When people say their “back hurts,” it’s usually a catch-all description for all sorts of back pain. And while treating the whole body is very important when it comes to back pain, it also helps to get specific. One contributor to low back pain, in particular, that you might not even be aware of, even though it’s quite common, is quadratus lumborum muscle pain. 

“The quadratus lumborum is the deepest muscle in the back — it spans from the vertebra in your lumbar spine to the top of your pelvis,” explains Vanessa Matos, PT, DPT, a physical therapist at Hinge Health. It’s common to feel pain here, as this muscle is engaged during a lot of different movements, from sitting to standing to walking to bending. 

How do you know if you have quadratus lumborum pain? “My patients generally describe it as deep low back pain, and when I ask them to show me where it hurts, they dig their hands into the back muscle right above their pelvic bone,” says Dr. Matos. Quadratus lumborum pain is usually nothing to worry about, reassures Dr. Matos. In almost all cases, you can manage your symptoms on your own with conservative, at-home measures. 

Read on to learn more about what causes quadratus lumborum muscle pain, along with how to treat it — especially with exercises recommended by our Hinge Health physical therapists.

What Is the Quadratus Lumborum Muscle?

“Your quadratus lumborum muscle is a stabilizer of your lumbar (lower back) area,” explains Dr. Matos. “It’s what allows you to tilt your pelvis from side to side and hike your hips up. When you stand on one leg, and raise your other hip, that’s your quadratus lumborum muscle working.”

Your quadratus lumborum muscle has other important roles. It functions as a breathing muscle, especially when you engage in deep breathing. And it helps you stand upright and keep your core strong. “Your quadratus lumborum muscle is a little bit of an unsung hero. It’s so deep in your musculature that most people rarely talk about it,” says Dr. Matos. As a result, when it hurts, it can be frustrating and confusing.

Quadratus Lumborum Pain: A Hinge Health Perspective

Back pain, including low back pain associated with your quadratus lumborum muscle, can feel frustrating, upsetting, or even a little hopeless, especially when it persists or interferes with your daily activities. No matter how bad your back pain is, or how long it’s been going on, you can always do something to help improve it. And that usually starts with moving more. 

Although moving through back pain can be scary and uncomfortable, small changes to your habits can yield benefits. “We tend to feel extra nervous about pain that happens in or near our spine,” says Dr. Matos. “But it’s safe and good to move. Even something as simple as going for a walk increases blood flow to that area, which helps to calm your muscles and nerves.” 

Symptoms of Quadratus Lumborum Muscle Pain

Quadratus lumborum muscle pain can contribute to symptoms like:

• Tightness and discomfort in the low back. 

• A deep, aching pain above the pelvis.

• Pain that gets worse with movement. You may notice it more when you walk or stand, or even roll over in bed.

• Pain that pops up when you sneeze or cough, both of which put strain on your quadratus lumborum muscle.

Quadratus lumborum muscle pain can also lead to referred pain in your pelvis or hips, or even sciatica, notes Dr. Matos. That’s one reason why it might be helpful to see a physical therapist, so they can do a thorough evaluation and help you figure out what the major contributors to your symptoms are. 

Quadratus Lumborum Muscle Trigger Points

Trigger points, which can feel hard or lumpy, are often referred to as knots. While it may feel like a knot, there’s no actual knot in your muscle. A trigger point is believed to be a dime- to quarter-sized tight band of muscle tissue and surrounding fascia. It’s usually caused by muscle strain or injury. 

Trigger points are common in the quadratus lumborum muscle, notes Dr. Matos. When you press on them, you may notice a sensation of deep pain that radiates into your lower back, pelvis, and hips.

Quadratus lumborum trigger points are best addressed with movement and stretching (see our treatment section below for more details), but massage may help you feel better, too.

Common Causes of Quadratus Lumborum Muscle Pain

Many factors can contribute to low back pain. Here are some of the most common reasons you may experience quadratus lumborum pain:

• Muscle strain. Our backs, including the quadratus lumborum muscle, are strong and designed to lift things and support our spines. But these muscles can get injured during activity or even if you sit in the same position for a prolonged period of time. “The good news is our body is designed to heal from these types of strains,” says Dr. Matos.

• Osteoarthritis. It’s very normal for your spine to change as you get older, resulting in osteoarthritis. This can cause pain and stiffness in back muscles, including your quadratus lumborum.

• Scoliosis. This condition causes your spine to curve sideways, which means your weight is distributed unevenly throughout your back. This, in turn, can cause strain on low back muscles, including the quadratus lumborum.

• Back injury. If you fall, or otherwise injure your back, you may experience some muscle guarding in your quadratus lumborum, says Dr. Matos. This is your body’s normal, protective response. “It causes the muscles around the injured area to tighten up to ‘splint’ the region,” she explains.

Back pain is complex and some factors may be out of your control, but there’s still a lot you can do to manage symptoms and feel better. 

Treatment Options for Quadratus Lumborum Muscle Pain

Most of the time, quadratus lumborum pain can be treated at home with conservative measures. The following tips from our Hinge Health physical therapists and medical doctors can provide relief for quadratus lumborum pain:

• Staying active. “Any type of aerobic exercise will help, since it promotes blood flow,” says Dr. Matos. Let pain be your guide as to what activity you choose. “You might find being upright walking or running more comfortable, rather than being hunched over a stationary bike or on a rower,” she advises. In addition, exercises that stretch and strengthen your quadratus lumborum, as well as surrounding back muscles, are important to help relieve pain. Another good option is yoga. A 2020 study found that patients with back pain, including quadratus lumborum pain, responded just as well to an at-home program that included yoga moves focused on the back area as they did with traditional stretching and strengthening exercises.

• Adjust your position. If you stay in the same posture for too long, it can cause tension and stiffness. “If you sit at a desk for long periods, try getting up every 30 minutes or so to walk around or stretch,” Dr. Matos advises.

• Over-the-counter pain medications. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for quadratus lumborum pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Massage therapy. Getting a massage from a licensed massage therapist can help soothe a tense and tight quadratus lumborum muscle. This may make it easier for you to do stretching and strengthening exercises. A 2020 study found that a specific type of massage therapy, known as trigger point massage therapy, is helpful to relieve muscle pain. “It also helps to bring healing nutrients to the area, so that your body can rebuild affected muscle,” Dr. Matos explains.

• Foam rolling. Like massage therapy, foam rolling can help to relieve trigger points that may contribute to your pain, says Dr. Matos. She recommends pressing your back against the wall into a lacrosse or tennis ball. “Roll it around the space between the top of your pelvis and the bottom of your ribs alongside your spine to see if that helps,” she advises.

• Acupuncture. Acupuncture can help bring healing to sore muscles, says Dr. Matos. A 2020 Cochrane review of 33 studies with more than 8,000 participants found that acupuncture was effective at treating all sorts of back pain.

• Physical therapy. A physical therapist can work with you to figure out what may be contributing to your quadratus lumborum pain and how to manage it with targeted exercises, like the ones below, to improve your flexibility and strength. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

While all the treatments above can help quadratus lumborum muscle pain, Dr. Matos says movement, especially exercises that focus on stretching and strengthening the back, is one of the best ways to relieve and prevent pain in this muscle. These exercises recommended by Hinge Health physical therapists are a great place to start. “These moves all help increase mobility, and also strengthen muscles to support the low back,” she explains.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Use Heat or Ice 

Sore muscles, including your quadratus lumborum, can often benefit from heat or cold therapy.The purpose of cold therapy is to decrease inflammation and swelling by reducing blood flow to the sore area, while heat can increase blood flow and open up your blood vessels, bringing in healing nutrients and relaxing the affected area. In most cases, it’s fine to use either, depending on what feels best for you. Dr. Matos recommends applying moist heat to your lower back for a few minutes before you stretch.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Bordoni, B., & Varacallo, M. (2018, December 19). Anatomy, Abdomen and Pelvis, Quadratus Lumborum. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535407/

2. Dayanır, I. O., Birinci, T., Kaya Mutlu, E., Akcetin, M. A., & Akdemir, A. O. (2020). Comparison of Three Manual Therapy Techniques as Trigger Point Therapy for Chronic Nonspecific Low Back Pain: A Randomized Controlled Pilot Trial. The Journal of Alternative and Complementary Medicine, 26(4), 291–299. doi:10.1089/acm.2019.0435

3. Mu, J., Furlan, A. D., Lam, W. Y., Hsu, M. Y., Ning, Z., & Lao, L. (2020). Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews, 12(12). doi:10.1002/14651858.cd013814

4. Bagcier, F, Batibay, S. (2020). The Effects of Virtual Reality-based Wii Fit Yoga on Pain, Functionality and Trigger Points in Non-specific Chronic Low Back Pain Patients: A Randomized Controlled Trial. Bosphorus Medical Journal, 7(3):75–81. doi:10.14744/bmj.2020.92486