Browsing Category

Chronic Pain

Back pain, Chronic Pain, groin pain, Hip pain

Quadratus Lumborum – Why it hurts and How to fix it

September 4, 2017 • By

Back pain, Quadratus lumborumThe Quadratus Lumborum can cause some real grief through your back, buttock, hip, and groin but with the right management, exercises and self-treatment, you can be pain free – long term.

Where is quadratus lumborum pain felt?

You can see the pain referral patterns below for the deep (closer to the spine) and superficial fibers of the QL muscle. Referral from the quadratus lumborum can vary a lot between people due to this varied referral pattern, in some, it can be a literal pain in the butt and others it is the side of the back, hip or the groin.

Quadratus lumborum pain Quadratus lumborum pain

Quick anatomy

You can easily see from the video below that is the quadratus lumborum tightens up, it can pull at your bottom ribs, vertebrae or pelvis and if this happens one side more than the other, it can lead to some real asymmetry and not just cause back pain but a whole raft of other things.

How can a tight quadratus lumborum effect you?

Apart from being painful, it can also increase the load on quite a few other structures. Often when one side tightens up it can lift that side of your pelvis a little making you feel out of place or out of alignment (even though your back can’t go out of place,1). It can also pull at your ribs, tilting you to the side, limiting your reaching and restricting your breathing. And last but not least if the QL is tight on both sides, you get more compression on your spine.

The QL can also:

  • Cause a sharp stabbing pain in the low back
  • Cause pain and limitation when trying to turn in bed or stand from sitting
  • Make it look like you have a leg shorter than the other by holding one side of your pelvis higher
  • Contribute to a lot of other issues such as patellofemoral pain, trochanteric bursitis and scoliosis due to asymmetrical tension

So how do we fix it?

In three steps:

  1. Ease the pain by decreasing tension by releasing the muscle (stretching often doesn’t help)
  2. Get you back to normal by regaining full range of motion through your back and hips
  3. And finally, treat the cause by improving strength of the QL so that it can handle everything you throw at it

 

1. Ease pain

For this, we need the muscle to relax so the most important thing is reducing aggravating activities and applying heat. Heat can be applied be a wheat bag, hot water bottle, heat rub or anything similar, it will make a big difference. Of course make sure you don’t make it too hot or hurt yourself, by following the instructions.

Also, you can directly release the quadratus lumborum, which is far more specific than stretching. Check out our past blog post to learn how to do a myofascial release for your Quadratus Lumborum.

2. Regain normal range

We need to now get everything back to normal – not just the quadratus lumborum but the muscles that have changed because of the asymmetry that the QL caused. The following stretch is perfect for this, just remember to relax into it and that it isn’t, no pain-no gain.

Gluteal stretch: This will help even you out and regain hip range

3. Strengthen

Now get you quadratus lumborum stronger so that it can handle what you want to be able to do. A stronger QL means less pain and you have more control and power, without having to avoid things constantly.

To load the QL, we need to load the side of your body and the best way to do this is the side planks and the one sided farmers carry:

Side plank Level 1

Hold for up to 1 minute. Once you can do that comfortably, progress to level 2 below.

side plank for core strengthening

Side plank Level 2:

In the side plank, raise your top leg up and down up to 10 times. Repeat 3 times each side.

 

Side plank leg raises

 

one sided farmers carry for QL strengtheningOne sided farmers carry:

Hold onto a dumbbell, kettlebell or anything with a bit of weight to it in one hand and do some laps (e.g. 10 x 10m laps on each side).

Carrying a weight on one side makes the QL and obliques on the opposite side work hard to keep you upright.

Note: Don’t do two sided carry like in the picture!

Tip: try to stay upright!

 

And that’s it.

Heat

Release

Stretch

Strengthen

Work at that most days and notice the results.

On a side note, once you are feeling improved, don’t slack off on the exercises, they are great to do just to maintain yourself in great condition, even if it is just three times per week.

 


Back pain, Chronic Pain, Health

Low Back Pain – Why it sticks around

February 11, 2014 • By

Lower Back Pain can be very limiting, annoying and really hang around. Her is how you can help that with some great info and lower back exercises!

In my previous posts on low back pain I have shown you how to get up and moving when in acute low back pain, what sciatica is and how to treat it and finally I made you a maintenance regime to keep your back strong and mobile.

Today I want to run through one of the reasons back pain can really hang around and affect our lives so much AND run through some effective lower back exercises to address these reasons.

 

As with a lot of other injuries such as ankle sprains, simple injuries can linger around and even turn chronic because proprioception is lost in that area. This means that you lose kinetic awareness, the ability to know where your body is in space. Our bodies are amazing in the fact that normally you can know where your body parts are with your eyes closed – like holding your arm up in a certain position, closing your eyes and copying it with the other arm – you will be very similar if not spot on. You can do this because you have proprioception.

A recent study compared chronic low back pain patients to pain free patients and looked at the ability to reposition into a good sitting position from being slumped down. they found that the patients with low back pain were undershooting and not getting into good positions – this increases the risk of further back injury and aggravation and you wouldn’t even know it. Also when a sample of the fascia surrounding the back and connecting the legs and arms together (thoraco-lumbar fascia) is taken and analysed – patients with back pain have lost the innervation to that area. This all adds up to you not knowing when your back is in a bad position when you have back pain and this can lead to ongoing problems.

So to re-train your back and get the feeling back there is a couple of things you can do:

  1. bird-dog exercise for glute and spinal strength, stability and balance. physiotherapy exerciseBird-Dog: This lower back exercise is great for retraining the thoraco-lumbar fascia – this connects two of the largest muscles in your body – Latissimus dorsi (Lats) and gluteus maximus. It helps to promote coordinated movement between upper and low limbs while having a stable low back. Action: start on your hands and then extend opposite arm and leg. Do this slowly and KEEP YOUR BACK STRONG (imagine there is your dinner or a fish bowl on your low back!). Do 2 sets of 20, alternating each side (you may need to start off doing less or just using the leg).
  2. Body checks: when at work, at the gym and especially when sitting – stop and check where you are in space , make sure your low back isn’t rounded out and your shoulders aren’t rounded forward. every 20 minutes check your self and right it.
  3. Keep you back strong and mobile with these great lower back exercises

 

Please comment, share and follow me for more!

 


Chronic Pain

Chronic pain – All in my head?

January 6, 2014 • By

Your central nervous system plays a massive role in ongoing and chronic pain, Here we will discuss why patients are often told pain is in their head and how you can help it train your brain.

chronic pain - is it in my head? - explained and how to fix itPain is subjective, meaning every single person responds to and feels it differently. This is because the pain receptors (nocioceptors) around your body sense something going on and send the signal up to your brain. How the brain processes/perceives this signal depends on a combination of things:

  • Gender: Hormones can affect perceived pain.
  • Family: How you were taught to react to pain as a child.
  • Past experience: The degree of pain felt in the past and how traumatic it was changes how your brain reacts to pain, for example.
  • Mood: Your mental state can affect how you feel pain. Things such as sadness, depression can increase pain perception. Be aware that it can also happen the other way around!

This is why there is a huge variety of pain tolerances in our society – the varying upbringings and experiences that occur in everyone’s lives.

Chronic pain and you:

Chronic pain is pain that exists after an acute injury has healed or after the normal tissue healing time (generalized to 3 months). For one reason or another reason, the injury does not fully heal (this could be because of some overlooked contributing factor but often for unknown reasons) and the nerve fibers continue to send pain signals up to the brain. With all these signals shooting up to the brain telling it that there is something bad going on, the brain begins to accept these like they are a normal thing, improving the pain pathways, making them more efficient. This results in more pain. Also along with this the chemical messengers that are used in the pain network increase and over time the threshold (how much stimulus is needed) for pain lowers.

Put more simply, with the continued and increased pain signals the brain gets used to them, think of them as normal and becomes more sensitive to them so a smaller and less intense stimulus is needed to feel pain! This is called Central Sensitization.

This is why people are often told that “it is in your head” and yes your brain is definitely contributing to your pain because it has become more sensitive but ALL PAIN IS REAL.

So how can we mitigate the effects of chronic pain and reduce the pain? Try some of these steps:

  1. Relax: Stress and tension will increase pain so practice relaxation techniques – these are easy and can reduce pain by up to 50%. There are multiple options here, find something that works for you! e.g. relaxation.
  2. Keep active: Physical activity boosts endorphins (natural pain-killer), boosts the immune system and helps get your body stronger!
  3. Get serious about rehabbing yourself – find out what you need to do from a Physio that will find your deficits and get to it, regularly and you will improve.
  4. Find appropriate healthcare providers e.g. a doctor that specializes in pain management, a psychologist and a physiotherapist that not only looks at your injury but you as a person.
  5. Eat healthy and don’t over indulge (no overeating, excess alcohol or tobacco consumption).
  6. Drink enough water: Females over 2 litres and men over 2.5 liters.
  7. Get enough sleep: Infants need about 16 hours per day, teenagers need about 9 and for most adults 7 to 8 hours a day is the best amount.
  8. Positive: Get social support by going to events etc that you enjoy(sports, music, dancing etc.) and keep positive people around you, not negative.

Remember all pain is real and everyone experiences it in a different way and most importantly it is NOT something you have to live with. It can be helped and improved.

Please like, share and comment.

 

You may also like:

5 great exercises for neck pain

Mobilise yourself!