Skip to Main Content

++

  • Low back pain
  • Mechanical low back pain
  • Lumbar sprain

++

++

  • M54.5 Low back pain
  • S33.5 Sprain of ligaments of lumbar spine

++
++

Description

++

  • Quadratus lumborum muscle runs from the posterior superior iliac crest to the 12th rib
  • Can be unilateral or bilateral depending on mechanism of injury
  • Tenderness along origin, insertion, and line of muscle
  • Pain over muscle that radiates with trigger point pattern
  • May cause respiratory issues due to insertion of the muscle on the 12th rib
  • Most episodes are self-limiting

++

Essentials of Diagnosis

++

  • Diagnosis made by clinical examination
  • Use of treatment- or impairment-based classification system is useful to determine evidence-based treatment plan
  • Reproduction of symptoms in specific postures and activities
  • Rule out systemic disease (red and yellow flags)

++

General Considerations

++

  • Presentation may vary significantly based on anatomical structures and psychosocial factors
  • Often difficult to determine patho-anatomical cause of pain
  • Poor spinal alignment, scoliosis, and 12th-rib dysfunction can cause irritation of muscle by altering the length-tension ratio

++

Demographics

++

  • Variable based on specific condition
  • May be specific to athletes, younger populations prone to extreme spinal movements

++

Signs and Symptoms

++

  • Pain lateral to lumbar spine between 12th rib and iliac crest that can be mechanically reproduced
  • Unilateral or bilateral pain along length of muscle or attachment
  • Lumbar segmental and 12th-rib hypomobility
  • Respiratory limitations
  • Difficulty with lumbar spine ROM
  • Often associated with poor body mechanics, core-muscle weakness, and postural deviations

++

Functional Implications

++

  • May be a leading cause of occupational disability
  • May impede ability to perform ADLs/IADLs
  • May impede participation in sports and other social activities

++

Possible Contributing Causes

++

  • Occupational factors
  • Congenital anomalies
  • Physical condition
  • Smoking
  • Obesity
  • Socio-economic factors
  • Psychosocial and behavioral factors
  • Postural changes
  • Weakness of core musculature
  • Tightness of hip flexors, external rotators, hamstrings

++

Differential Diagnosis

++

  • Facet joint dysfunction
  • Malignant spinal tumor or metastasis
  • Referred pain from visceral structures
  • Systemic auto-immune disease (rheumatoid arthritis, Reiter's syndrome)
  • Spondylosis
  • Spondylitis
  • Spondylolisthesis
  • Spinal misalignment
  • Sacral dysfunction
  • Erector spinae muscle strain
  • Myofascial pain syndrome
  • Herniated disc
  • 12th-rib fracture
  • 12th-rib dysfunction
  • Scoliosis
  • Respiratory problems
  • Leg-length discrepancy

++

Imaging

++

  • Not necessary in most cases; only with persistent symptoms not responding to conservative management or if red/yellow flags are present
  • MRI helpful in diagnosis to visualize structure of muscle, compressed or inflamed nerve root, or disc pathology
  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)
  • CT to show muscle structure, herniation compressing the spinal canal/nerves, or ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.