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Quadratus Lumborum Manual Static Release
Quadratus Lumborum Manual Static Release is a soft tissue therapy designed to help restore normal range of motion to the low back and hip region. This treatment addresses muscle adhesions in the Quadratus Lumborum muscle (QL) which can cause pain, limited mobility and potential spinal instability. Through manual palpation techniques and gentle, progressive stretching, Manual Static Release can help lengthen the QL muscle and reduce any discomfort. By helping to restore normal movement and tissue length,
Transcript
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This is Brent, President of the Brookbush
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...blank
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Institute, and in this video we're going
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over a quadratus lumborum, or QL static
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manual release. Now, if you're watching
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this video, I assume that you're watching it
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for educational purposes and that you are a
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licensed manual therapist. That means
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following the laws of scope of practice
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in your state, you are allowed to do
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manual release techniques- chiropractors,
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athletic trainers, physical therapists,
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massage therapists, osteopaths. I'm sure I'm
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forgetting somebody, but nonetheless, you're
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following your scope of practice.
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Personal trainers, this video probably
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does not apply to you, but you could
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potentially do this with your peers or
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any learning environment to help you
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with your functional anatomy knowledge.
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I'm going to have my friend, Sonja, come
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out. She's going to help me demonstrate
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this technique. Notice that she starts
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face down so I can access her quadratus
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lumborum. Before I would have Sonja even
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begin to lie down so I could do this
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technique, I would be 80% sure that her
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quadratus lumborum is involved in this
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technique. If I'm going to put my hands
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on somebody, I want to know that her QL
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is potentially causing things like an
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asymmetrical weight shift, or maybe it's
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related to something like some
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sacroiliac joint pain, or maybe I've seen
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some other dysfunction of her
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lumbo-pelvic hip complex or lumbo-thoracic
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spine that make me believe
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putting my hands on her is warranted and
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that quadratus lumborum release is going
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to help her with whatever compensation
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or patient complaint she's having. Now,
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all of our manual release techniques
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follow a very similar protocol that
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basically comes down to palpate and
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compress. But to get a little bit more
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detail than that, we do need to know how
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to palpate this muscle. We get bonus
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points for knowing where the trigger
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points are. I would start studying
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trigger point maps. They definitely help
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you with your hand placement and finding
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those overactive tissues. We want to be
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aware of anything around the tissue that
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we're palpating that may be insulted or
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irritated by pressure. In the case of the
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quadratus lumborum, we do have to
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consider that it is a deep muscle, and on
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the other side of that is the viscera,
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specifically the kidneys.
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And last, we do have to think about
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what is the best position for us to
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actually palpate and release this muscle.
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It's not just about patient comfort. Most
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therapists I see are great about making
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their patients comfortable. It is also
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about your comfort, so make sure that you
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are in a position- hopefully you have a
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high-low table or have access to a table that
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does adjust- so that you can use your
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body weight and your leverage and not
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just grip strength to actually get these
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releases. We don't want anybody's career
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ending early because their hands wore
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out. So, to get to this muscle, I'm going
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to have Sonja lift her shirt up
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so that her belly's exposed
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and her back's exposed. I'm just going to
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go ahead and tuck this right up
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underneath her sports bra here, so it
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stays out of the way. Sonja, do you mind if I
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move your pants here? So, what I'm going
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to do with her waistband, guys, is I'm
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just going to put it right up over- I'm
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going to tuck it under- I'm going to
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put it right up over her posterior iliac
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spine. This is this is kind of
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convenient for what I'm showing you guys
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on film here, because I have her 12th rib
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right here, and then I have her
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posterior ilium, and right between that
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is her quadratus lumborum. The only
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thing we have to think about now is this
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is a deep muscle. So, how do I
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differentiate this muscle from all the
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muscles that are on top of it, and also
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make sure that I'm not going so deep I'm
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just poking on her kidneys? I don't think
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Sonja came in here to get her kidneys
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poked on.
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So, what I would suggest is if you put
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the borders of your hands on the 12th
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rib and the posterior ilium, you start
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almost all the way on their side. Alright,
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so we're, maybe, just a couple inches from the
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most lateral border of their waistline,
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and then you dig in just a little bit
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and apply pressure toward their spine, so
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lateral to medial here. Unlike your
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transverse abdominis, external and
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internal obliques that wrap all the way
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around, your quadratus lumborum will have
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a defined lateral border. I found it
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right there, so now I got a nice lateral
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border, and I can follow that border from
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12th rib to posterior ilium, maybe just
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for palpation skills purposes. But then
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when I actually want to start looking
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for trigger points and doing some
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release, we do have a little problem in
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our technique. You know we can't just do
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those medial to lateral or lateral to
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medial strums we've done on some of the
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other muscles to find the tightest
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fascicle. What you guys are going to have
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to do is start at the lateral border,
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pick up your fingers, and then move them
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in a little bit, strum a few more fibers,
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move them in a little bit, and strum a few
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more fibers. So, I'm kind of like walking
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my hands in towards her lumbar spine
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rather than just these these broad
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strums I did before. It's the same basic
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concept. You're just going to find that
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if you try to strum this deep, you're
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going to get caught in tissue. I notice
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there's a nice, tight fascicle there. Once
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I find this nice, tight fascicle,
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I'm going to move either cranially or
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caudally, either towards her
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head or towards her tail to see if I
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can find if these tight fascicles are
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associated with a tight nodule. If I
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happen to find a tight nodule, just like
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all of my other techniques, I'm going to
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lean forward just until that point where
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I get a little tissue resistance.
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I always talk about
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that exponential curve of tissue tension
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and how we want to kind of be right in
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the trough. I don't need to push as far
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as her tissues will let me and find the
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end of her tissue extensibility locally.
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All I need to do is push just up to a
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moderate amount of tension, maybe just
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past the first resistance barrier. With a
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little practice, you'll find you need
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enough pressure to get a release, but apply too
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much pressure and you'll get so much
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feedback from the muscles, so much fight
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from the muscle that you'll never get a
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release. You want to be right in the
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middle there. I'm going to hold for 30 to
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120 seconds. Ideally, this table
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would be a little higher. guys I have it
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a little lower than I probably should-
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for taping purposes. But if this was a
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little higher and my arms were at 90
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degrees, you'd see that all I have to do
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is lean forward a little bit to exert
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pressure. I don't need to man handle
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her back. I don't have to use my arm
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strength. We don't want to turn
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this into a chest press. And then, once I
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get a release, I can move on to my next
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trigger point. Now, your trigger points
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are really easy to find in your
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quadratus lumborum. Your common trigger
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points- and you'll see this in our
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close-up recap- are right in the middle of
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the length of the muscle and then there
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tends to be some quadratus lumborum
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trigger points right over the sacroiliac
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joint, most often related to sacroiliac
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joint pain. Alright, so after I did these,
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I might come down here and do my same palpatory
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techniques and find those tight tissues.
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For these, you might have to be
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at a little bit more of a lateral to
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medial and posterior to anterior angle.
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You're just going to hold until you get a release. Now we'll have the
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close-up recap of our quadratus lumborum,
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or QL release. You guys will notice I
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have the trigger points already mapped
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out here, but they're pretty easy to find
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even if I didn't have them mapped out.
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This one tends to be right in the middle
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of the length of the quadratus lumborum.
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This one tends to be right over the
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sacroiliac joint and may be related to
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sacroiliac joint dysfunction. So, when we
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look for trigger points for the
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quadratus lumborum, when we look for
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those hypertonic fascicles, we are going
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to go from lateral to medial rather than
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posterior to anterior, as with the QL we
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do have to consider what's around the QL.
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The QL is a deep muscle and on the other
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side of it is our viscera, specifically
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our kidneys. I'm not really sure that I
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want to be applying a lot of pressure to
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the back of the kidneys, especially if
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I'm going to do this over and over again
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over several sessions, or if I'm going to
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ask my patient to follow this up with a
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home exercise program that includes QL
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release. I'm not sure what that pressure
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over time would do to my kidneys. I'm
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going to go ahead and take my hands and
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place the borders of my
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hands kind of on her posterior
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ilium and her 12th rib so I know where
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I am.
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And then, I'm going to use my thumbs to
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kind of brush over, using my lateral to
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medial strumming to find the tightest
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fascicles, just like I have with all my
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other muscles. I think with this muscle
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you guys will notice that since it's deep to
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things like my latissimus dorsi, my
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transverse abdominis, and even to some of
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the fibers of the internal obliques,
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we're going to have to kind of pick up
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our fingers here as opposed to being
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able to do this type of strumming, which
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we've done with other muscles. All I'm
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going to do is strum more superficial
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muscles if I do that. in this case, in
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this particular instance, we're going to
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want to find that lateral border of the
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QL by going from lateral to medial, and
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then picking up our fingers and slowly
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going over those fascicles until we find
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ones that feel abnormally dense,
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abnormally tense. Once I find
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them, then I can move
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proximal to distal, or in this case
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superior to inferior, inferior to
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superior. I found a nice little
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nodule right there.
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So, to increase pressure, I'm just
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going to- I have my elbows at about 90
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degrees- I'm just going to lean
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forward, applying pressure towards the
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lumbar spine until I get that little
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give back from the tissues. Remember, if
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if tissue tension is mapped on a graph,
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it kind of goes through an exponential
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curve. I want to go right up to the point
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where the tissue tension starts to
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increase. I don't want to go beyond that.
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We could say go just past the first
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resistance barrier, but we don't need to go
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to maximal tension in these tissues. If
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you push too hard, you'll get so much
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activity back that you'll probably never
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get a release. I'm going to hold this for
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30 to 120 seconds until I feel a release,
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a reduction in tension, or my fingers start
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to sink into the tissue a little easier.
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These are all signs that you've gotten a
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successful release. Once I have gotten a
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successful release, I could
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move on and see if I also have trigger
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points just above the sacroiliac joint,
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or I could move on to my next muscle. You
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guys have it- a static manual release of
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the quadratus lumborum, the QL, a great
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technique to have in your bag of tricks.
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This muscle does tend to follow the
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activity of the erector spinae when it
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comes to dysfunction and movement
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impairment. It is one of those muscles
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that can be problematic and can be a
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source of increased tension, nociception,
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and possibly pain, so you want to make
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sure that as you're going through your
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assessments for those with chronic low
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back pain that the quadratus lumborum is
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somewhere in the back of your head. Now,
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as with all of these techniques, guys,
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make sure you start with assessment
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before you do any manual
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technique. And before you do a manual
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technique on a patient, you should
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probably gather a colleague, grab one of
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your mentors, especially if you can grab
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another manual therapist and do some
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practicing. Nothing takes the place of
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live education when it comes to manual
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techniques and/or the mentorship of a
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manual therapist who can give you
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feedback. Having something like a study
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group or having a bunch of manual therapists
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get together and practice these
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techniques is education that I think
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can't be replaced and, maybe, should be in
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all of our repertoires. I look forward to
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hearing how this particular technique
00:13:0200:13:04
improved your outcomes. I'll talk with
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you soon.
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