Technique Highlight: Quadratus Lumborum Release

I was asked recently by a reader on the TrP post by Patrick Ward/Optimum Sports Performance on what I find with QL TrPs. While I don't treat TrPs directly, I do make a mental note when I palpate one, to see if it refers, and also to see post treatment if it is still there. Sometimes something as simple as postural correction will make them "go away."

The TrPs tend to refer to the buttock area, so those patients who you think may have radiating lumbar pain from disc or facet, or piriformis syndrome, may be radiating from the QL.

Pt: sidelying involved side up
PT: standing behind pt, table lower, or PT on a stool, or kneeling behind pt
Tech:

• use the area between the PIP and DIPs of your 2nd and 3rd digits for contact.
• The area for treatment is posterior to the midline and anterior to the erectors.
• This is in between the inferior 12th rib and superior lateral iliac crest. 
• slowly apply pressure laterally to medially until your fingers stop, assess the uninvolved side for differences in tone and tissue resistance
• the release is initially performed with oscillations, but can then be functionally released with the pt's ipsilateral UE going elevation repeatedly and then progression to the ipsilateral hip going into extension and adduction
• perform for 3-5 minutes or until it releases

Indications:

• difficult to correct lumbar lateral shift
• limitations in sidegliding or sidebending/rotation
• buttock pain/symptoms
• SIJ dysfunction

Here is a stretch I find effective once you have released it manually.