When was the last time you thought about the pairing of your glutes and your quadratus? This is an important mechanism, especially when ascending and descending stairs,

Here is a great exercises to help with that:

Go ahead and try this at home.

remember last mondays post? (if not, click here). Here is one way of telling whether your (or someone else’s) vestibular system is working. It will also give you an idea of how some people compensate.

Ready?

  • Stand up (barefoot or shoes does not matter).
  • place your hands resting on the top of your hips with your thumbs to the back (like your Mom used to, when you were in trouble). Your thumbs should be resting on your quadratus lumborum (QL) muscle.
  • tilt your HEAD to the LEFT
  • you should feel the muscle (ie the QL) under your RIGHT thumb contract
  • come back upright

repeat, but this time lean your BODY to the LEFT

  • same thing right? Now check the other side.

Everything OK? Everything fire as it should?

Now lets add another dimension.

  • slide your fingers down so they are just below the crest of the hip, resting above the greater trochanter (the bump on the side of your upper thigh). This should place your fingers on the middle fibers of the gluteus medius.
  • tilt your head (or body ) to the LEFT.
  • You should feel the LEFT gluteus medius and the RIGHT QL contract. These muscles should be paired neurologically. When walking, during stance phase on the LEFT: the LEFT gluteus medius helps to maintain the pelvis level, while the RIGHT QL, assists in hiking the RIGHT side.

If everything works OK, then your vestibulospinal spinal system is intact and your QL and gluteus medius seem to be firing and appropriately paired. If not? That is the subject for another post.

The Gait Guys. Helping you to understand the concepts of WHY compensations occur.

The Mighty Quadratus: Part 2  The Quadratus and Gait

Acting unilaterally without the ipsilateral foot fixed on the ground, it can raise the ilia on the side of contraction (as in a pull up or side bend on a Roman chair). The quadratus lumborum was more active than other muscles during isometric side support postures where the body is held horizontally almost parallel to the floor as the subjects supported themselves on one elbow on the floor together with both feet. 

It is active during single limb support during stance phase of gait on the contralateral side (along with the external oblique) to elevate the ilium. This is coupled with the ipsilateral anterior fibers of the gluteus medius and minimus pulling the iliac crest toward the stable femur.

Sahrmann states “the QL is optimally situated to provide control of lateral flexion to the opposite side via its eccentric contraction to provide control of the return from lateral flexion via its concentric contraction. The muscle is also positioned to play a role in the rotation that occurs between the pelvis and spine during walking”. This makes you really think about the interplay of this muscle, and another stance phase stabilizer, the psoas major, which attaches opposite the QL on the anterior aspect of the vertebral body, IN FRONT of the transverse process.

Acting bilaterally, it extends the lumbar spine, deepening the lordosis and acting to limit anterior shear of the vertebral bodies.

It is able to stabilize the 12th rib during forced expiration, thus acting as an accessory muscle of respiration. This fixation is important when we need to superimpose pelvic movements upon it. Furthermore, it increased activation in response to increasing compression in static upright standing postures.

Bottom Line?:

Think of the QL, especially during gait abnormalities or recalcitrant low back pain. The more it is stressed, the more it is activated. If someone had mild weakness of the stance leg gluteus medius, it may be called into play to pick up some of the slack. Expect to see increased activity paraspinally, with particular attention paid to the 12 rib attachments.

In our flexor dominant society, the QL may play a role in generating unilateral shear forces on the lumbar spine (along with the ipsilateral psoas), especially in individuals with poor ankle rocker or decreased hip extension.

The QL: it’s not only for breakfast anymore…..

We still are…The Gait guys

The Mighty Quadratus: Part 1

Today we explore the Quadratus lumborum and its functional anatomy.

It is useful to think of the QL as having two divisions. Though they can’t act independently, it helps when thinking about it from a functional standpoint. The first, or lower division arises from the medial portion of the iliac crest and adjacent iliolumbar ligament, inserting onto the transverse processes of the lumbar vertebrae, running in the coronal plane from lateral to medial and posterior to anterior in the saggital plane. The second, or upper division arises from the lumbar transverse processes of the upper 4 lumbar vertebrae at their upper and lower corners and insert into the inferior border of the 12th rib, running in the coronal plane from medial to lateral and in the saggital plane from anterior to posterir. Approximately half of the fascicles of this second division act on the twelfth rib; the rest act on the lumbar spine.

The QL is primarily a coronal plane stabilizer. Acting unilaterally with the lower body fixed and feet on the ground, it laterally bends the lumbar spine. Normally, with lateral bending of the lumbar spine while in a lordotic posture, we see what is called type I coupled motion, or deviation of the spinous process to the side of lateral bending. The QL would oppose (or perhaps more correctly attenuate) this motion, having a moment of moving the spinous process to the opposite side of contraction. Perhaps it is when the QL become dysfunctional, pulling the ipsilateral transverse process outward (and thus moving the spinous to the opposite side) that we see aberrant (or Type II) motion in the lumbar spine. It is interesting that when the lumbar spine is flexed (as in sitting or forward bending) type II motion is normal, and now the QL becomes prime mover. Due to the angle of attachment here, it can create shear and potentially contribute to injury.

Whew!! Stay tuned for the QL and gait tomorrow!

Yup, if you are reading this, you are a gait geek too!!

Shawn and Ivo