By John Hofman
Back injuries are the number-one injures in the fire service; most firefighters suffer from some type of lower back pain. Too often, we self-diagnose the problem as a slipped disk or sciatic pain. The funny thing is that we all have slipped disks, so could it be something else causing the pain?
Your quadratus lumborum (QL) muscle might be the problem, and you may not even know it. The QL plays a prominent role in chronic lower back pain as well, becoming a key player in the subsequent onset of sciatica symptoms and hip pain. Many times these trigger points can have referred pain to the psoas, piriformis, and glutes. The QL muscle’s role is to stabilize your torso in the frontal plane. For example, if you hold a two-inch hose roll in your right hand, the left QL contracts, preventing you from leaning to the right. If you have paralysis in the QL muscle, it would be impossible to walk.
Another important role that the QL muscle plays is in side bending. When you lean to the side, the QL must lengthen and then contract to pull you back up. However, it is not recommended to train that way (e.g., side bends) because of the stress placed on the disks. According to Dr. Stuart McGill, the QL muscle needs endurance strength and should be trained in a static position, such as side planks. The overall goal of the QL is to provide lumbar stability.
Over the years, I have seen the QL muscle become problematic to many firefighters; if it is not working properly, it can have detrimental effects on them physically. When you are walking with a hose roll in the right hand, the left QL muscle is firing to help maintain posture while your right glute medius is working to maintain proper gait. If those muscles become weak, that excessive load can affect other areas of your body such as your knee (patellar tendonitis) because the hips and core cannot stabilize throughout the movement pattern.
Simply, when someone has right knee pain, the right glute medius is usually weak. And since the right glute medius works with the left QL, there’s usually weakness or trigger points in the left QL. In other words, if you have right knee pain, strengthen your left QL; as a result, your right glute medius will take stress off the knee.
So, how do you know if you have a weak QL Muscle? Perform a side plank and see how long you can hold it. Then, compare it to the other side. If you perform 60 seconds on the right side plank and 30 seconds on the left side plank, the left is weak and you need to strengthen it.
Side Planks—Level 1, Modified and Side.
Kneeling Lateral Press
Bottoms Up Suitcase Walk
Stretching the QL
It is necessary to stretch these muscles to regain suppleness after injury. However, if it doesn’t recover completely after a few weeks of stretching, you haven’t addressed the daily punishment you are putting them through. Refer to the following videos.
TRX Long Torso Stretch
Quadratus Lumborum Symptoms and Findings
The signs and symptoms associated with active quadratus lumborum trigger points follow:
- Severe, deep, aching lower back pain during movement or rest, in nearly any position, but it is worse in the upright posture of standing or sitting.
- A sharp, knife-like pain when moving the hips/pelvis.
- People will attempt to support and stabilize their upper body with their hands. This bracing with the hands occurs during walking and sitting; it is the hallmark sign of active QL trigger points.
- Coughing and sneezing can create episodes of agonizing pain; the muscle is contracting to stabilize the rib cage.
- The pain from untreated QL trigger points may progress to involve the groin and genitalia and cause sciatica symptoms.
- The lower back pain from QL trigger points may also turn into severe hip pain over time that resembles trochanteric bursitis.
- An elevated hip crest is a common postural distortion with QL trigger points.
Causes of Quadratus Lumborum Trigger Points
The following factors may activate or reactivate trigger points in the QL muscle:
- Any activity that involves bending and twisting at the waist such as reaching for an object on the floor, which can overload the QL muscle.
- Lifting heavy or awkward objects such as a patient, especially if it involves twisting at the waist.
- Bending over to put on pants, especially if a foot becomes entangled in the pants and the person lose his balance.
- Automobile accidents.
- A genetically short leg that causes a lateral tilt in pelvis. Walking or running on a sloping surface such as the side of the road or venting on a roof prop) may also predispose the QL muscles to overload and trigger point activity.
- A soft bed that sags like a hammock or a tempurpedic mattress may activate or reactivate QL trigger points by placing the muscle in a shortened or stretched position for an extended period.
John Hofman is the strength and conditioning coach for the Sacramento (CA) Fire Department, He oversees the Wellness Center; coordinates the department’s medical and fitness assessments; develops recruit fitness training, pre-employment medical and fitness evaluations; and assists the department’s 20 certified Peer Fitness Trainers. In addition, he is the strength and conditioning coach for the California Regional Fire Academy, Sierra Fire Technology Program, Rocklin Fire Department, and South Placer Fire District. He also consults with the Fire Agency Self-Insurance System of California. Visit John’s Web site at www.firefighterfitnessonline.com.
In an effort to help keep firefighters safe Strength & Conditioning Coach John Hofman authored Beyond the Turnouts: A Comprehensive Guide to Firefighter Health & Wellness — where he combined the latest research and his years of experience developing firefighter health and wellness programs within the fire service. CLICK HERE for more info about the book.