with the QL due to the muscle being located deep within the body. Stretching is also not very effective and can even aggravate the problem so you have to attack this in a different way.

The most logical method to use and get the muscle back to its optimal length is by addressing poor stabilization and mobility deficits around the pelvis and thoracic rib cage that are causing the problem in the first place. However, this can get really messy and confusing so I will look at all the factors that you need to consider and how you can go about restoring this muscle back to normal.

Where Is The Quadratus Lumborum and What Does It Do?

The quadratus lumborum is a deep trunk muscle. That means it is located below other muscles. In the case of the quadratus lumborum, it is found under the lats and paraspinals. The quadratus lumborum helps to make a side bend and extension motion of the low back but like many other muscles of the trunk its main feature is with resisting these motions.

In Dr Stuart McGill’s book “Lower Back Disorders” on page 62 he notes that during EMG testing of this muscle hardly changes length during any spine motion suggesting that it contracts virtually isometrically!

They performed an experiment where they had people stand upright with a bucket held in one hand. They gradually increased the load in the bucket and observed the muscle activation of the QL and obliques and found they both increased their activity each time more load was added even though the body did not move.

They concluded that this muscle is highly involved with stabilization of the spine as opposed to providing movement which is very similar to the role of the abdominal stabilizers and the psoas muscle. This gives you a few clues as to why it is repeatedly strained or injured.

There are two ways most people experience pain with the QL.

1. The first and most common is due to compensation and becoming a tight over-working muscle causing trigger points and spasms. While the QL is able to extend, side bend, and provide rotation of the trunk, it is more concerned with stabilization and preventing these motions than being a prime mover muscle and creating them.
2. The second is when the muscle is lengthened or strained when it is overstretched as seen in sports like cricket or golf where someone overextends their back too quickly. For the everyday person this is not as common but is definitely a factor at times.

Compensation with the QL is seen easily when someone has a walking dysfunction like lateral pelvic tilt that forces the body to either tilt or rotate to one side constantly, creating either compression or lengthening on either side of the body. One side is compressed and overworking, while the other is over-stretched and weakened. A chain reaction of compensation throughout the body occurs.

Any movement that requires rotation or side bending can be a real problem, but worse than that is any activity that needs to resist rotation and side bending is also a problem.

See picture below and the video to the right explains how this works in more detail.

Trying to address the muscle itself with stretching or trigger point release is pointless for it is a reactionary muscle responding to problems caused elsewhere. Trying to strengthen the weakened side in isolation will also create problems.

So what should you do? The first thing you should do is look for postural clues.

Determine What Type Of Posture You Have

Performing a postural assessment always provides me with several clues before I do anything else and should be the first thing on your list to do. You can read this article to see more about how to do this – Posture is everything when working with chronic pain

The scoliosis posture seen below gives a clear visual of this where weakness on one side forcing excessive curvature of the spine on one side and an uneven pelvis which is the most obvious assumption.

However, it is not limited to lateral pelvic tilt and scoliosis as this same problem can occur in other posture types. If you have weak and lazy glutes but good hip mobility you will find the body collapses on one side forcing the QL into the reaction of trying to stabilize the spine.

A person with excessive anterior tilt and the over-dominating hip flexors inhibiting the glutes from firing as seen in the lordosis and kyphosis posture below will often have very weak glutes and experience extension related back pain problems and SIJ dysfunction. This leads to back muscles that are extremely rigid and tight making rotational movements robotic and exposing the QL to be compressed.

The other postures can also exhibit weak glutes but these are often very tight and restricted leading to problems with hip extension and over-active hamstrings. This person will often have a stiff leg and fall out to the other side. This is common to the butt gripper and the person stuck in a posterior tilt of the pelvis as seen in the flat back and sway back posture below.

See the picture below to see examples of these postures.

In all these cases there is known weakness with the glutes and muscles supporting the pelvis but the approach you need to take will be slightly different to begin for each. Some will respond better to more stabilizing exercises to gain more control whereas others like the flat back will need more mobilizing to allow better positioning. Exercises like the hip thrust will be great for the anterior tilt but cause a stack of trouble for the posterior tilt flat back person even though they both need strengthening.

If you skip this stage and go straight to strengthening you risk creating more problems.

Restoring Functional Strength To The GLUTES Is The Key

While the core muscles are a big part of the equation they will very easily be sacrificed if the prime moving muscles of the glutes and hips are not working correctly. Tight hip muscles greatly inhibit the glutes from firing and compensation is the end result. 

When the glutes become weak or inhibited, the chances of other muscles like the QL to compensate increase. The most impaired movement pattern is seen with a hip hiking action during the swing phase of walking when the QL initiates the movement. Hip hiking places excessive side-bending compressive stresses on the lumbar segments.

Mobility and stability problems can exist at the same time but which one do you focus on first. The big mistake many people make is to try and work on the stability problems first before improving mobility. True functional stabilization will not be achieved while there is a mobility restriction present which is why you must address your mobility problems first.

The glutes really are the key to everything, for weakness with this muscle group sets off a chain reaction of compensation that can be very difficult to restore. Weakness with the glutes and a lack of mobility at the hips will continue to force the QL to react to lateral flexing or exacerbating spinal instability when you move so you must use several exercises to correct this.

The video below shows you how I might assess the strength and function of the glutes and gradually progress to more difficult movements using a series of stretches, stability drills, and strengthening exercises.

There are a wide variety of glute exercises and I like to try and use several that hit the muscles at different angles and positions to ensure I increase the chances of working effectively. Some people restrict their thinking to only one or two exercises whereas I will use several different actions. You can read about these in more detail in the article – Analysing pros and cons of the 15 best glute strengthening exercises

This is where it gets really confusing for the same weakness will cause different types of compensations.

A person with excessive anterior tilt in a single leg stance that has weak and lazy glutes you will see the body collapse to the inner side of the body as the glutes do not have the strength to maintain the level position of the pelvis and prevent it from dropping. The QL has no choice but to react and try to pull the pelvis upwards. This means that this type of QL reaction will benefit from a variety of glute strengthening exercises that encourage some degree of stiffness such as the hip thrust.

Whereas the opposing person with a posterior tilt and flat back or sway back in a single leg stance will present with stiff and tight glutes that often force the body to side flex but usually to the outside of the body. This person often tries to use their knees with all hip loaded movements as the glutes are so restricted.

If you try to force hip movement with this person without addressing the mobility first you will usually see a stiff leg that locks out the knee and it almost looks like the person is pole vaulting themselves as they walk and their body falls out to the side. This person will benefit from more mobilizing type exercises at first and anything that forces the glutes to lengthen the fibres as opposed to contraction as seen with the hip thrust.

You can read more about hip mobility ideas in this article – 10 ways to improve hip mobility

I must state that these are all generalisations and there are exceptions to these rules all the time but from experience these are the common mistakes I see that show how the compensations will differ depending on the postural type. The more information you can gather as to how you are moving the more precise your exercise selection will be.

The Romanian deadlift is the key in ALL cases but far more beneficial to the posterior tilt person in the beginning for its mobilizing effect. Later on the single leg Romanian deadlift exercises will be more beneficial for the anterior tilt person for the strengthening effect.

Don’t Ignore The Role Of Foot Stability

This is an area that is all too often ignored but could be the very cause of all the trouble.

One of the most interesting features of the hip and the core is its close relationship with what happens at the feet! I wrote a very detailed article explaining this earlier this year – How weak feet create weak glutes

The two videos below give you a good explanation and examples of this in action.

In the book “Barefoot Strong” by Dr Emily Splichal she explains how there are 2 ways in which the feet and core are connected during movement.

1. Co-activation patterns
2. Fascial integration

Co-activation means that the firing of one muscle leads to a simultaneous firing of another muscle. It could be a muscle right next to the one firing or a muscle further up the kinetic chain. The reason the body does this is to improve stability of the body for more efficient movement.

Fascial integration is where the body uses fascia to connect various muscles together in one big chain known as a myofascial sling. These slings when they are working well, help us move efficiently, produce more force, and create more speed. They help integrate the small stabilizer muscles of the core together with the large prime mover muscles that coordinate movement.

As you will see shortly exercises that utilize the slings are a big part of restoring function to the QL.

Proper big toe function ensures that you will be able to engage your glute muscles effectively.

But how does this work exactly?

Within milliseconds of your foot touching the ground it sends a signal to the hip to prepare for single leg stability. Any delay in hip stability will result in poor leg alignment which can result in knee problems, ankle sprains and various hip injuries.

The feet drive the reflex stability of the hip and in particular the big toe acts as the catalyst for optimal glute engagement. If you struggle to activate your glutes during walking try to actively dorsiflex your big toe just prior to heel strike as this helps to increase the stiffness of the foot in preparation for impact with the ground.

How do I try to improve this?

Well, there is not one single exercise but several I may use to develop the strength and stability that I need. I may use a combination of foot specific drills and hip activation drills as seen in the videos above. All of this sets the foundation to do the exercises that have a big effect on the glutes and they are the single leg exercises.

Strengthen The Glutes In The Single Leg Stance

This is where you start to put it all together and also where you can see problems appear. 

At first the weakness in this stance is the problem but once the skill and strength is achieved it can almost fully eliminate the problem. However, if you over-train the legs with either too much load, or too much frequency you will go back to where you started! There is a fine line between addressing the weakness and creating too much fatigue which brings on stiffness. Finding the balance is the key.

The single leg deadlift is the ultimate glute and hip strengthening exercise as it needs to stabilize the hip, act as a hip rotator, and lock the head of the femur into the socket. All of this creates a very tight and stable hip joint during the single leg stance which prevents the ball and socket joint from rattling around during walking and running and it prevents the lateral pelvic tilt causing all of the problems to the QL.

Unfortunately, it requires a high degree of skill and strength to get it right. I might use simpler versions like the Toe Touch Drill first before using any loaded strength exercises to ensure the skill and posture is up to the task.

Watch the videos below to see examples of these.

If you can get the hang of these exercises you are well on the way to restoring the strength and function to the hip and preventing the QL from being strained.

You can read more about this exercise in the article – 6 single leg deadlift progressions to improve hip stability and strength

What About Strengthening The Core?

There is no doubting that using exercises to strengthen the core will help but you must keep in mind that some exercises can be problematic in the beginning for it may exacerbate the QL which is already overworking. This is why you need to address mobility restrictions and weakness of the hips first and then gradually introduce the core loaded exercises second.

The video below discusses several exercises that utilize the obliques and the QL.

I tend to favour exercises that still move the arms and legs to force the core to act as an anti-movement muscle which is exactly what the QL is designed to do. Having said that I don’t begin with those exercises as they can be too difficult at first and use simpler exercises first such as side planks and the Pallof press.

Starting with the side plank this is a great exercise for the unique position allows it to activate the lateral oblique and (QL) muscles on only one side of the body, making it an excellent choice for addressing weak links in stability. It also has quite a high degree of lower abdominal activation which many people are not aware of.

Secondly, while the muscle activation is quite high it places minimal forces on the spine. As the spinal loads are minimized it makes for a perfect exercise to use in the early stages of rehabilitation when pain sensitivity is quite high making it hard to use more functional based movements.

Thirdly, it also engages an important stabilizer of the hip/pelvis on the lateral hip being the glute medius which is regularly linked to problems of the hip and lower back. This is particularly useful with problems like lateral pelvic tilt where there is a significant weakness on one side of the body.

The only problem with this is it can sometimes be too aggressive especially on the side that is over-worked so I might use other exercises to minimize this.

The Pallof press in this case might be a much better choice as you can distribute some of the load away from the area in pain but still have this anti-flexion feeling about it.

This exercise is usually used with a cable machine or with resistance bands that you hold out in front of your torso while pressing it out and back. This tension pulls you toward the anchor point and your core resists to keep your torso front on. People who experience shearing of the spine will find this type of exercise invaluable as it teaches you how to effectively brace the core while completing movements with your upper body.

I have found this to be quite useful with people who excessively extend their lower back with overhead movements and leg exercises like squats, lunges, and step-ups. This is a common problem seen with people with sacroiliac joint (SIJ) dysfunction and it is a reaction of the spine to the weakness in the glutes. While strengthening the glutes is a big part of correcting the underlying problem having exercises like this to assist the process can be invaluable.

You can read more about each of these exercises in the articles below

• Which version of the side plank is best for the core
• How to use the Pallof press to strengthen the core

While these are both great exercises I will get much more long term benefits from using exercises that feature the use of the slings and arguably the best exercise is the suitcase carry.

Suitcase Carry

If there is one exercise that stands above all others when talking about the QL then the suitcase carry would be it. It exacerbates any weakness that may exist in the hip region forcing the QL to react making it an exercise to treat with caution. Ironically, for that very reason it can also be a game-changer that gets rid of the problem for good if you learn to execute it correctly.

If you have read any of my articles about hip pain you will know I will talk about the suitcase carry a lot for it is such a tremendous exercise for putting all of the parts together into one exercise. The only problem is similar to the single leg exercises in that it can be very difficult to get right so you will have to spend a lot of time with it and maybe use other exercises first.

The glutes help support the pelvis to allow the leg swing and they also extend the hip when you walk. On the other side of the body the QL assists the function of holding up the pelvis to allow the leg swing meaning the glutes and QL of opposing sides work together as a team. The internal obliques stops the pelvis from tilting and controls the twisting action to allow the hip to power leg swing. The external oblique does the same job except in the other direction.

This activates what is known as the lateral sling which is one of the four slings the body uses to create efficient movement. This sling connects the glute medius and glute minimus of the stance leg to the adductors and with the contralateral Quadratus Lumborum (QL). This sling plays a critical role in stabilizing the spine and hip joint in everyday activities like walking upstairs which the person with lateral pelvic tilt has all sorts of trouble with.

This has obvious weakness with almost all back pain sufferers and a program to develop the integration of the inner unit and outer unit is crucial for long term success in getting rid of their pain.

Rotational Movement

The one thing the suitcase carry does not address is rotation and this is another area where things start to get messy and where people start to encounter problems. It would be easy to leave this out and ignore it but at some point it will come back to haunt you so you have to find a way to develop this.

Often I might start with a floor based exercise that is easier to learn how to control the movement as seen in the video below.

This is a great exercise invented by Dr Stuart McGill and features in all of his books relating to back pain. The purpose of this exercise is to teach the abdominal muscles to create a torsional stiffness during rotational movement and prevent the spine from twisting and the hips from compensating. As opposed to the traditional plank exercise that emphasises holding for long periods of time this movement is more concerned how you maintain stability to move. A fantastic exercise for learning how to stabilise effectively first before you move. This is a perfect introduction to the more integrated and complex exercises to come.

This is a lot harder than it appears and many people struggle to get this right when they first try it.

However, the main standing rotational movements are often the missing ingredient to efficient athletic movement.

Once again the stiffness in the hips is a real problem with rotational movements being effectively executed and where the QL is easily aggravated or forced into providing movement when it should be stabilizing. This is also where you start to see the use of the slings become more prominent for they require a rotational movement to be efficiently used. This is what relates to walking, running, throwing a ball and all the things that make us move really well.

If you find this concept hard to digest I have discussed rotation and back pain in great depth many times and you will find this article a great read to get your head around this – Is rotational movement bad for your back?

What Exercises Should You Use?

Most people would assume it would be the wood-chop which although it is a great exercise and builds good rotational strength and movement it is the integrated movements like the single cable pull that works the best.

Once again this is due to the fact that it incorporates activity of all the main factors causing QL compensation in the first place being the weak glutes, weak feet, tight hips, and poor coordination and timing. The main benefit is the use of the slings and in this case the posterior sling. If you have executed the lateral sling with the suitcase carry you should be able to get this right however this can be a bit harder as there are more moving parts to control.

The posterior sling is where the glute max of one hip works with the latissimus dorsi of the opposing side to create tension in the lower back region called the thoracolumbar fascia. The action of these muscles along with the fascial system is to prevent rotation of the pelvis when we walk and enable you to store energy to create more efficient movement. Most of the exercises that use this sling are pulling movements.

Each sling has a corresponding partner on the opposing side and as they both cross the midline they help to connect the upper body with the lower body to either accelerate or decelerate movement. Also it must be stated that this criss-cross connection enhances the stability of the trunk and spine and is why exercises that use these slings are referred to as core strengthening exercises.

To get this right I would start with simple variations and gradually increase to the more difficult version as shown in the videos below.

In my recent article about learning how to use the weight shift method I discussed in great detail why you need to spend time teaching the body how to transfer weight from one leg to the other in succession to eradicate dysfunction with walking.

Stationary unilateral and bilateral exercises are great for building strength into the muscles, but the dynamic moving exercises are the best at reprogramming the nervous system for efficient movement. Unfortunately, they can be difficult to learn so you have to be patient and use a combination of simple and complex exercises to do this.

Read this article to see more – How to develop skill and strength with the weight shifting method

Do You Need More Help?

If you have back pain and have seen a health professional for a diagnosis and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process! For more information you can watch a quick trailer video of what is included. 

Click here or on the image below to get a copy.

Summary

I apologize for the length of this article and you can see why I decided to break this up into two parts.

The main thing to understand is that the QL is a reactionary muscle that is forced to act and respond to a pelvis that drops from weaknesses created elsewhere. Trying to either release or strengthen this muscle on its own is very risky and pointless for it is not really the problem. When it is working at its best it performs a stabilizing isometric contraction as opposed to a role of actually moving the body. This means the best exercises to maintain its function and strength need to have this approach such as the suitcase carry and single leg exercises.

Learning to develop dynamic actions that use multiple joints that mimic the action of walking will go a long way to preserving the strength of the hips and avoid making the QL react to dysfunction.  

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 19 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• The Gift Of Injury - By Dr Stuart McGill and Brian Carroll
• Functional Patterns
• 8 Steps To Pain Free Back - By Esther Gokhale
• The Vital Glutes - By John Gibbons
• Movement - By Gray Cook
• Corrective Exercise Solutions - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Knee Injuries In Athletes - by Sports Injury Bulletin
• The ACL Solution - by Robert G Marx
• Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek