Quadratus Lumborum Syndrome

Overview

What is quadratus lumborum syndrome?

The quadratus lumborum muscle sits in the small of the back to the side of the spine. It is enclosed in a fascial sheath. Following a blow to the back (such as a knee in the lumbar spine in footballers), this muscle can become tight and bound up within its fascia.

Why does it cause back pain?

The quadratus lumborum muscle connects the lumbar spine transverse processes to the pelvis. It is enclosed within a muscle sheath. The front of this sheath sits posterior to the sheath for the psoas muscle. The quadratus lumborum muscle moves the trunk to the side, hence tension in the muscle can create myofascial pain.

Do I need an X-ray or scan?

Not unless your doctor is trying to exclude other causes of back pain.

Symptoms

One-sided lower back pain (typically along the waistline)

Pain that radiates to the hip, buttock, or upper thigh
Increased pain when standing, bending sideways, or twisting
Pain when rising from a seated position
Difficulty finding comfortable sleeping positions
Noticeable stiffness in the morning
Visible postural asymmetry (one hip may appear higher)
Tenderness when pressing directly on the QL muscle
Pain that worsens with prolonged sitting or standing
Difficulty with weight-bearing on the affected side
Reduced flexibility when bending to the opposite side
Sometimes accompanied by referred pain to the groin

The hallmark characteristic is typically persistent, aching pain concentrated on one side of the lower back, just above the pelvis.

Diagnosis

The diagnosis of Quadratus Lumborum Syndrome begins with a thorough medical history review where our clinicians gather information about pain patterns, onset timing, and factors that worsen or relieve symptoms. This provides crucial context for understanding the patient's condition.

Physical examination follows, where the practitioner palpates the QL muscle to identify tenderness and trigger points. They assess range of motion (particularly side-bending), observe posture for asymmetry, and test muscle strength in the lower back and core. Characteristic findings include pain when bending away from the affected side and tenderness directly over the muscle.

Differential diagnosis is essential, as QL syndrome symptoms can mimic other conditions like facet joint dysfunction, sacroiliac joint issues, herniated discs, or hip pathology. While diagnostic imaging such as X-rays or MRIs isn't typically necessary, it may be ordered to rule out other potential causes.

In challenging cases, a diagnostic injection with local anesthetic directly into the QL muscle may be performed. Significant pain relief following injection strongly supports the diagnosis of QL syndrome, providing confirmation when clinical presentation is unclear.

Treatment

What can I do about it?
The quadratus lumborum responds well to a combination of approaches including massage therapy, trigger point release, and gentle stretching. Heat therapy, such as warm compresses or therapeutic ultrasound, can relax the muscle and increase blood flow. Correcting postural habits, especially asymmetrical standing or sitting positions, is crucial for long-term relief. A physical therapist can prescribe targeted exercises to strengthen core muscles that support the QL. For severe cases, dry needling or injections may provide relief from persistent spasms.

Will It Get Better?
Yes, most cases of Quadratus Lumborum Syndrome resolve with appropriate treatment. Recovery typically occurs within 2-6 weeks when following a consistent treatment plan. Patients who address underlying postural issues and complete their rehabilitation exercises see the best outcomes. Even chronic cases generally show significant improvement with the right approach. Maintaining core strength and proper body mechanics will help prevent recurrence. While occasional flare-ups may occur with certain activities, most people return to full function without limitations.

Disclaimer
Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Our specialists assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to your doctor at the time of your consultation.