384 | QL Causing Low Back Pain or Tightness?

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

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[00:01:53] Let's talk about the QL this episode.

[00:01:56] This is like a muscle that gets blamed for a lot of whether it's low back pain specific or maybe it's radiating into the hip.

[00:02:05] So we just want to bring an understanding.

[00:02:08] Now, we've talked about the QL before, but this was quite a while back.

[00:02:12] And so I think updating, you know, the information, making sure that it's fresh in your mind.

[00:02:19] And if you have not been listening for that long, now you get to experience what we talk about with the QL and what you can really do.

[00:02:28] Because you're probably here, you know, as someone who's been told, you know, your QL is the reason for your low back pain or you need to stretch your QL and or we need to release your QL and do we?

[00:02:39] Yeah, the QL, I feel like it's kind of used as a scapegoat in some of these scenarios.

[00:02:43] And the QL very well might be tight or, you know, might be.

[00:02:48] But again, it's kind of the scapegoat because it's really not a huge or significant muscle in its function.

[00:02:55] It's kind of just this square shaped muscle that attaches on the top of our iliac crest and our low rib cage.

[00:03:01] And it's involved in helping extend the spine and laterally flex the spine and just give some stability between the rib cage and pelvis.

[00:03:11] But we have so many other major players in all of those movements.

[00:03:16] You know, we've got our erector spinae muscles, which are the big ropey muscles that go up the center of our back that are our primary movers into extension.

[00:03:25] Same with the multifidi, we also have the transverse abdominis that wraps all the way around from our corset muscle that gives that stability in the same area from our rib cage to our pelvis.

[00:03:39] We've got the obliques, our abdominal obliques, the internal and external obliques that also help with rotation and side bending to some degree.

[00:03:48] Yeah, and it really is what I think is one of the coolest aspects of it because in reality, you know, when we're talking about the overall force that it produces, when we're talking about, you know, side bending and extension, it really only accounts for less than 10% of that bending and that lumbar extension, you know, when in comparison of those larger back muscles.

[00:04:16] So I think that's really important to note, like this isn't the only muscle that's kind of bending you to the side or that's not the only muscle we're working when we're doing exercises that are side bending.

[00:04:31] So it's really important to keep the whole aspect of the trunk back and core in mind when we're talking about the QL.

[00:04:39] And that already gives you an indication of then what we can start to work on, I think.

[00:04:45] And that's what's cool.

[00:04:46] Before we dive in more about the QL, I have to say, have you heard about electrolytes?

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[00:05:16] But are you hydrating?

[00:05:18] Are you getting enough hydration?

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[00:06:02] And it's the number one thing that helps me to hydrate.

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[00:06:47] So I highly recommend, again, that is drinklement, drinklmnt.com backslash optimal.

[00:06:55] Use our code.

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[00:07:01] So I hope you use it.

[00:07:03] And the next level is that like one of its other functions is that it's an accessory inspiration muscle.

[00:07:11] Yeah, that's what I was going to say is the coolest thing about it.

[00:07:14] Accessory, that's what you were going to say was the coolest thing is it's an accessory respiratory muscle, which essentially means it helps us breathe when we're doing forced inhalations.

[00:07:23] And the thing that I love about this being an accessory respiratory muscle is that it helps us expand through the low rib cage rather than our other accessory muscles, which get talked about more often, which is our upper chest muscles and our neck muscles.

[00:07:36] And Jen and I talk about all the time in depth.

[00:07:40] We want to be breathing and expanding through that low rib cage.

[00:07:43] And furthermore, the QL has direct contacts into that diaphragm.

[00:07:49] The diaphragm has these arcuate ligaments that branch out and attach into the low back, same areas that the QL attach.

[00:07:56] So if we're breathing through the diaphragm, if we're using the QL and other lower intercostal muscles to expand through the low rib cage, that in itself is going to help bring relaxation to our QL just through breath.

[00:08:13] Which is goes back to why it's so important to get that foundation of understanding where you're breathing from, especially as women.

[00:08:22] I feel like we've been trained to kind of hold our bellies in and, you know, kind of keep our chest back and be in this good posture.

[00:08:28] But what we end up doing a lot of times is this opposite breath pattern where as I breathe in, my belly actually comes in and I expand through my chest.

[00:08:39] And then as I breathe out, I let my belly relax, which is the opposite of what we want to be doing.

[00:08:44] When we breathe in, we want our belly to relax, but really not push out.

[00:08:48] We want that expansion from the sides and the back.

[00:08:50] And finding that expansion from the sides to the back actually takes work and actually takes practice, you know.

[00:08:58] And I think it's also important to understand how integral the QL is into these fascial connections into the thoracolumbar fascia.

[00:09:07] You know, like our, so thoraco meaning thoracic, so upper back, lumbar meaning low back.

[00:09:16] So it's this fascial, you know, huge fascial connection along our low back that connects into our QL as well.

[00:09:25] And so there's integrations along that whole upper and low back that connect into how that QL is going to feel and respond based on the tension we may have throughout that entire fascia.

[00:09:38] Not to mention the bottom portion of the QL then kind of connects into where the glutes are.

[00:09:43] And that's where our IT band, which is another massive thick portion of fascia that runs down that lateral line.

[00:09:50] So this is all to say that when we are moving and we have muscles that might be more dominant or less dominant, they're all tugging through these fascial planes.

[00:10:01] And if we have imbalances, the QL is going to be a part of that chain.

[00:10:06] Yeah.

[00:10:06] And as we mentioned, it's not the strongest muscle.

[00:10:08] It's not the most powerful mover.

[00:10:10] So it can get thrown around and taken advantage of a little bit.

[00:10:14] And that might be one of the reasons that we have tension or trigger points there.

[00:10:18] Well, let's talk about like what you might feel if you really are having QL pain.

[00:10:24] QL pain will be characterized more by like a deep aching.

[00:10:27] You know, it's different from something like SI pain where people will point in one spot when it comes to SI pain.

[00:10:34] And that might be described more as sharp.

[00:10:36] But QL pain is going to be more deep aching on the side of the body.

[00:10:39] And you will have this pain with extended sitting, pain with transitions from sitting to standing or aching and pain in the mornings.

[00:10:48] And you're usually kind of like grabbing a little bit higher than like your pelvic bone or like where the SI is.

[00:10:55] It's a little bit like you're kind of grabbing your back.

[00:10:58] And kind of in the side meat of the body.

[00:11:01] Right.

[00:11:01] Between the ribs and the pelvis.

[00:11:02] And you can if you put your hand like turn your hand and grab it around the back above your pelvis and then move your hip bone up.

[00:11:10] And you can kind of feel all that musculature where that QL and other muscles are involved to kind of starting to activate and move.

[00:11:18] And so it's usually around that area that people are starting to feel that deep ache and that pain around that area.

[00:11:27] And that's where we can, okay, kind of attribute that to maybe some low back pain that you're having.

[00:11:33] And it can almost mimic because it's more of like a diffuse aching pain.

[00:11:36] It can mimic other low back pain symptoms or even hip symptoms.

[00:11:39] Some people might think they have like a hip bursitis, especially because where the QL is, we have a lot of nerves coming out of those low lumbar segments of the spine.

[00:11:49] And some of them run through or along the QL and we can get nervy type entrapment.

[00:11:55] So we might also be feeling nervy type pains, tingling pain.

[00:11:59] So sometimes the symptoms will present a little bit differently and might mimic other symptoms of other conditions.

[00:12:05] But that's kind of the best way to group all of the QL type symptoms in one place.

[00:12:09] Now we want to talk about, okay, so what can I do, right?

[00:12:12] Because most of the time the treatments are so pinpointed.

[00:12:17] And trust me, as a physical therapist, I've done this myself where, you know,

[00:12:22] the point of getting hands-on treatment in a specific muscle is to cause relaxation of that muscle so that we can start to move in different patterns.

[00:12:31] Which can be effective.

[00:12:32] Which can be so effective.

[00:12:34] We're not releasing the tissue.

[00:12:36] We're not lengthening the tissue.

[00:12:37] We're not, you know, releasing fascia.

[00:12:41] These trigger points that we might feel into this QL area is, are just trigger points for the brain.

[00:12:49] Think of that.

[00:12:49] Like I'm alerting the brain that there's some tension and tightness there.

[00:12:53] And so if I can tap into that to cause some relaxation within that area, no matter what tool or technique that I'm using,

[00:13:00] you cannot use that alone.

[00:13:02] Because what caused that tension, those trigger points and that tightness to develop in the first place?

[00:13:09] If we never address the root cause of what happened, you can continue to get all these treatments and feel better for the short term.

[00:13:17] But they're going to come back if we never get to the root cause of why.

[00:13:22] So that being said, yes, manual treatment can be a part of your rehab or can be a part of your plan or process to get rid of this QL pain.

[00:13:32] But where else do we want to look?

[00:13:34] And with all that we mentioned, how the QL has interconnections all the way from essentially the knee to the neck,

[00:13:41] we really want to be focused all along that chain.

[00:13:46] Like priority number one though, is try the breath.

[00:13:49] Try that deep rib cage expansion.

[00:13:52] Get in a very comfortable position, whether it's laying on your back or sitting.

[00:13:55] Take some deep breaths, focus on expansion through the low rib cage.

[00:13:59] As you exhale, nice long controlled exhales.

[00:14:03] That's going to help us downregulate that nervous system and really just downregulate tension throughout the whole body.

[00:14:08] But especially with the QL, because it has those connections directly into the diaphragm,

[00:14:12] it makes me think there's got to be a little more interplay there.

[00:14:16] Where if we're doing effective diaphragmatic breathing,

[00:14:19] it's going to have a little more influence on the relaxation in the QL as well.

[00:14:23] And one of my favorite techniques to kind of cause relaxation around the area,

[00:14:29] especially when we're talking about, okay,

[00:14:31] it's so interconnected into the fascia along that whole upper and low back,

[00:14:34] is using the gorgeous ball from Tune Up Fitness.

[00:14:39] And this ball, you can kind of lay on your back.

[00:14:42] And if you try to, and if you, it's a super grippy material of the ball.

[00:14:46] And you just deflate it a little bit.

[00:14:48] And if you rotate around that ball, you kind of wind up the tissue.

[00:14:53] And you take a deep breath into that wound up tissue.

[00:14:56] And you breathe and you relax into that and then unwind.

[00:15:00] And it's going to like feel like it's unwinding the tissue.

[00:15:03] I mean, there's so many nerve endings and everything that we're going to get

[00:15:07] to have that response to cause that relaxation.

[00:15:10] But you can do that all along the back.

[00:15:12] And then one tool that I specifically love.

[00:15:15] So this is, again, stuff that you can do on your own

[00:15:17] to cause that release type feeling and that relaxation is using the IntelliRoll.

[00:15:22] The IntelliRoll, because of the design of this foam roller,

[00:15:27] actually has like a divot on one of the main ends of it.

[00:15:32] And if you lay on your side on that,

[00:15:34] you can kind of open back and kind of come forward.

[00:15:39] We'll show this on YouTube.

[00:15:40] But you can massage directly into that QL without laying on your back,

[00:15:47] without direct pressure of just like a ball.

[00:15:49] But this kind of helps to disperse that pressure

[00:15:52] to help to cause that better relaxation.

[00:15:56] Remember, the goal isn't that we're trying to use a lacrosse ball

[00:15:59] or super hard tool to like really dig into tissue

[00:16:03] because that's digging into tissue isn't going to do anything.

[00:16:07] We're not breaking anything up.

[00:16:09] But if we can cause relaxation through these,

[00:16:12] the gorgeous ball, soft ball, or, you know,

[00:16:16] laying on this IntelliRoll that's designed for the low back

[00:16:21] and the QL to be affected in that area,

[00:16:23] we can really help to cause that relaxation on your own

[00:16:26] and then get into some movement that we're going to talk about.

[00:16:29] And one more reason that I love these tools is like

[00:16:32] people will still say, oh, that's passive tools.

[00:16:35] That's what you just talked about with massage.

[00:16:36] I think it's a step above a passive tool because you can,

[00:16:41] you're more actively in control of the pressure.

[00:16:43] You have to be in control.

[00:16:45] And when you combine it with your breath

[00:16:47] and maybe some movement while you're doing it,

[00:16:49] it becomes more of an active and dynamic treatment,

[00:16:53] again, that you have control over.

[00:16:55] You're doing it to yourself.

[00:16:56] It's not something someone is doing to you.

[00:16:58] And then once we have found that relaxation,

[00:17:00] this is where the real work takes place.

[00:17:03] This is where we just want to get into some general movement.

[00:17:06] We want to be able to go through movements

[00:17:08] that may have previously felt restricted

[00:17:11] or may have previously felt like it aggravated that pain.

[00:17:14] Because now that we have the relaxation,

[00:17:15] we might have a little more variability

[00:17:18] to do those movements with less discomfort.

[00:17:20] And this is where we want to,

[00:17:22] like we talked about all the muscles

[00:17:23] that kind of combine and touch into this QL area, right?

[00:17:27] Which transverse abdominus, we talked about a lot,

[00:17:30] which is our inner core, our diaphragm, our inner core.

[00:17:34] So not only, so going a step beyond

[00:17:37] just like getting back into good foundational

[00:17:40] diaphragmatic breathing,

[00:17:41] but then we want to get into good foundational deep core work

[00:17:44] where we're understanding how to use that diaphragm

[00:17:46] and that transverse abdominus effectively together

[00:17:49] so that we can get better dynamic support

[00:17:53] around that entire trunk and utilize more muscles

[00:17:56] rather than our low back or QL taking over during core exercises.

[00:18:02] You know, we don't want them to dominate movement.

[00:18:04] We want more balance throughout the entire trunk and pelvis.

[00:18:06] So if we start to learn how to utilize your deeper core muscles,

[00:18:10] then we can take pressure off of just the QL kind of taken over

[00:18:15] or doing a lot.

[00:18:16] And that's where, again, it's like, okay,

[00:18:18] so getting this deep core understanding

[00:18:20] and then how that translates into functional

[00:18:22] and everyday movement is really important.

[00:18:24] And then one last thing is like,

[00:18:27] how do I get more hip control, right?

[00:18:29] So that my, again, when I bend, when I move,

[00:18:33] it's not just for my QL,

[00:18:35] but it's also like my hips are bending

[00:18:37] and I'm using that glute power and that glute force

[00:18:41] to help the energy that I'm feeling all throughout my trunk.

[00:18:44] And I think especially doing that in single leg variations

[00:18:48] because then it's going to force you to use that deep core stabilization.

[00:18:53] And that's why starting with the deep core,

[00:18:55] perfect place to begin because then when you transition into those other movements,

[00:19:00] you're going to prevent that QL from feeling like it's getting tugged around too much

[00:19:05] because we have set the foundation.

[00:19:07] We've set that core stability

[00:19:09] and now getting into stuff like a single leg deadlift

[00:19:12] or even just an offset deadlift,

[00:19:14] doing lateral type lunches,

[00:19:16] doing single leg variations of step downs or step ups.

[00:19:21] Those are really going to help us use that QL in conjunction

[00:19:25] with all our other core muscles in a way that's effective and balanced

[00:19:28] rather than before where something was out of whack

[00:19:32] and causing that QL to feel like it needed to tighten down

[00:19:37] and create stability.

[00:19:40] Well, and what's funny too is like we're not saying,

[00:19:43] we didn't start this conversation by saying,

[00:19:45] okay, first you're going to do the QL stretch,

[00:19:47] then you're going to do side planks,

[00:19:49] then you're going to do...

[00:19:50] That's what everyone says is the QL stretch

[00:19:52] and even a lot of like research and studies that we looked up,

[00:19:55] they're like,

[00:19:55] oh, the side plank is the best exercise to get activation in the QL.

[00:19:59] Like, okay, that's great,

[00:20:00] but do we need more activation in the QL?

[00:20:03] Yeah, what if we need to look at the other areas of the body?

[00:20:05] Yeah.

[00:20:06] What if we need to just relax

[00:20:07] and then find out how to get to coordinate better with everything else?

[00:20:10] So yes, those exercises are great.

[00:20:12] And when you're working on that deep core coordination,

[00:20:15] throw some side planks in there.

[00:20:16] See how it feels?

[00:20:17] There's some Copenhagens in there.

[00:20:19] Yeah.

[00:20:19] See how they feel?

[00:20:21] And that QL stretch feels amazing.

[00:20:23] It does.

[00:20:24] Just for like the whole lateral line,

[00:20:26] not even just the QL,

[00:20:27] but like everything from the lats all the way down the leg.

[00:20:30] Which people call it the QL stretch,

[00:20:32] but it is like...

[00:20:33] It's a lateral line stretch.

[00:20:34] Lats, it's stretching QLs,

[00:20:35] it's stretching obliques,

[00:20:36] it's stretching all the way down through your glutes

[00:20:39] and through the IT band.

[00:20:40] It's putting tension on that whole line.

[00:20:41] So it does a lot more than just stretch the QL

[00:20:45] and can be a great part to throw in with that mobility work you're doing

[00:20:50] on like the quarter spaller and teller roll,

[00:20:52] do a QL stretch and then get into some deep core work.

[00:20:55] And then we want to start working some of that single leg functional type movement

[00:21:00] to get everything working together.

[00:21:03] Thanks for joining us for another episode.

[00:21:05] Hope that was helpful.

[00:21:06] And if you know of someone out there who's having QL pain or low back pain,

[00:21:10] please pass this episode along.

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[00:21:22] If you're interested in trying a free week of the Gen Health membership,

[00:21:26] go down to the link in the show notes.

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[00:21:30] And of course, we'll see you next time on the Optimal Body Podcast.