Are you dealing with a QL strain or one-sided low back pain?
In this blog, I’m going to teach you everything you need to know about managing the issue.
Looking to improve your strength, mobility, and overall fitness? Check out our Low Back Resilience program!
Quadratus Lumborum (QL) Anatomy & Function
The Quadratus Lumborum, or QL, is one of the deepest muscles located in the lower back that attaches from the pelvis to the lumbar spine and bottom portion of the twelfth rib.
The QL primarily acts to side bend and extend the lumbar spine, although its strength is limited by its size and leverage. Based on its connection to the last rib, the QL also aids with breathing.
Quadratus Lumborum Strain (or not?)
It is often believed that one-sided low back pain, worsened by movements that stretch the QL, such as side bending, flexion, or a combination of the two, is caused by a QL strain.
However, it’s difficult to single out the QL for 2 main reasons:
1. Despite popular belief, it cannot be pressed on in isolation. If you’re trying to press on the QL, you’ll inevitably be pressing on other muscles and structures as well due to its depth.
2. The QL cannot contract or be stretched in isolation because other muscles and ligaments share overlapping functions. In fact, part of the QL blends with the iliolumbar ligament.
The good news is that regardless of the exact musculoskeletal tissue involved, I’m going to provide you with advice, exercises, and programming to help.
First Things First
Low back pain is usually managed in an overly complex manner because it’s often considered scary or mysterious.
In reality, it can be helpful to approach new episodes of low back pain the same way you think about ankle sprains – you take it easy for a couple of days and slowly get back into your normal routine.
Most episodes of low back pain completely resolve on their own because the human body is resilient and adaptable.
If you’re experiencing a recent onset of symptoms that’s highly irritable or debilitating, you don’t necessarily need to aggressively stretch immediately. You wouldn’t do that with an ankle sprain.
You can certainly perform some gentle movements within comfort, such as cat cows or lumbar rotations.
Some people find belly breathing really calming and relaxing. You can sit upright or lie on your back, place one hand on your stomach and one on your chest, and take slow, deep breaths.
Or you can keep up with a walking program. It’s one of the best things you can do for your body and health overall.
It’s also important to temporarily modify, minimize, or avoid aggravating activities, whether that’s related to sports, specific exercises in the gym, or certain daily activities like sitting for a prolonged period of time.
If one-sided low back pain is becoming a recurring problem for you, you need to try to identify and address the primary contributing factors.
It’s not uncommon for someone who wakes up in the morning with symptoms to blame it on their sleeping position rather than consider how sitting on the couch and drinking for 8 hours the day before may have played a significant role. Therefore, if you’re relatively sedentary, being more active and attempting to cultivate a healthier lifestyle can help.
If you always tweak your back doing the same exercise in the gym, you probably need to improve your preparation or programming.
Exercise Overview
The exercises I’m going to present are pretty straightforward. The goal is to simply train the muscles of the low back in a comprehensive way to improve your tolerance and confidence to different positions and movements over time.
Movements that create a stretch under load are probably going to be more provocative initially, so you can start with the isometric exercises, which are just static holds, whenever you feel ready.
Side Bend Isometrics
Let’s start with side bend isometrics, also known as anti-lateral flexion exercises. Here are 3 options:
Option 1: Side Plank – Support your upper body with your forearm, straighten your legs, stack your feet, and keep yourself in a straight line. If this is too difficult, you can do a short side plank on your knees or elevate your upper body on a bench, box, etc.
Option 2: Suitcase Carry – Hold a weight in one hand and stand tall. You can do this stationary or while walking.
Option 3: Roman Chair – With your bottom leg in front, set up with the pad at hip height and hold this position. The more horizontal you are, the harder it will be to hold.
Aim for 2 to 3 sets of 30-60 seconds for any of these exercises. Progress by increasing hold times, adding weight, or changing the position of your body.
You can also incorporate some unilateral exercises in the rest of your training, such as split squats with a dumbbell in 1 hand, since they can provide a similar stimulus as the suitcase carry.
Side Bend/Lateral Flexion Exercises
Now let’s look at the 3 dynamic versions of these exercises:
Option 1: Side Plank Thruster – The set-up is the same as the side plank, but now you’ll lower your hip to touch the floor before lifting back up.
If you want to make this more challenging by increasing the range of motion, elevate your legs and arms on benches, boxes, or whatever you have available.
Option 2: Suitcase Carry Side Bends – Without bending your knees or moving too much from your hips, reach toward the ground as far as you can comfortably go before returning to standing upright. Your uninvolved arm can be down by your side or up overhead.
Option 3: Roman Chair Side Bends – The set-up is the same as before, but you’re side bending your trunk toward the floor and back to the starting position. This can be done with or without weight, and with your arms across your chest, at your side, or overhead.
Aim for 2-3 sets of 8-15 repetitions while focusing on keeping the movements slow and controlled. Progress by increasing the range of motion, adding weight, or changing the position of your arms.
Back Extension Exercises (Isometrics)
For the back extension isometrics, which will also involve the hip extensors, here are 2 options:
Option 1: Roman Chair Back Extension Isometric – With the pad at the level of your hips, hold your trunk in a straight line. This can be performed with or without weight. The more horizontal you are, the harder it will be to hold the position.
If you have an exercise ball at home, you can set up in a similar way while trying to anchor your feet.
Option 2: Prone Superman – With your arms down by your side, slowly lift your torso and legs off the floor, only as far as tolerable, and hold this position. If needed, you can choose to just lift your upper or lower body. You can also play with your arm position and how much you actually raise off the ground.
Other bodyweight exercise options include bird dogs and bridges.
You can aim for 2 to 3 sets of 30-60 seconds for any of these exercises. Progress by increasing hold times, adding weight, or changing the position of your body.
Back Extension Exercises
For the dynamic back extension exercises, here are 3 options:
Option 1: Roman Chair Back Extension – Flex toward the floor and come back up. You can do this exercise with or without weight.
Option 2: Deadlift Variations – Conventional deadlifts, in which you start from the floor, will generally require more range of motion than single leg deadlifts or Romanian deadlifts that start in standing. The intention for any variation is to keep the low back relatively flat.
To purposely round the spine, Jefferson curls with a lighter weight are another possibility.
Option 3: Bridges or Hip Thrusts – These can be double leg or single leg, with or without weight.
Aim for 2-3 sets of 8-15 repetitions while focusing on keeping the movements slow and controlled. Progress by increasing the range of motion or adding weight.
Keep in mind that even some upper body exercises require back extension strength and endurance, such as bent over rows.
Programming Considerations
With regards to programming, exercises from each category can be performed 2-3 times per week.
For example, you could start with isometrics by doing side planks and prone supermans on one day and roman chair isometrics for lateral flexion and back extension a different day.
Over time, you could add in a third training day and/or start to incorporate the dynamic exercises.
Although I provided specific hold times and repetition ranges, you can modify the suggestions based on your goals. For instance, you might eventually perform the exercises in the 6-10 rep range to build more strength as your tolerance and confidence improve.
The key is to focus on consistency with your routine for at least 3-6 months. Some exercise variety can be beneficial, and you definitely want to perform the exercises on both sides when applicable.
If you’re wondering about other pieces of equipment, you can use a Reverse Hyper, Glute Ham Developer, or GHD, or whatever else you have available to you.
You can also do other exercises that I may not have covered here, such as the popular QL walk, in which you sit with your legs straight out in front of you and scoot forward and backward, with or without weight in your hands.
Other Considerations
Other considerations include things like rolling and stretching. You can always press or roll on a muscle if it feels good, but many people end up doing this for months or even years on end without much long-term success because it doesn’t create the same lasting effects that exercise or other lifestyle habits do.
With respect to stretching, you should achieve the results you want by performing the exercises demonstrated earlier through your full range of motion and gradually progressing that over time. However, you certainly can do any leaning or reaching stretches in standing, child’s pose, 90/90, or other positions if they feel good for you.
Summary
In summary, the Quadratus Lumborum, or QL, is one of the deepest muscles located in the lower back that primarily acts to side bend and extend the lumbar spine. Although it is often believed that one-sided low back pain, worsened by side bending, flexion, or a combination of the two, is caused by a QL strain, it’s difficult to single out the QL based on its depth, proximity to other muscles and ligaments, and shared function with other structures.
The good news is that regardless of the exact musculoskeletal tissue involved, there are strategies and exercises you can use to help.
Although low back pain can sometimes feel scary and mysterious, it doesn’t necessarily have to be approached much differently than a minor ankle sprain in most cases – take it easy for a couple of days as needed and slowly get back into your normal routine. You can facilitate this process with simple movements like cat cows and lumbar rotations, as well as belly breathing exercises and keeping up with a walking regimen.
It’s also important to temporarily modify, minimize, or avoid aggravating activities, whether that’s related to sports, specific exercises in the gym, or certain daily activities like sitting for a prolonged period of time.
If one-sided low back pain is becoming a recurring problem for you, try to identify and address the primary contributing factors, whether they’re related to your gym program or your lifestyle and habits.
Lastly, you can incorporate exercises that train the muscles of the low back in a comprehensive way to improve your tolerance and confidence to different positions and movements over time.
Movements that create a stretch under load may be more provocative initially, so you can start with isometric exercises, which are just static holds, whenever you feel ready.
As your tolerance and confidence increases, move through larger ranges of motion, add or increase weight, and use a variety of exercises to challenge yourself more over time.
Do you want a structured plan that’s going to provide you with the knowledge and tools to feel more confident, capable, and resilient than ever before? Check out our Low Back Resilience Program!
Want to learn more? Check out some of our other similar blogs:
Disc Herniations, Anterior Pelvic Tilt, Core Stability
Thanks for reading. Check out the video and please leave any questions or comments below.
