Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Low back painMechanical low back painLumbar sprain ++ 724.2 Lumbago847.2 Lumbar sprain ++ M54.5 Low back painS33.5 Sprain of ligaments of lumbar spine ++ Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders +++ Description ++ Quadratus lumborum muscle runs from the posterior superior iliac crest to the 12th ribCan be unilateral or bilateral depending on mechanism of injuryTenderness along origin, insertion, and line of muscle Pain over muscle that radiates with trigger point patternMay cause respiratory issues due to insertion of the muscle on the 12th ribMost episodes are self-limiting +++ Essentials of Diagnosis ++ Diagnosis made by clinical examinationUse of treatment- or impairment-based classification system is useful to determine evidence-based treatment planReproduction of symptoms in specific postures and activitiesRule out systemic disease (red and yellow flags) +++ General Considerations ++ Presentation may vary significantly based on anatomical structures and psychosocial factorsOften difficult to determine patho-anatomical cause of painPoor spinal alignment, scoliosis, and 12th-rib dysfunction can cause irritation of muscle by altering the length-tension ratio +++ Demographics ++ Variable based on specific conditionMay 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 reproducedUnilateral or bilateral pain along length of muscle or attachmentLumbar segmental and 12th-rib hypomobilityRespiratory limitationsDifficulty with lumbar spine ROMOften associated with poor body mechanics, core-muscle weakness, and postural deviations +++ Functional Implications ++ May be a leading cause of occupational disabilityMay impede ability to perform ADLs/IADLsMay impede participation in sports and other social activities +++ Possible Contributing Causes ++ Occupational factorsCongenital anomaliesPhysical conditionSmokingObesitySocio-economic factorsPsychosocial and behavioral factorsPostural changesWeakness of core musculatureTightness of hip flexors, external rotators, hamstrings +++ Differential Diagnosis ++ Facet joint dysfunctionMalignant spinal tumor or metastasisReferred pain from visceral structuresSystemic auto-immune disease (rheumatoid arthritis, Reiter's syndrome)SpondylosisSpondylitisSpondylolisthesisSpinal misalignmentSacral dysfunctionErector spinae muscle strainMyofascial pain syndromeHerniated disc12th-rib fracture12th-rib dysfunctionScoliosisRespiratory problemsLeg-length discrepancy +++ Imaging ++ Not necessary in most cases; only with persistent symptoms not responding to conservative management or if red/yellow flags are presentMRI helpful in diagnosis to visualize structure of muscle, compressed or inflamed nerve root, or disc pathologyX-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)CT to ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.