Name: Quadratus Lumborum Manual Static Release
Uploaded: 2023-04-26T00:59:50.000Z
Duration: 13 min 14 s

English captions

https://stream.mux.com/yoHj2lA8fwFGxDN2d2rX4MNTWCfkQJYaWhoPSilXa68.m3u8

Learn the proper technique for quadratus lumborum static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this step-by-step instructional video from the Brookbush Institute. This evidence-based course provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to alleviate quadratus lumborum over-activity and trigger points, alleviate tension in the low back, and improve lumbopelvic stability. Ideal for clinicians and movement professionals, including physiotherapists, athletic training students, licensed massage therapists, and chiropractors, seeking to enhance their manual therapy skills for spinal health, rehabilitation, and performance.

Introduction to Quadratus Lumborum Release Techniques

Understanding the Quadratus Lumborum and Indications for Release

Palpation Techniques for the Quadratus Lumborum

Identifying Trigger Points and Applying Pressure

Practical Application of Manual Release Techniques

Assessment and Collaboration in Manual Therapy

Quadratus Lumborum Manual Static Release

This is Brent, President of the Brookbush Institute, and in this video we're going over a quadratus lumborum, or QL static manual release. Now, if you're watching this video, I assume that you're watching it for educational purposes and that you are a licensed manual therapist. That means following the laws of scope of practice in your state, you are allowed to do manual release techniques- chiropractors, athletic trainers, physical therapists, massage therapists, osteopaths. I'm sure I'm forgetting somebody, but nonetheless, you're following your scope of practice. Personal trainers, this video probably does not apply to you, but you could potentially do this with your peers or any learning environment to help you with your functional anatomy knowledge. I'm going to have my friend, Sonja, come out. She's going to help me demonstrate this technique. Notice that she starts face down so I can access her quadratus lumborum. Before I would have Sonja even begin to lie down so I could do this technique, I would be 80% sure that her quadratus lumborum is involved in this technique. If I'm going to put my hands on somebody, I want to know that her QL is potentially causing things like an asymmetrical weight shift, or maybe it's related to something like some sacroiliac joint pain, or maybe I've seen some other dysfunction of her lumbo-pelvic hip complex or lumbo-thoracic spine that make me believe putting my hands on her is warranted and that quadratus lumborum release is going to help her with whatever compensation or patient complaint she's having. Now, all of our manual release techniques follow a very similar protocol that basically comes down to palpate and compress. But to get a little bit more detail than that, we do need to know how to palpate this muscle. We get bonus points for knowing where the trigger points are. I would start studying trigger point maps. They definitely help you with your hand placement and finding those overactive tissues. We want to be aware of anything around the tissue that we're palpating that may be insulted or irritated by pressure. In the case of the quadratus lumborum, we do have to consider that it is a deep muscle, and on the other side of that is the viscera, specifically the kidneys. And last, we do have to think about what is the best position for us to actually palpate and release this muscle. It's not just about patient comfort. Most therapists I see are great about making their patients comfortable. It is also about your comfort, so make sure that you are in a position- hopefully you have a high-low table or have access to a table that does adjust- so that you can use your body weight and your leverage and not just grip strength to actually get these releases. We don't want anybody's career ending early because their hands wore out. So, to get to this muscle, I'm going to have Sonja lift her shirt up so that her belly's exposed and her back's exposed. I'm just going to go ahead and tuck this right up underneath her sports bra here, so it stays out of the way. Sonja, do you mind if I move your pants here? So, what I'm going to do with her waistband, guys, is I'm just going to put it right up over- I'm going to tuck it under- I'm going to put it right up over her posterior iliac spine. This is this is kind of convenient for what I'm showing you guys on film here, because I have her 12th rib right here, and then I have her posterior ilium, and right between that is her quadratus lumborum. The only thing we have to think about now is this is a deep muscle. So, how do I differentiate this muscle from all the muscles that are on top of it, and also make sure that I'm not going so deep I'm just poking on her kidneys? I don't think Sonja came in here to get her kidneys poked on. So, what I would suggest is if you put the borders of your hands on the 12th rib and the posterior ilium, you start almost all the way on their side. Alright, so we're, maybe, just a couple inches from the most lateral border of their waistline, and then you dig in just a little bit and apply pressure toward their spine, so lateral to medial here. Unlike your transverse abdominis, external and internal obliques that wrap all the way around, your quadratus lumborum will have a defined lateral border. I found it right there, so now I got a nice lateral border, and I can follow that border from 12th rib to posterior ilium, maybe just for palpation skills purposes. But then when I actually want to start looking for trigger points and doing some release, we do have a little problem in our technique. You know we can't just do those medial to lateral or lateral to medial strums we've done on some of the other muscles to find the tightest fascicle. What you guys are going to have to do is start at the lateral border, pick up your fingers, and then move them in a little bit, strum a few more fibers, move them in a little bit, and strum a few more fibers. So, I'm kind of like walking my hands in towards her lumbar spine rather than just these these broad strums I did before. It's the same basic concept. You're just going to find that if you try to strum this deep, you're going to get caught in tissue. I notice there's a nice, tight fascicle there. Once I find this nice, tight fascicle, I'm going to move either cranially or caudally, either towards her head or towards her tail to see if I can find if these tight fascicles are associated with a tight nodule. If I happen to find a tight nodule, just like all of my other techniques, I'm going to lean forward just until that point where I get a little tissue resistance. I always talk about that exponential curve of tissue tension and how we want to kind of be right in the trough. I don't need to push as far as her tissues will let me and find the end of her tissue extensibility locally. All I need to do is push just up to a moderate amount of tension, maybe just past the first resistance barrier. With a little practice, you'll find you need enough pressure to get a release, but apply too much pressure and you'll get so much feedback from the muscles, so much fight from the muscle that you'll never get a release. You want to be right in the middle there. I'm going to hold for 30 to 120 seconds. Ideally, this table would be a little higher. guys I have it a little lower than I probably should- for taping purposes. But if this was a little higher and my arms were at 90 degrees, you'd see that all I have to do is lean forward a little bit to exert pressure. I don't need to man handle her back. I don't have to use my arm strength. We don't want to turn this into a chest press. And then, once I get a release, I can move on to my next trigger point. Now, your trigger points are really easy to find in your quadratus lumborum. Your common trigger points- and you'll see this in our close-up recap- are right in the middle of the length of the muscle and then there tends to be some quadratus lumborum trigger points right over the sacroiliac joint, most often related to sacroiliac joint pain. Alright, so after I did these, I might come down here and do my same palpatory techniques and find those tight tissues. For these, you might have to be at a little bit more of a lateral to medial and posterior to anterior angle. You're just going to hold until you get a release. Now we'll have the close-up recap of our quadratus lumborum, or QL release. You guys will notice I have the trigger points already mapped out here, but they're pretty easy to find even if I didn't have them mapped out. This one tends to be right in the middle of the length of the quadratus lumborum. This one tends to be right over the sacroiliac joint and may be related to sacroiliac joint dysfunction. So, when we look for trigger points for the quadratus lumborum, when we look for those hypertonic fascicles, we are going to go from lateral to medial rather than posterior to anterior, as with the QL we do have to consider what's around the QL. The QL is a deep muscle and on the other side of it is our viscera, specifically our kidneys. I'm not really sure that I want to be applying a lot of pressure to the back of the kidneys, especially if I'm going to do this over and over again over several sessions, or if I'm going to ask my patient to follow this up with a home exercise program that includes QL release. I'm not sure what that pressure over time would do to my kidneys. I'm going to go ahead and take my hands and place the borders of my hands kind of on her posterior ilium and her 12th rib so I know where I am. And then, I'm going to use my thumbs to kind of brush over, using my lateral to medial strumming to find the tightest fascicles, just like I have with all my other muscles. I think with this muscle you guys will notice that since it's deep to things like my latissimus dorsi, my transverse abdominis, and even to some of the fibers of the internal obliques, we're going to have to kind of pick up our fingers here as opposed to being able to do this type of strumming, which we've done with other muscles. All I'm going to do is strum more superficial muscles if I do that. in this case, in this particular instance, we're going to want to find that lateral border of the QL by going from lateral to medial, and then picking up our fingers and slowly going over those fascicles until we find ones that feel abnormally dense, abnormally tense. Once I find them, then I can move proximal to distal, or in this case superior to inferior, inferior to superior. I found a nice little nodule right there. So, to increase pressure, I'm just going to- I have my elbows at about 90 degrees- I'm just going to lean forward, applying pressure towards the lumbar spine until I get that little give back from the tissues. Remember, if if tissue tension is mapped on a graph, it kind of goes through an exponential curve. I want to go right up to the point where the tissue tension starts to increase. I don't want to go beyond that. We could say go just past the first resistance barrier, but we don't need to go to maximal tension in these tissues. If you push too hard, you'll get so much activity back that you'll probably never get a release. I'm going to hold this for 30 to 120 seconds until I feel a release, a reduction in tension, or my fingers start to sink into the tissue a little easier. These are all signs that you've gotten a successful release. Once I have gotten a successful release, I could move on and see if I also have trigger points just above the sacroiliac joint, or I could move on to my next muscle. You guys have it- a static manual release of the quadratus lumborum, the QL, a great technique to have in your bag of tricks. This muscle does tend to follow the activity of the erector spinae when it comes to dysfunction and movement impairment. It is one of those muscles that can be problematic and can be a source of increased tension, nociception, and possibly pain, so you want to make sure that as you're going through your assessments for those with chronic low back pain that the quadratus lumborum is somewhere in the back of your head. Now, as with all of these techniques, guys, make sure you start with assessment before you do any manual technique. And before you do a manual technique on a patient, you should probably gather a colleague, grab one of your mentors, especially if you can grab another manual therapist and do some practicing. Nothing takes the place of live education when it comes to manual techniques and/or the mentorship of a manual therapist who can give you feedback. Having something like a study group or having a bunch of manual therapists get together and practice these techniques is education that I think can't be replaced and, maybe, should be in all of our repertoires. I look forward to hearing how this particular technique improved your outcomes. I'll talk with you soon. 

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Manual release techniques for the commonly overactive trunk muscles. Soft tissue release techniques for the erector spinae, multifidus, psoas major and iliacus (iliopsoas), and quadratus lumborum (QL). Advanced soft tissue, massage, trigger point palpation, and mobilization techniques to inhibit antagonists. The reliability and validity of manual release techniques for excessive forward lean, anterior pelvic tilt, asymmetrical weight shift, back pain, sacroiliac joint (SIJ) dysfunction, and lumbopelvic hip complex dysfunction (LPHCD).

Static Manual Release: Trunk Muscles (for Lumbo Pelvic Hip Complex Dysfunction)

 is a deep muscle that lies lateral to the transverse processes between the 12th rib and the posterior iliac spine.

Unlike the muscles of the abdominal tourniquet or the more superficial 

 which blends with the thoracolumbar fascia, the 

 has a defined lateral border 3 - 4cm from the spinous processes of the lumbar spine.

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.)

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.

Starting with your thumbs several inches from the spine, depress the thumbs 1 - 2 cm into the tissue of the back.

Gently glide your fingers from lateral to medial, attempting to identify a defined lateral border.

 have a gentle obliquity from inferolateral to superomedial; this lateral approach will result in the 

 fibers feeling as if they are vertically oriented.

 , when palpating from the posterior side, is the 

 (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).

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

Gently glide your thumbs from lateral to medial with the intent of identifying a lateral border.

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 

 , attempting to glide across the entire muscle in one stroke will result in gathering too much tissue and uncomfortable local tissue stretch.

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.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Quadratus Lumborum Manual Static Release

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