I must admit I have thought about writing an article about the Quadratus Lumborum (QL) and Psoas muscles for a 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 with people suffering with hip problems and also when people tried to execute the complex multi-joint exercises I have been using a lot, so I thought it would be a good idea to 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 major. 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 Exactly Is The QL 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 QL, it is found under the lats and paraspinals. The QL 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
“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.
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.
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 will also create problems.
So what should you do?
Determine What Type Of Posture You Have
Performing a postural assessment always provides me with lots of information and should be the first thing on your list to complete to give you a starting point. It can give you some clues as to where the hidden problems are.
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 shown above.
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 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. In some cases this may be all I need to do, but with the person who has suffered with QL problems for a long time it will not be enough.
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
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 generalizations 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!
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.
- Co-activation patterns
- 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 video below.
I also suggest to read the article – How to strengthen weak feet for more ideas
Single Leg Exercises
This is where you start to put it all together and also where you can see problems appear.
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 Hip Airplane first before using any loaded strength exercises to ensure the skill and posture is up to the task.
Watch the video below to see example of this.
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.
What About Core Exercises?
here is no doubting that using exercises for the core will help but you must keep in mind that some exercises can be problematic in the beginning for it may tighten up something that is already overworking such as the side plank.
I tend to favor 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.
Watch the videos below to see how to do the side plank
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.
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 as it can flare up any existing problems.
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.
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 Rotation 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 I find 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 mid-line 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 video shown above.
It is important to use exercises like these to teach the body how to transfer weight from one leg to the other in succession to eradicate dysfunction with walking. Basically making walking more efficient.
The video below gives you several examples of doing this.
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.
Do You Need More Help?
If you currently have back pain I suggest seeking some help from a respected therapist or trainer before trying any of the following exercises. You might need to spend some time with simple exercises to ensure you can activate your inner unit stabilizer muscles. Often these muscles are very lazy or respond too slowly for people with back pain exposing their spine to loads.
You will find exactly how to do this in our Back Pain Secrets PDF book or 90 minute online video where I take you through a series of detailed assessments, and a step by step process for addressing the cause of your pain.
Click here to download this online.
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.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Functional Anatomy of the Pelvis and the Sacroiliac Joint – 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
•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