Quadratus lumborum stretch (12 different exercises)

INTRODUCTION

Ultrasound-guided transversus abdominis plane (TAP) nerve block has become a common analgesic method after surgery involving the abdominal wall. Because TAP blockade is limited to somatic anesthesia of the abdominal wall and highly dependent on interfascial spread, various newer techniques have been proposed to enhance analgesia, either in addition to TAP nerve block or as a single modality. In particular, variants of quadratus lumborum nerve blocks (QLBs) have been proposed as more consistent methods with an aim to accomplish somatic as well as visceral analgesia of the abdomen. The present evidence, mainly case reports, suggests that different variants of QLB have different analgesic effects and mechanisms of action, although this has not been formally validated. In particular, transmuscular QLB and the so-called QLB2 may result in wider and longer sensory blockade compared to TAP nerve block (T4–L1 for QL nerve block vs. T6–T12 for the TAP nerve blocks) (Figures 1 and 2). This chapter focuses on underlying principles for TAP blockade and the newer QLB techniques, with an understanding that the information about the latter is based on sparse evidence of limited quality as outcome-based studies are not yet available.

FIGURE 1. The transverse abdominis plane (TAP) and quadratus lumborum 1 (QL1) nerve blocks anterior view. Injection of 20 mL of contrast in the TAP nerve block resulted in the posterolateral spread from the 12th rib to the iliac crest. The QL1 nerve block after injection of 20 mL of contrast resulted in the spread of the contrast toward the transverse process cephalad alongside the thoracolumbar fascia to the 11th and 10th intercostal spaces.FIGURE 2. Transverse abdominis plane (TAP) and quadratus lumborum 1 (QL1) nerve blocks: posterior view. Injection of 20 mL of contrast in the TAP nerve block resulted in the posterolateral spread from the 12th rib to the iliac crest. After injection of 20 mL of contrast, the QL1 nerve block resulted in the spread of the contrast toward the transverse process cephalad alongside the thoracolumbar fascia to the 11th and 10th intercostal spaces.

References[edit | edit source]

References will automatically be added here, see adding references tutorial.

1. ↑
2. ↑ Keith L. , Anne M. R . Clinically Oriented Anatomy 7th edition. philidephia : Lippincott Williams & Wilkins.2017
3. ↑
4. Morgan J.  Modern Principles of Core Training. Lulu.com, 2010
5. McCall P. Cutting Edge: Training the Fascial Network (Part 2). Sign.;888:825-3636.
6. Wallden, M. (2014). The middle crossed syndrome – New insights into core function. Journal of Bodywork and Movement Therapies, 18(4), 616–620. doi:10.1016/j.jbmt.2014.09.002 
7. Page .P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach .Champaign . Human Kinetics. 2010.
8. ↑

Function[edit | edit source]

Actionsedit | edit source

• Quadratus Lumborum fixes the 12th rib to stabilize diaphragm attachments during inspiration
• Lateral flexes the vertebral column
• Extends lumbar vertebrae
• It forms with the contralateral Tensor fascia lata and Gluteus medius a lateral myofascial sling which aims to maintain frontal plane stability of the pelvis.

Functional Contributionsedit | edit source

• The primary antagonist to each quadratus lumborum muscle is the quadratus lumborum muscle on the other side of the body
• The muscle group is considered a postural muscle group
• It’s one of the muscles that tends to be tight and overactive

PATIENT POSITIONING AND EQUIPMENT SELECTION

For QL nerve blocks, the lateral decubitus position is preferred over the supine position as it provides better ergonomics and relevant sono-images of the neuraxial structures. A low-frequency (5- to 2-MHz) curved array ultrasound transducer in transverse axis is preferred to visualize the three lateral abdominal wall muscle layers and the QL muscle.

A 22-gauge, short-bevel needle is recommended for the single-injection technique, whereas an 18- to 21-gauge, 10-cm Tuohy needle with extension tubing is used for catheters. A peripheral nerve stimulator may be useful as a warning sign to prevent further needle advancement should the needle be mistakenly placed too deep and next to the lumbar plexus.

Learn more about Equipment for Peripheral Nerve Blocks

Quadratus Lumborum Kası Nedir?

Quadratus lumborum , karnın derinliklerinde yatan ve bel omurgasının her iki yanında yer alan dikdörtgen şeklinde bir kastır. QL, daha büyük kasların altında ve böbreklerin üzerinde yer alan derin bir bel kasıdır.

Fonksiyonel olarak QL, omurganın ve pelvisin stabilizasyonuna katkıda bulunur. Bir taraftaki kası bükmek gövdeyi bu yöne doğru bükerken her iki tarafın da bükülmesi omurgayı uzatır. QL ayrıca göğüs kafesi hareketleri sırasında on ikinci kaburgaya sabitlenir ve nefes verdiğinizde yardımcı bir kas görevi görür.

Quadratus lumborum, lomber omurgayı (alt sırt=bel) stabilize etmek için iliopsoas, lomber paraspinaller ve çeşitli ligamentlerle çalışan bir ekip olarak işlev görür.

(Paraspinal kaslar, erector spinae denilen  sırtınızı destekleyen üç kas grubundan oluşur. Bu üç kas alt omurgadan boyuna kadar uzanarak işlev görürler.)

A Tight QL and Serious Back Problems

The constant sideward stress of a tight quadratus lumborum creates a shearing motion in your lumbar and sacral vertebrae that can result in crippling back injuries.

Depending on the degree of tightness and the length of time you go without correcting the issue, you can suffer from:

Compression of the S1 nerve (a pinched nerve) which besides causing intense pain all the way down to your calf, can weaken your whole leg and make it hard to even lift your heel off the ground

Degenerative disc disease, which is usually the natural breakdown of your discs with age, except tight QL muscles are making it happen much faster.  Once you’ve suffered from degenerative disc disease the damage can be permanent

Scoliosis, a deformity that occurs when the spine is abnormally rotated and curved sideways. The constant pull from your tight QL will put a persistent curve in your spine that will cause major health problems

3 Step Quadratus Lumborum Stretch Program

Step 1 – Stretch the Tight Side

Here are three highly effective quadratus lumborum stretches:

Stability Ball Quadratus Lumborum Stretch

• Start by kneeling on the floor with the stability ball directly to one side.
• Now, lean over with your right arm to hold the stability ball and rest one side of your torso on the ball.
• Next, slowly straighten out your left leg (while still bending your other leg to maintain stability).
• To stretch the quadratus lumborum, slowly raise your arm up toward the ceiling.
• To increase the stretch, extend your arm over your head, in the opposite direction of your knees.
• Try holding the stretch for around 20 – 30 seconds and repeat two or three times for each side.

Standing Quadratus Lumborum Stretch

• First find a place to hold onto like a fence, pole or door frame.
• Now put your hands straight up in the air with straight elbows and bend to the side in the direction of whatever anchor point you’re using.
• Next you’ll move your outside foot behind you and toward the anchor point you’re holding.
• Slide your hands down as your body bends sideways into a comfortable stretch.
• Once you’ve reached your limit, relax into the stretch and hold it for 20 -30 seconds, while contracting the core muscles on the other side.
• Now, slowly ease back up.

Step 2 – Strengthen the Other Side at End ROM

Just stretching the quadratus lumborum isn’t good enough; you have to strengthen the opposite side at its range of motion to notice a change in the balance of the two sides.

Side Lying Hip Internal Rotation Strengthening

• Begin by lying on your side, your core muscles engaged, and your head resting on your bottom arm.  Bring your bottom knee slightly towards the chest and rest it on the ground.  Put your top knee in the air while keeping your foot on the ground and behind your bottom foot.
• Rotate your bottom leg while lifting your bottom knee towards the ceiling, keeping the top leg still and your feet on the ground.
• Return to the starting position and repeat.
• Repeat for other side.

Step 3 – Strengthen both sides through their full ROM

You need to train both left and right QL through their full range of motion to get the most benefit from my 3 step quadratus lumborum strength program.

To do this we can use the simple Dumbbell Side Bend:

• The key to this is starting top down and going vertebrae by vertebrae, without leaving the frontal plane of motion
• So start bending your cervical spine by putting ear to shoulder, then the thoracic spine and finally you’ll get a little bit of motion through the lumbar spine, then return

Don’t Let Tight QT Muscles Slow You Down

Use my 3 step quadratus lumborum stretch program to fix the pain that tight QLs are causing you and prevent the problem from recurring*.

*Although the information shared on PrecisionMovement.coach is based on a well-researched, scientific approach towards health and fitness, every person is unique and individual results may vary.

The information in this article is one more piece of information that will help you build and maintain a powerful core that will enhance your athletic ability while preventing injury.

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SUMMARY

The various TAP nerve blocks can provide somatic analgesia for abdominal wall surgery. QL nerve blocks can provide somatic as well as visceral analgesia of both the abdominal wall and the lower segments of the thoracic wall and therefore could be a useful analgesic modality for selected abdominal surgeries. QL nerve blocks may provide visceral analgesia due to their paravertebral and possibly epidural spread. The information in this chapter is based on the current knowledge, with an understanding that more specific recommendations are pending a stronger evidence base.

REFERENCES

• Carney J, Finnerty O, Rauf J, et al: Studies on the spread of local anaesthetic solution in transversus abdominis plane nerve blocks. Anaesthesia 2011;66:1023–1030.
• Elsharkawy H: Quadratus lumborum nerve block with paramedian sagittal oblique (subcostal) approach. Anaesthesia 2016;71:241–242.
• Skandalakis JE, Colborn GL, Weidman TA, et al: Skandalakis Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery. Paschalidis Medical, 2004.
• Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R: The thoracolumbar fascia: Anatomy, function and clinical considerations. J Anat 2012;221:507–536.
• Karmakar MK, Gin T, Ho AMH. Ipsilateral thoracolumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection. Br J Anaesth 2001;87:312–316.
• Børglum J, Jensen K, Moriggl B, et al: Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anesth 2013.
• Hebbard PD: Transversalis fascia plane nerve block, a novel ultrasound-guided abdominal wall nerve block. Can J Anaesth 2009;56:618–620.
• Mcdonnell JG, Curley G, Carney J, et al: The analgesic efficacy of transversus abdominis plane block after caesarean delivery: A randomized controlled trial. Anesth Analg 2008;106:186–191.
• Carney JJ, Mcdonnell JG, Ochana A, Bhinder R, Laffey JG: The transversus abdominis plane nerve block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008;107:2056–2060.
• Kadam VR: Ultrasound-guided quadratus lumborum nerve block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013;29:550–552.
• Visoiu M, Yakovleva N: Continuous postoperative analgesia via quadratus lumborum nerve block—An alternative to transversus abdominis plane nerve block. Paediatr Anaesth 2013;23:959–961.
• Chakraborty A, Goswami J, Patro V: Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep 2015;4:34–36.
• Blanco R, Ansari T, Girgis E. Quadratus lumborum nerve block for postoperative pain after caesarean section: a randomised controlleds trial. Eur J Anaesthesiol. 2015;32:812–818.
• Murouchi T, Iwasaki S, Yamakage M. Quadratus Lumborum Nerve Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery. Reg Anesth Pain Med. 2016;41:146–150.

INDICATIONS

Most of the indications for QL nerve blocks are based on case reports and clinical anecdotal experience. There are no studies comparing the safety and efficacy of the three types of QL nerve block. Table 1 compares and summarizes the three types of QL nerve blocks.

TABLE 1.Main features of QL nerve blocks.

	QLB1	QLB2	TQLB
Clinical indications	Abdominal surgery below the umbilicus.	Abdominal surgery either above or below the umbilicus (any type of operation that requires intra-abdominal visceral pain coverage and abdominal wall incisions as high as T6)	Abdominal surgery either above or below the umbilicus (any type of operation that requires intra-abdominal visceral pain coverage and abdominal wall incisions as high as T6)
Dermatomes covered	L1	T4 to T12-L1; blocks the anterior and the lateral cutaneous branches of the nerves	T4 to T12-L1; blocks the anterior and the lateral cutaneous branches of the nerves
Lower extremity weakness	Not reported	Not reported	Potential
Spread to lumbar plexus	Not reported	Not reported	Potential
Needle entry and approach	Lateral abdomen near the posterior axillary line, below the costal margin and above the iliac crest and inserting the needle inplane with the curved array probe oriented axially.	Lateral abdomen near the posterior axillary line, below the costal margin and above the iliac crest and inserting the needle inplane with the curved array probe oriented axially.	Lateral abdomen near the posterior axillary line, below the costal margin and above the iliac crest and inserting the needle inplane with the curved array probe oriented axially.
Potential complications	Complications are related to the lack of anatomical understanding and needle expertise. It is possible to puncture intra-abdominal structures such as the kidney, liver, and spleen.	Complications are related to the lack of anatomical understanding and needle expertise. It is possible to puncture intra-abdominal structures such as the kidney, liver, and spleen.	Complications are related to the lack of anatomical understanding and needle expertise. It is possible to puncture intra-abdominal structures such as the kidney, liver, and spleen.
Injection site	Potential space medial to the abdominal wall muscles and lateral to QL muscle, anterolateral border of the QL muscle, at the junction with the transversalis fascia, outside the anterior layer of the TLF and fascia transversalis	Posterior to the QL muscle, outside the middle layer of the TLF	Anterior to the QL muscle, between the QL and the psoas major muscles, outside the anterior layer of the TLF and fascia transversalis, close to the intervertebral foramen
Level of difficulty	Intermediate	Intermediate	Advanced

The various QL nerve blocks share the same indications as of the TAP nerve block. Some examples are as follows:

• Large-bowel resection, open/laparoscopic appendectomy, and cholecystectomy
• Cesarean section, total abdominal hysterectomy
• Open prostatectomy, renal transplant surgery, nephrectomy, abdominoplasty, iliac crest bone graft
• Ileostomy
• Exploratory laparotomy, bilateral nerve blocks for midline incisions

NYSORA Tips

• Close to the transverse process, the QL muscle appears thin as it is visualized anterior-posterior; visualized from the flank, the muscle looks much broader.
• Use color Doppler before insertion of the needle to detect the lumbar arteries on the posterior aspect of the QL muscle or any other large vessels.
• The QL is identified medial to the transversus abdominis muscle. The latissimus dorsi and erector spinae muscles are superficial and more hyperechoic.

Quadratus Lumborum’un İşlevi

Quadratus lumborum’unuz birkaç şekilde çalışır:

• Alt omurgayı yana doğru büküyor. (lower spine lateral fleksion)
• Gövdeyi döndürür.
• Pelvisinizi stabilize eder yani sabitler.

Örneğin, bir elinizle ağır bir çanta taşırken karşıt taraftaki QL’niz sizi düz tutmak için zorlu bir şekilde kuvvet üretir. Patlayıcı fırlatma veya tekmeleme işi yaptığınız, QL’nuz gövde konumunu korumak için sert bir şekilde esner ve vücudun her yerine güç aktarmak için omurganın dengelenmesini sağlar. (yani core kası olarak stabilizasyon sağlar.)

Kritik olarak, QL yürüdüğümüzde karşı taraftaki gluteal (kalça) kaslarıyla çalışır, bu yüzden bu kaslar zayıf olduğunda diz üzerine aşırı baskı uygulayabilir çünkü hareket şekli dengesizleşir ve merkez kasların, kalçaların stabilitesini kaybetmesine neden olur.

Sıkı Quadratus Lumborum ve Kalça İlişkisi

Sıkı olan QL tarafında lateral rotasyon olarak da bilinen uzunca etkilenen bir kalça; Bir kalça diğerinden daha yükseldiğinde, yükseltilmiş taraftaki bacağı fonksiyonel olarak kısaltır. Bu, pelvisin tepesini ve kalçayı göğüs kafesine doğru çeken sıkı bir QL’un sıkca belirtisidir.

Kısaca QL gerginliği belin o tarafını kısaltır, bel bölgesinde strese neden olur ve potansiyel olarak şiddetli sırt ağrısına ve skapular problemlere devamında düşmüş omuzlara neden olur. Bu bölgede ki sürekli çekme diz, ayak bileği ve bel ağrılarına neden olacaktır.

Квадратная мышца поясницы —

М. quadratus lumborum, квадратная мышца поясницы, четырехугольная мышечная пластинка, лежащая впереди m. erector spinae и отделенная от последнего глубоким листком fascia thoracolumbalis. Начавшись от подвздошного гребня и lig. iliolumbale, она идет к XII ребру и к поперечным отросткам I-IV поясничных позвонков.

Функция. Квадратная мышца поясницы при одностороннем своем сокращении вместе с другими брюшными мышцами и m. erector spinae наклоняет в сторону позвоночный столб с грудной клеткой. При тоническом сокращении на обеих сторонах одновременно с теми же мышцами она удерживает позвоночник в вертикальном положении. Оттягивая XII ребро книзу, может действовать и как выдыхательная мышца. (Инн. Th12, L1-4. Plexus lumbalis.)

Какие анализы и диагностики нужно проходить для Квадратной мышцы поясницы:

Осмотр травматолога

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Другие анатомические термины на букву «К»:

Кисть

Крайняя плоть (препуций)

Клитор

Коленный сустав

Кровь

Кишечник

Кровеносные сосуды

Конечный мозг

Костная ткань

Костный лабиринт

Клетка

Кадык (адамово яблоко)

Кровеносные капилляры

Капилляры

Кость

Кости голени

Кости стопы

Ключица

Копчиковые позвонки

Копчик

Крестец

Кости запястья

Колено

Кора головного мозга (плащ)

Кожа

Красный костный мозг

Клапан аорты

Кровобращение плода

Крестцовое сплетение

Копчиковое сплетение

Клетчатка глазницы

Конъюнктива глаза

Клиновидная кость

Кости лица

Кости предплечья

Кости кисти

Кости пальцев кисти

Кости пальцев стопы (фаланги)

The Function of the Quadratus Lumborum

Your quadratus lumborum functions in several ways:

• It bends the lower spine sideways
• It rotates the trunk
• It stabilizes your pelvis

So when you’re carrying a heavy bag in one hand your QL on the opposite side is firing hard to keep you straight.  Throwing or kicking explosively requires the QL to flex hard to maintain torso position and stabilize the spine to transfer power throughout the body.

Critically, the QL works with the gluteal muscles on the opposite side when we walk, so when those muscles are weak it can put excessive stress on the knee because the movement pattern becomes unstable causing the core and hips to lose stability.

An effective quadratus lumborum stretch will help* undo this damage.

Techniques[edit | edit source]

Related Pathologiesedit | edit source

Dysfunction of the lumbar structures whether degenerative, neuropathy, and/or inflammatory, may contribute to poor muscle firing and weak stabilization by the QL.

Lumbar spine pathologies like bulging discs, and facet joint hypertrophy from chronic inflammation may effect nerve conduction and response to the QL and Iliopsoas resulting in poor muscle stabilisation and mechanical stress from chronic contracture.

Moaratty-Koehler Syndrome (MKS) is another condition related to QL dysfunction.

Treatmentedit | edit source

https://youtube.com/watch?v=OxJzVs738Oo%3F

https://youtube.com/watch?v=Xjg6Gkla03g%3F

https://youtube.com/watch?v=m-U4X9R4JDo%3F

https://youtube.com/watch?v=22B2SpMpoUQ%3F

What Causes the QL to Tighten Up?

You can’t win when you’re dealing with a tight QL; inactivity and overuse can both cause a tight QL.  The key issue is chronic forward flexion: whether you’re sitting still or riding a bike, maintaining forward flexion for long periods can create tight QL muscles [].

The back surgery I had when I was in high school left me with a contracted right side – the side where the scar is.  Because of this, my right shoulder is lower than my left and before doing any exercise; I always lengthen the right QL to achieve symmetry, especially with any axial loading exercises like Squats or Deadlifts.

This is just something I have to do before training and it won’t go away because it’s related to the huge scar I have from going under the knife that will never be as elastic as normal skin.

stretches

I have divided these stretches into 3 different levels of intensity (light, moderate, strong).

(Note: If you have lower back issues, start on light stretches and progress as appropriate.)

A) Light stretch

1. Knee to chest

Target area: Lower Quadratus Lumborum

Instructions:

• Lie on your back.
• Bring your knees up and hug your knees towards your chest.
• Be sure to keep your legs completely relaxed.
• Gently hug your knees towards your chest.

2. Child’s pose

Target area: Lower Quadratus Lumborum

Instructions:

• Start in a crawling position.
• Sit on your completely bent legs. (see above)

  Bring your buttocks towards the back of your ankles.

• Stretch out both arms and place them in front of you.
• Aim to round your lower back as much as possible.
• To stretch the left side, reach out both arms to the opposite right side. (and vice versa)

3. Side tilt (standing)

Target area: Upper Quadratus Lumborum

Instructions:

• Whilst standing, place your left hand on left hip.
• Push your hip towards the right.
• Whilst reaching over to the left with your right hand, tilt your torso to the left.
• Aim to feel a stretch on the right side.
• Repeat on other side.

4. Side tilt (sitting)

Target area: Upper Quadratus Lumborum

Instructions:

• Sit crossed leg on the floor.
• Pin and maintain your right leg down.
• Reach over to the left side with your right arm.
• Feel the stretch on the right side.
• Repeat on the other side.

B) Moderate stretch

5. Side lie on exercise ball

Target area: Upper and Lower Quadratus Lumborum

Instructions:

• Lie on your side on an exercise ball.
• Keep your feet near a wall to maintain balance.
• Reach over with the arm on the upper side.
• Aim to feel a stretch on the upper side.
• Repeat on other side.

6. Side lie on bed

Target area: Lower Quadratus Lumborum

Instructions:

• Lie on your side on the bed.
• Allow for your upper leg to hang off the side.
• Reach over with the upper arm and hold onto something stationary to keep you pinned down.
• Relax your upper leg and allow gravity to pull you into the stretch.
• Do not let your pelvis rotate forwards.
• Aim to feel a stretch on the upper side.
• Repeat on other side.

7. Wall lean

Target area: Upper Quadratus Lumborum

Instructions:

• Place your right forearm onto the wall.
• Position your legs away from the wall.
• Lean the right side of your body onto the wall.
• Aim to feel a stretch on the side closer to the wall.
• Repeat on other side.

8. Side lie QL stretch

Target area: Upper Quadratus Lumborum

Instructions:

• Lie down on your side.
• Prop your upper body onto your forearm.
• Whilst keeping your pelvis pinned to the ground, try to push your torso as up right as possible.
• Aim to feel a stretch in the upper Quadratus Lumborum on the side closest to the floor.
• Repeat on other side.

9. Pelvic side tilt

Target area: Lower Quadratus Lumborum

Instructions:

• Whilst standing, lean all the way over to your right side.
• Allow your left leg to lift and dangle.
• Allow gravity to pull your left leg down.
• Do not let your pelvis rotate.
• Aim to feel a stretch in the left side.
• Repeat on other side.

C) Strong stretch

10. Wall stretch

Target area: Upper/Lower Quadratus Lumborum

Instructions:

• Assume the position above.
• Whilst holding onto the door frame, let your upper arm take the weight of your body.
• Whilst anchoring your legs as shown, aim to bend your mid section as much as possible.
• Repeat on other side.

11. Side lie QL stretch (elevated)

Target area: Upper Quadratus Lumborum

Instructions:

• Lie down on your side.
• Prop your forearm onto a chair.
• Whilst keeping your pelvis pinned to the ground, try to push your torso as up right as possible.
• Repeat on other side.

12. Side bend (with wide stance)

Instructions:

• Start with your feet wide apart with your left foot turned out to the side.
• With arms outstretched, start to bend all the way to your left side.
• Aim to reach your upper arm as far to the left as possible.
• Keep your body in line with your left leg.
• Keep your legs fairly straight.
• Repeat on other side.
• Target area: Upper Quadratus Lumborum

Conclusion

By now, you should have 12 different ways to do a Quadratus Lumborum stretch!

You do NOT have to do ALL of them.

Pick the ONE that gives you the best stretch… and do it regularly!

What to do next

1. Any questions?… Leave me a comment down below.

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the QL stretches!

DOSE AND VOLUME OF LOCAL ANESTHETIC

The TAP nerve blocks as well as the TQL nerve block and QLB1 are “tissue plane” nerve blocks and thus require large volumes of local anesthetic to obtain reliable blockade. For each of the TAP nerve blocks, a minimum volume of 15 mL is recommended. The local anesthetic dose needs to be considered for the size of the patient to ensure that a maximum safe dose is not exceeded, especially with dual bilateral TAP nerve blocks. The QL region is relatively vascular as the lumbar arteries lie posterior to the muscle. Absorption of the local anesthetic into the circulation depends primarily on the vascularity of the site of deposition. As the QL muscle is well vascularized and a large volume of local anesthetic is needed, the dose should be calculated accurately to prevent high peak plasma concentrations of local anesthetics in this type of nerve block.

For additional information follow the link to Clinical Pharmacology of Local Anesthetics

Sıkı Bir QL ve Ciddi Sırt Problemleri

Sıkı bir quadratus lumborumun sürekli yanal stresi belinizde ve sakral omurlarınızda, sırtınızın sakatlanmasına neden olabilecek bir kesme hareketi yaratır .

Sızdırmazlık (problem) derecesine ve sorunu düzeltmeden gittiğiniz süreye bağlı olarak, aşağıdakilerden muzdarip olabilir:

Sıkı QL kasları dışında genellikle disklerinizin yaşla doğal olarak parçalanan dejeneratif disk hastalığı, çok daha hızlı gerçekleşmesini sağlıyor . Dejeneratif disk hastalığından muzdarip olduktan sonra hasar kalıcı olabilir.

Skolyoz, omurga anormal şekilde döndürüldüğünde ve yana doğru kıvrıldığında meydana gelen bir deformitedir. Sıkı QL’nizden sürekli çekme, omurganızda önemli sağlık sorunlarına neden olacak kalıcı bir eğri oluşturacaktır.

Diz Ağrısı ve QL Bağlantısı 

Diz ağrısı farklı bir Quadratus lumborum problemidir. Sızdırmazlık yerine yani problemli bölge, muhtemelen zayıf bir QL kasınızdan dolayı olur.

Sağ diz ağrınız varsa nedeni genellikle sol QL ve sağ kalça arasında bir kuvvet dengesizliği yaratılmasından dolayıdır. Sol QL kasınızı güçlendirerek bu diz ağrısını hafifletebilirsiniz!

Tight QLs and a Hiked Hip

A hiked hip, also known as lateral rotation on the affected side; is when one hip sits higher than the other functionally shortening the leg on the elevated side [].  This is a common symptom of a tight QL, which attaches at the top of the pelvis and pulls the hip closer to the ribcage.

QL tightness shortens the waist on that side causing stress on the lumbar area and potentially causing severe back pain, and a dropping shoulder that will produce scapular problems.

This constant pulling on one side can create a range of other unpleasant symptoms:

• Low back pain
• Knee pain
• Foot pain

If one hip is noticeably higher than the other (and you don’t have a true leg discrepancy) or one shoulder is noticeably lower than the other, the odds are good that you’re suffering from a tight quadratus lumborum.

Pain coming from the quadratus lumborum will be described as being anything from a deep low back ache to a knife like sensation. The techniques we’ll go through today could provide relief.