Quadratus Lumborum Manual Static Release

Differentiation

1. The quadratus lumborum (QL) is a deep muscle that lies lateral to the transverse processes between the 12th rib and the posterior iliac spine.
2. Unlike the muscles of the abdominal tourniquet or the more superficial latissimus dorsi which blends with the thoracolumbar fascia, the QL has a defined lateral border 3 - 4cm from the spinous processes of the lumbar spine.
3. With your patient in prone, ask them to adjust their clothing to reveal the lumbar region of their back. (With a little practice this technique may be performed through clothing.)
4. Place the blade of one hand (the 5th metacarpal) on the 12th rib, and the blade of the other hand on the posterior iliac crest. This will establish the cranial and caudal borders of your palpation zone.
5. Starting with your thumbs several inches from the spine, depress the thumbs 1 - 2 cm into the tissue of the back.
6. Gently glide your fingers from lateral to medial, attempting to identify a defined lateral border.
7. Although the fibers of the QL have a gentle obliquity from inferolateral to superomedial; this lateral approach will result in the QL fibers feeling as if they are vertically oriented.

Potentially Sensitive Tissues

• The only muscle deeper than the QL , when palpating from the posterior side, is the psoas (which is palpated through the abdominal wall). Some care must be taken to avoid unnecessary pressure to the nerves of the lumbar plexus and the viscera (specifically the kidneys).

Trigger Points

• Common trigger points in the QL occur at the "base" of the muscle, just superior to the sacroiliac joint, and in the middle of the muscle adjacent to L2 - L4.

Release Technique

1. With your patient in prone, ask them to adjust their clothing to reveal the lumbar region of their back. (With a little practice this technique may be performed through clothing.)
2. Place the blade of one hand (the 5th metacarpal) on the 12th rib, and the blade of the other hand on the posterior iliac crest. This will establish the cranial and caudal borders of your palpation zone.
3. Starting with your thumbs several inches from the spine, depress the thumbs 1 - 2 cm into the tissue of the back.
4. Gently glide your thumbs from lateral to medial with the intent of identifying a lateral border.
5. To identify taut bands is will be necessary to use short strokes, assessing a few fascicles at a time. Because of the depth of the QL , attempting to glide across the entire muscle in one stroke will result in gathering too much tissue and uncomfortable local tissue stretch.
6. Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied. Generally, "bowing" the fibers with some lateral to medial force will aid in "pinning" the nodule.
7. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).