Low back pain – SI Joint Pain

Quadratus Lumborum "I've Been Shot in the Back" Muscle - One-Sided Low Back Pain and SI Joint Injury

This month's topic will be one of the most important for many readers.

A remarkable number of people are familiar with a joint that you really have no business knowing about unless you’re an anatomy professor.

It’s not like your elbow or knee or wrist that you willingly use every day. In fact, it barely even moves at all, but rather wiggles a little when you walk in a tiny figure 8 pattern that is virtually undetectable to all but the trained professional’s eye.

It’s called your Sacroiliac Joint or SI joint, and if you put your hands on your hips backwards, your fingers would pretty much be right on top of the joint (as shown in green on our 4 yo model to the left). Not exactly one of the "head, shoulders, knees, and toes" parts of the body we refer to on a regular basis.

So why in the world would anyone have even heard of this joint, outside of anatomy class?

The reason it's far more familiar than it should be is because when you injure this joint, it is so painful it often drops you right to the floor. It is described as "one-sided low back pain that feels like you’ve been shot in the back and have to hold on to anything around you just to remain somewhat upright."

The disabling pain covers pretty much right where the hand is in the picture of our little friend. When it happens, you have no choice but to lie in bed until it heals enough to stand again. This joint alone is responsible for an enormous number of visits to the chiropractor, which is where many of us have learned or relearned of its name.

But wait, isn’t this e-Newsletter about muscles, not joints?

Well, first the key to a healthy joint is healthy strong flexible muscles that attach to it, move it and support it. Remember this physiology fact: Muscles are the first line of defense for any joint.

It just so happens that the SI Joint is often not hurt due to trauma, but rather to myfascial dysfunction of a big rectangular muscle in the low back called the Quadratus Lumborum (QL), which literally translates to “rectangular low back muscle”.

Here is what it looks like in the drawing to the left (highlighted in green), from the instructive handbook, Trigger Point Therapy for Low Back Pain by Sharon Sauer, CMTPT, LMT and Mary Biancalana, CMTPT, LMT, two leaders in the Trigger Point Therapy field.

The red dots indicate the referred pain pattern of the trigger points found in the deep and superficial fibers of the QL near the X’s in the drawing. Look where the referred pain is located ... RIGHT OVER THE SI JOINT. It turns out that many times the "Shot in the Back" pain is actually referred pain from trigger points in the QL!

It cannot be stressed enough how painful it is and how disabled one becomes when these trigger points are activated. Many have wondered if they will be crippled the rest of their lives when they first experience this pain.

So, here again we find that a muscle turns out to be the key to one of the most severe ailments the average person can experience. The QL is important not only in keeping the SI joint healthy and supported, but it is also responsible for the dreaded one-sided "shot in the back pain" that cripples its victims.

As always, it is never necessary to suffer something like suddenly collapsing to floor in agony when picking up a pencil you dropped. You can prevent injury to your SI joint and the disabling low back pain just by keeping your QL healthy!

It’s easy to do, as you will see below. And it feels good to treat the QL, as you’ll soon find out. The only real downside is that you’ll have one less excuse to take a sick day from work!

That said, let’s now take a look at some tests and self-care techniques for your Quadratus Lumborum.

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional. Please consult your physician to determine whether these self-care tips are appropriate for you.

2 Quick Tests to Determine if You Have TP's in Your Quadratus Lumborum:

Test #1: QL Side Bend Test

For this test, stand erect with hands at sides turned so fingers are flat against your thighs. Without bending forward or backward, bend to the side and slide your fingers down the side of your thighs as far as they will go. A passing result is when your fingers reach the knee. A not passing result is when your fingers do not reach the knee. In the picture shown, the patient does not pass on either side. The Trigger Point Therapist is measuring the distance to the floor on the right side to keep track of progress after treatment.

Test #2: QL Palpation To palpate the QL, either stand or lie on your back and press your fingers with moderate pressure into the muscle tissue on your side right between the top of your hips and the bottom of your ribs (as shown to the left).

Another Physiology Fact: Healthy Muscles do NOT hurt when you press on them.

A passing result, as always is finding NO taut bands or painful areas when you are pressing into the muscle. If you find taut bands of muscle and tender spots, you have trigger points in your QL.

Simple Self-Care Remedies

Treating your QL muscle is not only easy but often very enjoyable. Your low back often feels instantly stronger and more flexible after just a few minutes of self-care. Follow the instructions below:

Step 1: Warming Up with Moist Heat A warm shower, bath or Fomentek bag works very well for 10-15 minutes to loosen up the fibers of the QL.

Step 2: Compression The best tools are a medium sized therapy compression ball against the wall and the Backnobber.

Ball on Wall Place the ball between your waist and the wall, just above the pelvis and below the ribs. Lean into the ball with strong but tolerable pressure. To add a stretch, raise the same side arm up above the head and lean toward the opposite side. Roll the ball until you cover the entire muscle, stopping for 2-3 breaths at all tender spots and taut areas.

Backnobber on Stretch

Lie sideways over a pile of pillows, as depicted, to stretch the upside QL. Press the Backnobber into the stretched upside QL, pausing for 2-3 full breaths on each tender area and taut band. Alternate leaning forward and backward as you apply pressure to reach different layers of the muscle.

Step 3: Stretching the QL

Finally, there are two wonderful stretches for the QL that will help keep it flexible and healthy:

1.) Standing Lateral Flexion:

Stand and raise your arm over your head and lean to the opposite side, as shown. Hold for 20 seconds. Rest and repeat 2 more times 2-3 times daily. You can rest your other hand on a table or back of a chair for support. Perform on both sides. For added stretch, you can use your other hand to grab the outstretched arm at the wrist and pull into a further stretch.

2.) Repeat QL Stretch While Reclining

Repeat the QL stretch If you are too acute or tired to stretch standing, you may lie on your side over a stack of pillows. Raise the upside arm overhead and let the upside leg drop all the way to the surface you are lying on behind or in front of the downside leg. Hold for 30 seconds and relax. Repeat 2-3 times per day on each side.

Thank you as always for reading and educating yourself on how to keep your body strong, flexible and healthy with full range of motion! Please pass the information on to others!

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