Persistent quadratus lumborum (QL) muscle tightness on either the right or left side of the back is a common complaint in those with low back trouble. Countless stretches have been developed to stretch the QL which is located between the pelvis and ribs, and when tight produces discomfort either above your hip or under your rib on your side. QL tightness is often treated with a variety of massage, foam roller work and stretching techniques, but resistant cases are often only resolved once the underlying cause of QL tightness is addressed.
One of the most common reasons for persistent QL tightness and the repeated need of QL stretching is hip hiking caused by an external rotated thigh. When the thigh is rotated outwards due to poor posture and movement habits, the pelvis or hip “hikes” upwards which shortens the QL muscle, causing tightness or pain. This is easily identified by people who habitually cross their legs or stand and walk with their foot turned outwards more than 7 degrees. As the thigh turns outwards, the outer (lateral) hamstring muscle on the back of the thigh shortens. This and other shortened muscles keep the thigh externally rotated while standing and walking, which causes the pelvis to swing or hike upwards, shortening the QL. In this common scenario, no amount of QL stretching will have lasting results unless the hip external rotation is corrected.
While there are several muscles that typically need stretching in this case, the out (lateral) hamstrings are one of the most important. Targeting the lateral hamstrings in a stretch is much different than usual hamstring stretches because the thigh needs to be internally rotated.
One method of lateral hamstring stretching to help with QL tightness can be done on the floor or on an exercise bench. From this lying face up position, pull your bent knee on the side to stretch so that it is directly above your hip. Stabilizing this knee with your hands, straighten the knee until a mild stretch is felt along the back of your thigh in your hamstrings. To target the lateral hamstrings, twist your thigh inwards as you do this (your kneecap will rotate towards your midline). Only use an amount of knee straightening and inwards thigh twist so that a mild stretch sensation is felt along the outside of the back of your thigh.
Hold this position of mild stretch until the stretch sensation resolves. This may take 15 to 90 seconds. Once resolved, you may then straighten the knee or tilt the forefoot down slightly farther for a second level of stretching.
Practicing the lateral hamstring stretch 2-6 times daily and avoiding turning your thigh outwards in all positions and daily activities will go a long way in reducing hip hiking and QL tightness.
After a while, you will not need to stretch your QL as the underlying cause of tightness has been addressed.
Dr. Michael C Remy, DABCO, CCSP is a chiropractic sports orthopedist who specializes in custom walking exercises for back pain and spine rehabilitation. His Low Back Stretch Program offers simple and effective back pain solutions through improved walking movements and techniques.
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