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Quadratus lumborumMusculus quadratus lumborum

Deep, four-sided muscle between the iliac crest, the 12th rib and the lumbar spine that side-bends the lower back and hitches the hip.

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LatinMusculus quadratus lumborum
Origin
  • Iliolumbar ligament
  • Posterior part of the inner lip of the iliac crest
Insertion
  • Lower border of the 12th rib (medial half)
  • Tips of the transverse processes of L1–L4
Action
  • One side: laterally flexes the lumbar spine to the same side
  • One side, with the trunk fixed: elevates the pelvis on the same side (hip hitching)
  • Both sides: extend the lumbar spine
  • Fixes the 12th rib during breathing, giving the diaphragm a stable base
NerveVentral rami of the 12th thoracic and upper lumbar spinal nerves (T12–L4)
NameLatin for 'square (muscle) of the loins'; it is roughly four-sided.

Palpation

  1. Client prone, or side-lying with the top arm overhead to open the space between ribs and pelvis; stand beside the table.
  2. Find the lateral edge of the erector spinae in the lumbar region, and the gap between the iliac crest and the 12th rib.
  3. Sink in slowly from the lateral edge of the erectors, pressing in towards the spine (towards the transverse processes), not straight down.
  4. Ask the client to hitch the hip up towards the ribs on that side; feel QL tighten under the fingers.

Landmarks: Iliac crest

Clients who sit for long periods often report aching in the lower back just above the Iliac crest, and QL is often part of that picture. It lies deep to Erector spinae, so you reach it by working in from the side, just lateral to the erector columns. The kidneys lie in front of it: press into the muscle towards the spine, never straight down into the abdomen, and keep pressure light over the floating ribs.

Side-lying with the top arm overhead opens the space between the ribs and pelvis and makes the muscle easier to reach.

Sources disagree on two points. Gray’s (1918) lists the nerve supply as T12 and L1–L2, while Wikipedia gives T12–L4. Gray’s also says both sides together flex the trunk, while Wikipedia (and most modern texts) say they extend the lumbar spine. This note uses the modern version.

Techniques

  • Effleurage — Long, gliding strokes with the whole palm that spread the medium, warm the tissue and link the other strokes together.
  • Petrissage — Kneading strokes that compress, lift and squeeze the muscle away from the bone, working the tissue between the hands.
  • Compression — Pressing straight down into a muscle with the palm, fist or forearm, holding briefly, then releasing and moving on.
  • Passive stretching — The therapist gently moves a relaxed limb to lengthen a muscle to a point of mild stretch and holds it there, with no effort from the client.

Works with

  • Erector spinae — Three long columns of muscle (iliocostalis, longissimus and spinalis) running beside the spine from the sacrum to the skull that extend and side-bend the back and hold the trunk upright.
  • External oblique — Broad, outermost muscle of the side of the abdomen that flexes, side-bends and rotates the trunk to the opposite side.
  • Internal oblique — Middle layer of the side abdominal wall, lying under the external oblique, that flexes the trunk, compresses the abdomen and rotates the trunk to the same side.

Opposes

  • Rectus abdominis — Long, strap-like muscle running vertically down the front of the abdomen that flexes the trunk and helps compress the abdomen.

Used in routines

Sources

  1. Wikipedia, Quadratus lumborum muscle
  2. Gray's Anatomy (1918), IV. Myology 6d: The Muscles and Fasciae of the Abdomen (Public domain; Bartleby edition read via the Internet Archive.)