Low back pain is a prevalent global health issue affecting millions of people, causing significant disability and economic burden. This condition encompasses nociceptive, neuropathic, and nociplastic pain, and compensatory patterns sometimes often resulting from modern lifestyle factors such as prolonged sitting and reduced physical activity. Particularly in sitting professionals, musculoskeletal issues like quadratus lumborum (QL) muscle dysfunction can contribute to chronic lower back discomfort.
Low back pain encompasses nociceptive, neuropathic, and nociplastic pain, sometimes grouped under nonspecific low back pain which is brought on by an exaggeration of pain in the central nervous system are all included in the broad category of low back pain
According to studies, up to 23% of adults globally experience chronic low back pain, and between 24% and 80% of cases reoccur within a year. Adults experience up to 84% of their lifetime with back discomfort
This condition is often painful and can occur due to modern life style and digital revolution has transformed daily activities, with extended screen time (average 8-10 hours), prolonged sitting in non ergonomical positions puts undue stress on the lower back muscles, resulting in pain, stiffness, and fatigue
As common as the condition exists, there are several procedures, and these tried and tested forms of rehabilitation have proven to provide the most effective results for the betterment of the largest number of patients
The lumbar spine is designed to be incredibly strong and provide stability, protecting the highly sensitive spinal cord and spinal nerve roots. At the same time, it is highly flexible, encouraging mobility. This occurs in different planes across the body. In addition, tightness in and around the muscle decreases lumbar mobility by inactivating muscles in response to firing changes and shortening muscles
The quadratus lumborum muscle enthesopathy and myofascial pain are two major causes of lower back pain
31yr male works as a software expert, right hand dominant. He complained of lower back pain/discomfort, which was localized at right Quadratus lumborum (QL) muscle which started slowly and progressed sharply. He was given medicines which gave him some relief & was then directed to physical therapy. He complained of lower back stiffness and referred pain radiating to his right lower limb after sitting for more than 15 minutes, which made it difficult for him to stand up straight instantly.
VAS is a numerical pain rating scale used to assess pain intensity, A ruler is used to measure the distance (mm) between the patient's mark and the "no pain" anchor on the 10-cm line. This measurement yields a score between 0 and 100. Higher scores correspond to more intense pain. no pain (0–4 mm), mild pain (5–44 mm), moderate pain (45–74 mm), and severe pain (75–100 mm).
The Oswestry Disability Index (ODI), a patient-completed questionnaire, provides a subjective percentage score of function (disability) in activities of daily life. The questionnaire has 10 questions which consists of our day-to-day activities of daily living and each question contains of 6 statements which will be scored from 0 to 5 based on the answers given by the patient and o indicates the least disability and 5 indicates more disability and overall score was calculated as a percentage and in that the 0% indicates no disability and 100% indicates the highest level of disability.
Schober’s test is classically used to determine if there is a decrease in lumbar spine range of motion (flexion). An increase of less than 9cm is a positive test and may indicate Positive Schober’s Test: Less than 9cm increase in length with forward flexion: Decreased lumbar spine range of motion.
This novel approach was selected over the conventional treatment methods as it integrates multiple therapeutic interventions (dry needling, MET, segmental mobility and progressive loading) that specifically target the biomechanical relationship between QL and iliopsoas muscles, addressing both local and global movement systems while providing rapid pain relief and functional restoration as shown in
The therapeutic intervention consisted of Initially, invasive intervention trigger point dry needling 0.25*0.75mm sterile, single-use, solid filament needles were used was performed targeting both the superficial and deep fibres of the right quadratus lumborum with a 10-15 minutes of intervention time and needle manipulation was done pistoning technique.
Immediate post-needling care, cryotherapy was administered to the treated area for 15 minutes at the right QL region, spanning from T12 to L4 vertebral levels. Subsequently, neuromuscular modulation was done using transcutaneous electrical nerve stimulation (TENS)with a frequency of 80-120Hz and pulse duration 50-100 microseconds and intensity was adjusted to patient comfort level producing visible muscle contraction with 20 minutes of duration and the quadripolar application surrounding the hypertonic quadratus lumborum.
Therapeutic exercise intervention of quadratus lumborum eccentric loading using the post-isometric relaxation (PIR) protocol in a left side lying position with initial contraction: 20% of maximum voluntary contraction and Hold duration of 7-10 seconds with Relaxation phase between 3-5 seconds and Stretch phase of 15-20 seconds for Sets 3-5 repetitions.
The left iliopsoas underwent a release protocol using manual therapy specifications patient lying in supine and hip flexed to 90 degrees with progressive pressure application with respiratory synchronization with a duration of 30-45 seconds per point and gradually progress pressure through 3 cycles and followed by the release it went to activation sequence in hook lying position with spine in neutral and 10 repetitions *3 sets with 5 seconds hold per repetition.
The tailored exercise regimen was described in detail in
Post-intervention imaging demonstrates marked improvement in muscular symmetry and notable correction of spinal alignment shown in
|
DAY |
TREATMENT PROGRAM |
EXERCISE |
SETS/DURATION |
REPETATIONS |
FREQUENCY |
|
Day 2 |
Stretching: Quadratus lumborum |
side bending stretch |
30 sec hold |
3 reps |
3x daily |
|
|
|
modified child’s pose |
30 sec hold |
3 reps |
3x daily |
|
|
Stretching: Iliopsoas |
Half-kneeling Strech |
30 sec hold |
3 reps |
3x daily |
|
|
Mobility: Lumbar |
Cat-camel exercise |
3 sets |
10 reps |
3x daily |
|
Day 3 |
Stretching: Quadratus lumborum |
side bending stretch |
30 sec hold |
3 reps |
3x daily |
|
|
|
modified child’s pose |
30 sec hold |
3 reps |
3x daily |
|
|
Mobility: Lumbar |
Rotation in Quadruped |
3 sets |
10 reps |
3x daily |
|
|
Stability |
Transversus Abdominis Activation |
7 sec hold/2 sets |
10 reps |
2x daily |
|
Day 4 |
Stretching: Iliopsoas |
Half-kneeling Strech |
30 sec hold |
3 reps |
3x daily |
|
|
Mobility: Lumbar |
Cat-camel exercise |
3 sets |
10 reps |
3x daily |
|
|
Stability |
Transversus Abdominis Activation |
7 sec hold/2 sets |
10 reps |
2x daily |
|
|
|
pelvic floor activation |
3sets |
10s contractions/5 sets |
5 min total |
|
Day 5 |
Stretching: both |
All stretches |
30 sec hold |
3 reps |
3x daily |
|
|
Mobility: lumbar |
both exercises |
3 sets |
10 reps |
3x daily |
|
|
Stability |
both exercises |
As Prescribed |
As Prescribed |
As Prescribed |
|
Day 6 |
Previous exercises + |
side plank progressions |
3 sets |
15 sec holds |
60s rest |
|
|
Strength: obliques |
Pall of press |
3 sets |
12 reps |
daily |
|
Dat 7 |
Previous exercises + |
side lying hip abduction |
3 sets |
15 reps,3 sec hold |
daily |
|
|
Gluteus Medius |
Review all exercises |
As prescribed |
As Prescribed |
daily |
The comparison between the baseline and one-week outcome measures following manual therapy and tailored exercise programs is shown in
These findings suggest that there was a reduction in pain and improvement in spinal mobility, as well as disability, following the manual therapy and tailored exercise therapy program.
Low back pain is frequently caused by the quadratus lumborum, which is often overlooked in spinal mobility and stability
The physiological benefits of stretching extend beyond simple mechanical elongation of muscle fibres. When applied appropriately, stretching initiates several physiological responses, including enhanced blood flow, increased tissue elasticity, and improved proprioceptive feedback
The case study showed significant improvement in VAS, ODI, and spine mobility (Schober's test) within a week of sessions, maintained through exercises
There exists a significant relationship between the quadratus lumborum (QL) and iliopsoas muscles as demonstrated in this case report. The hypertonic left QL creates tension that draws the lumbar vertebrae toward the iliac crest. This mechanical force induces lateral spinal flexion to the left side, which develops as a compensatory mechanism for the right iliopsoas tension. The resultant lateral flexion elevates the left hemipelvis, and in response, the body compensates through right iliopsoas hypertonicity, which functions to restore spinal alignment toward midline and maintain pelvic stability
QL shortening results in ipsilateral lumbar compression, subsequently diminishing intervertebral spacing. This mechanism progressively leads to pelvic rotation, increased lumbar lordosis, compensatory scoliosis, and altered hip biomechanics. The interdependence of these muscles is particularly significant due to their shared attachments to the lumbar spine and their synergistic roles in postural maintenance and movement. Dysfunction in either muscle typically affects the other, as both are integral to spinal and pelvic stability
The result of the study proved that there was significant difference in improvement in pain, disability, and functional assessment to conclude the combined effect of Myofascial release, muscle energy technique of Quadratus lumborum has been shown to be effective in treatment, followed by follow-up exercises given to the patient.