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groin 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.

 


groin pain, Hip pain, Lower limb

Hip Arthritis: The best self-management exercises

August 15, 2013 • By

Hip Osteoarthritis affects 11.5% of men and women and can be an extremely debilitating Hip osteoarthritis self treatment, self help exercises to decrease paindisease for those of you affected. Clinical guidelines for best treatment recommend a combination of conservative non-drug treatment and drug therapies and in particular a focus on “self help and patient driven treatments”. This is what I want to give you today – the information, advice, tools and exercises that you need to decrease the pain and limitations from Hip Arthritis and feel great!

Article layout:

  1. Risk factors for hip OA
  2. Exercise program
  3. Physical activity and weight loss
  4. Physio benefits and self-help tools

Risk factors: Developing arthritis of the hip is due to a combination of factors that add up to increase the load through your hip joint and leading to increased degenerating and bone growth.

Below are the main factors leading to Hip OA:

– Joint shape and past injury

– Predisposition to OA: Gender, age, race, genetics

– Poor muscle function and stability surrounding the hip

Factors adding to OA pain and progression:

– Obesity

– Physical activity levels

– Co-morbidity

– Muscular function.

So: There are definitely some factors there such as joint shape, past injury and age, that we cannot alter, but there is A LOT that we can help with and improve, so in the rest of this post, that is exactly what we are going to do!

Goals of program:

– Unload the hip joint.

– Strengthen and stabilize muscles surrounding the hip.

– Address the contributing and aggravating factors.

Exercise Program:

birddog exercise to muscle coordinatin, glute activation. decrease low back and hip pain

Bird-Dog exercise

Goal: In order to increase muscle coordination and glute activation.

Action: on your hands and knees, slowly extend out your opposite arm and leg, hold for 5 seconds then lower down and repeat 10 times.

Tips: start with just one leg if this is too hard.

 

bridge - glute strenght, decrease back, hip and knee pain.Bridge exercise

Goal: to increase strength and activation of low back and hip extensor muscles.

Action: Lying on your back with knees bent, squeeze your glutes and lift your bottom and low back off the ground. Hold for 5 seconds, lower down and repeat 10 times.

Tip: to advance, cross arms over chest and keep one leg straightened out in the air.

Clam exercise plus - gluteus medius strengthening, pelvic stabilityClam exercise

Goal: to increase hip stability and balance and to reduce hip drop when walking.

Position: Side lying with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 30reps on each side.

hip flex 2Hip Flexor stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Action: In the position shown, reach up tot he sky, tuck your bottom underneath you and hold for 1 minute.

Tip: Add a cushion under your knee if sore.

 

 

glut and Lat stretch - Hip flexibilityGlute stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Position: starting on hands and knees, bring one knee in between your hands and straighten the other leg behind you. walk your hands out in front, first onto your elbows and then reaching out if possible.

Tip: take the back leg across to the opposite side.

Advanced exercise:

Single leg Squat, hip stability and strengthDouble and single leg squats: These exercises make the hip stabilizers work in unison and are great for those of you with mild OA.

Start performing Double leg squats and progress to 1 legged, making sure not to work into pain.

Tip: stick your bottom out like you are going to sit down.

 

Do all exercises daily and twice daily if you have the time!

Physical activity and weight loss

Increase load though excess body weight can cause increased pain and disease progression and is something we can definitely do something about! Having a graded exercise program where you gradually increase your activity levels can decrease, pain, increase quality of life and importantly reduce the need for joint replacement in people with hip osteoarthritis.

The best way to do this? set an achievable goal eg. Bike, 10km, walk 3 km, run 20 minutes, swim 500m etc and the time you want to do it in(eg. 2 months) then build slowly towards this! Not only will exercise help your hip arthritis but it will improve your peace of happiness and well-being over-all!

There is a lot of people out there saying to stay off arthritic joints but exercise has been proven to be very beneficial for arthritis so it is a matter of doing what your body can handle – swimming and biking are great as they put less load through the joints.

The Benefits of Physiotherapy:

The benefits of manual therapy are very real and can make a huge difference to your pain and movement. To help out with the great work to you do at home (see exercises above!) I fully recommend consulting a good hand-on Physiotherapist/ Physical Therapist and you won’t be disappointed.

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Quick Stability and Balance test

Glute activation: the missing link


Back pain, foot pain, groin pain, Knee pain, Lower limb, running, training

Quick Stability and Balance test

July 29, 2013 • By

Here we discuss an easy test you can do in front of a mirror at home to see why you are having hip, knee or back painGood lower limb stability and control comes straight from your gluteal muscles, and if these aren’t functioning right – your back, hip, knees and feet better watch out!

Stability of the Lower Limb ultimately derives from your hip. The muscles surrounding your hip work to keep your entire body upright on top of your leg and vice versa work to maintain correct alignment of your leg. I see far too many injuries caused by poor hip stability, such as:

  • Patello-femoral pain (knee pain)
  • IT band syndrome
  • Femoral acetabular impingement (hip pain)
  • Iliopsoas tendinopathy (groin pain)
  • Patella tendinopathy
  • and much more hip, knee and foot repetitive strain injuries!

The simple Single Leg Squat is a fantastic test to look at Lower limb biomechanics and control and can easily show you why you are getting pain or tightness down the chain,

The test:

This is best done in front of a mirror or video camera.

Position: Standing on one leg with your arms straight out in front of you (Your other leg can be out in front or bent beside your other leg but never touching the ground or other leg).Single leg Squat, hip stability and strength

Action: squat down like you are going to sit on an imaginary chair behind you. Stop and come back up when you reach your challenge point (before you fall over).

Repeat 10 times (If you can!), then start again on the other leg.

What to look for:

  • Your knee should track straight above your foot, towards your big toe. Typically with poor hip stability you will see the knee going inwards or shaking – If it does this your glutes are not firing or strong enough.
  • No hip drop – your pelvis should stay level (horizontal) if it drops – we have a problem!
  • Your knee bends right forward past your toes – you are relying far too much on your quads and not using your Glutes and so leaving your leg vulnerable.
  • Can’t do 10 reps or you start doing any of the above three towards the end – your Glutes have poor endurance.

 

So, how do we improve your results? See my post on Exercises to Improve Glut activation and strength and re-test every two weeks to check your progress.

 

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