Patients with low back pain can be seen everywhere in life, and most of them show lumbar disc herniation after going to the hospital for filming. In fact, according to relevant research, only 4% of the population is the real low back pain caused by lumbar disc herniation, and 96%, the vast majority of low back pain is caused by other reasons. From our soft tissue point of view, the most common cause of long-term low back pain is the quadratus lumborum injury.
Anatomy of the quadratus lumborum
The quadratus lumborum muscle is rectangular in shape and is regarded as the posterior abdominal muscle in functional anatomy, located outside the psoas major muscle, It connects inferiorly to the iliopsoas ligament (originating from the transverse process of L5 and spreading laterally to the posterior upper part of the iliac crest.The iliopsoas ligament originates from the immature quadratus lumborum muscle fibers before the age of 20 and exists only in the Postural animals), the posterior part of the iliac crest, and terminates superiorly at the medial half of the 12th rib and the ends of the transverse processes of L1-L4.
Location of quadratus lumborum
Anterior view of quadratus lumborum
heightRelationship between quadratus lumborum and iliolumbar ligament (white)
span>According to its fiber shape, it can be divided into three bundles:
The function of quadratus lumborum >
Clinical symptoms of quadratus lumborum trigger points
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The pain is severe and deep. Sometimes it can also be tingling, knife-like pain, especially when exercising.
Symptoms of acute sciatica: When the quadratus lumborum muscle is acutely injured In some cases, spasm may occur. Raising the height of the pelvis on that side will cause compression of the sciatic nerve passing through the obturator foramen, resulting in the symptoms of acute sciatica. The symptoms are not necessarily caused by acute intervertebral disc herniation.
The range of pain involved is as follows: span>
Upper Trigger Points: It involves the flanks of the lower back, the iliac crest of the buttocks, and the anterior and superior areas of the groin. The sacroiliac joints, as well as the scrotum and testes can also be involved.
The trigger point below: mainly involves hip pain and Tenderness, pain in the patient during sleep.
Middle Trigger Point: It mainly involves severe pain and tenderness in the sacroiliac joint and gluteal fold. Sometimes it involves a tingling or discharge-like pain in the front of the thigh.
Signs and symptoms of the quadratus lumborum
Active trigger points of the quadratus lumborum can induce the following symptoms.
Severe, deep pain during activity or rest. Almost any position will do, but it will be aggravated when standing or sitting.
The pain is stabbing or knife-like when the hip or pelvis moves.
When the patient is sitting or standing, the patient usually supports the upper body with the hands to maintain balance. This is a clear sign of active trigger points in the quadratus lumborum.
Coughing and sneezing can make the pain worse.
When patients get up in the morning, they almost crawl to the bathroom on their hands and knees.
The patient was unable to turn when he was lying on his back.
Examination of the quadratus lumborum
Patients stand upright with feet apart Shoulder width, arms at your sides. The therapist stands behind the patient and places his hands on either side of the patient’s hips to stabilize the pelvis so that it does not rotate and tilt.
At this time, instruct the patient to slide the hand freely along the outside of the leg , cannot rotate the torso.
Observe that the patient’s hands can slide down the outside of the leg to the same position, that is, the level of the knee joint.
Contralateral pain, stiffness, or tightness during flexion usually indicates a quadratus lumborum injury.
Example of quadratus lumborum treatment
Isometric contraction-relaxation exercise of quadratus lumborum:
The patient is placed on the side with the upper leg extended and the lower leg flexed. Ask the patient to lift the hip to resist the pull on the leg. That is, let it resist the pull with the muscles of the iliac crest and tighten the hip joint in the direction of the shoulder.
>Movement:
The therapist holds the patient over the ankle joint, And make it abduct about 20 degrees.
Instruct the patient to resist the action and tell “don’t move” for about 5s.
Make sure the patient’s body is neutral and not rotated forward or backward.
The patient relaxes after holding on for 5s.
As you relax, pull the leg and stretch the quadratus lumborum.
Then repeat this contraction-relax-stretch several times.
Pap Ball Application
Prone Leg Raise:
At the top of the ball, support the ground with both hands forward, legs straight back, toes touching the ground.
Exhale, straighten your right leg to keep your toes back, and slowly lift off the ground.
Inhale, slowly lower the right leg back to its original position, then switch to the left leg to do the above.
Repeat this five times.
Lateral stretch:
sitting on top of the exercise ball, Extend your arms to the sides, palms forward, against the back of the ball.
Inhale and slowly lift your right arm up Overhead.
Exhale, press your right arm to the left and lift your right hip slightly.
Repeat for five breathing cycles.
Then return to sitting position and switch left arm Do the above actions.
Source: Internet, Rehabilitation Xiao Nanning