Quadratus Lumborum Post IsometricTreatment

Techniques involving post isometric relation stretching of Quadratus Lumborum clinic use.

                                                           (Travell & Simon)

Tawrej P, Kaur R, Ghodey S.
Immediate Effect of Muscle Energy Technique on Quadratus Lumborum Muscle in Patients with Non-Specific Low Back Pain.
Indian Journal of Physiotherapy & Occupational Therapy. 2020 Jan 1;13(1) 180-185

Palpation technique is as follows:

“patient abducts the uppermost leg until the practitioner palpates strong quadratus activity  (elevation of around 30° usually)”

technique more or less verbatim:

  • Done bilaterally
  • preceded by 20 min hot pack (not available during Covid though I suppose you could put in toss away plastic bag). – Control just got hot packs
  • The practitioner stands behind the side-lying patient, at waist level.
  • The patient has the uppermost arm extended over the head to firmly grasp the top end of the table
  • on an inhalation, patient abducts the uppermost leg until the practitioner palpates strong quadratus activity  (elevation of around 30° usually)
  • The patient holds the leg isometrically in this manner, allowing gravity to provide resistance for 10-second , the patient allows the leg to hang slightly behind him over the back of the table.
  • The practitioner straddles this and, cradling the pelvis with both  hands (fingers interlocked over crest of pelvis), leans back to take out all slack and to ease the pelvis away from the lower ribs during an exhalation.
  • The stretch should be held  for between 10 and 30 seconds.
  • Contraction followed by stretch is repeated with raised leg in front of, behind the trunk in order to activate different fibers

Comment – I prefer and Janda style of post-isometric stretch:

  • First, I will pinch and shake the muscle 100 times to loosen or inject if that fails. Some need iliac crest cutaneous nerves, tender in area, injected with D5W (1/3  time the QL will just relax with that)
  • Patient with bad side up with back near edge of table
  • good leg bent, other dangling over edge of bed
  • Place had on iliac crest and ask patient to hike up the crest
  • after 10-15 second, tell them to relax and at same time forcefully push down iliac crest
  • Being leg up and massage for a bit
  • repeat 3 times
  • Warning – do not push leg down (just iliac crest) as former irritates iliotibial band.
  • People are much surprised with how much better can feel

I believe the quadratus lumborum is a real player in all back issues and needs attention

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