Why Does Your Left Quadratus Lumborum Hurt?
What this covers
The quadratus lumborum muscle is often painful when people complain of lower back pain. However, trying to directly treat the quadratus lumborum is usually not productive because the quadratus lumborum is just the victim of dysfunction elsewhere in the body.
On the left side, the QL gets overactive to try and support the pelvis when you are on your left leg and you've lost stability in the left hip. The QL should be active when your weight is on the left leg, but you shouldn't feel it. You don't feel it because the hip musculature (left hamstring, adductor, and glute medius) should do most of the work.
But in the presence of left hip weakness, the left QL will start too work overtime. It can also be stressed out due to the rightward pull of the bigger right diaphragm muscles that rotates the lumbar spine to the right.
https://pritrainer.com/pri-left-aic-right-bc-beginner-example-program/
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QL muscle pain is not a local problem but a symptom of postural dysfunction, hip weakness, and breathing mechanics dysfunction; treating it requires restoring hip stability, postural alignment, and breathing patterns rather than direct muscle work.
- QL pain stems from compensatory overactivity due to weak hip stabilizers and overall spinal extension patterns
- Direct treatment of QL is ineffective; resolution requires correcting underlying postural patterns and hip weakness
- Proper breathing mechanics and hip stabilization eliminate QL pain by allowing the muscle to return to normal activation levels
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When the left hip is weak, the left femur sits in a lax (stretched-out) hip joint creating instability, forcing the brain to compensate by recruiting lower back muscles and hip flexors to stabilize the joint rather than relying on appropriate hip musculature.
“when your left side is really really weak when this left hip is really weak and the femur the left leg that sits in that left acetabulum when that left hip joint when that left femur is really weak the hip joint itself is probably stretched out so you probably have laxity in the front of the hip joint it's just unstable this whole thing is unstable you'll often use your lower back muscles not you consciously but your brain will use your lower back muscles and hip flexors to help stabilize that joint”
The QL is anatomically positioned perfectly to stabilize the trunk over the pelvis because it spans from the top of the pelvis to the lowest rib, making it ideally suited for this compensatory stabilization role when hip stability is compromised.
“of course the ql is perfectly positioned to do that because on top of it is the ribcage and the ql goes from the top of the pelvis to the bottommost rib which isn't actually on this so it's stabilizing when you put your weight on your left leg theoretically that ql joint i'm sorry that ql muscle should activate to help stabilize everything over on this left side”
The quadratus lumborum (QL) muscle becomes noticeable to the patient only when it causes pain, because it is a deep stabilizer that should function without conscious awareness; when pain develops, it is stubborn and severe.
“i often tell clients that they should never know that they have a ql muscle the quadratus lumborum muscle because the only time you know that you have one or when you become aware that you have one it's because it hurts and ql pain is stubborn and it hurts a hell of a lot”
Left QL pain persists because the muscle never achieves relaxation when the pelvis and ribcage remain in dysfunctional postural positions; chronic agitation from continuous tension prevents healing even with muscle-focused treatment.
“when you put your weight on your left leg but the pelvis never gets into the proper position and the ribcage never gets into the proper position it's just going to stay agitated because it just never gets to relax”
The QL muscle is actively involved in breathing mechanics, helping to anchor the bottom rib during exhalation, so dysfunction in breathing patterns creates chronic QL overactivation.
“so it's active in breathing but when you don't have proper breathing mechanics it's going to again it's going to be overactive so those are the things that you have to do to get the left ql to turn off and again i've never treated a ql directly because you generally don't have to it's just a sign of extension being overall extended back arched and rotated slightly to the to the right which is the left aic right bc pattern”
The QL attaches to multiple lumbar vertebrae (probably L5, L4, L3, L2), and consistent rotation of these vertebrae creates constant tensile stress on the QL muscle, leading to chronic tension and pain.
“the ql attaches to these the ql attaches to each vertebrae on the bottom so i think it's they attach to probably l5 l4 l3 l2 i don't know how far up but they attach to those lumbar vertebrae so if the lumbar vertebrae are rotated in one direction consistently then there's going to be a constant pull on that ql on the left side”
QL pain is often associated simultaneously with SI joint pain and hamstring pulls because the hamstring inserts beneath the pelvis into the tuberosity and blends with SI joint ligaments, which also blend with the quadratus lumborum, creating anatomical continuity in that region.
“it's often also associated with uh s i joint pain at the same time and maybe hamstring pulls because when you look at the line of pull the hamstring inserts underneath the pelvis into the tuberosity that blends with the i believe the si joint ligaments and then i think also the si joint ligaments it was a it's been a long time since i read it but i believe the s-i joint ligaments also blend with the quadratus lumborum to a little to a to a degree don't quote me on that but it's all in that same area”
When left hip stabilizers are insufficient, the left QL cannot properly deactivate during the loading phase of gait because it must work overtime to compensate for hip laxity, preventing the normal transition from extension to flexion that would allow the muscle to relax.
“the problem is if the left hip is so weak that you can't step stabilize the hip itself with the appropriate hip musculature that left ql is going to have to work overtime and you're still going to be an extension when you put your weight on your left leg instead of shifting into flexion so that ql can never turn off”
Direct treatment of the QL itself is ineffective from a postural restoration perspective; effective treatment requires correcting the underlying postural dysfunction using beginner-level postural restoration techniques.
“what do you do for the left ql well nothing directly working on the ql itself isn't going to change a situation from a postural restoration perspective what you have to do is just like the beginner techniques that i have on my website you have to learn how to get off of your right leg to turn your pelvis to the left”
Treatment of left QL dysfunction requires: (1) learning to get off the right leg and rotate the pelvis to the left, (2) getting the left ribs down through exhalation to engage obliques, (3) securing the femur in the hip using left hamstring, left adductor, and left glute medius.
“you have to learn how to get off of your right leg to turn your pelvis to the left you have to learn how to get your left ribs down through exhalation to engage the obliques and you really have to work hard on that left hip joint securing that femur into the hip itself using the left hamstring left adductor left glute medius is huge”
The right QL muscle is overactive as a victim of overall body extension (hyperextension); direct treatment of the right QL is ineffective because the muscle will resolve itself once other postural issues are corrected.
“the ql muscle and i did make a video about the right ql muscle and why you don't really worry about it it's really painful but you don't do anything for it it's it's a victim of extension throughout the whole body you don't really work on the ql itself because once everything else is working properly the ql will just resolve itself”
For the right QL to deactivate, the right side of the body must be unloaded by shifting stabilization to the left side of the body; this left-sided stabilization is the prerequisite for right QL shutdown.
“for that right ql to turn off you the right side of your body needs to be unloaded which means you need to be able to get to the left side of your body and stabilize on the left side of your body so the right ql turns off”
Left QL pain results from two distinct planes of motion dysfunction: the QL is overused to stabilize a weak left hip, and the lumbar spine rotation disrupts normal QL activation patterns.
“the ql on that left side is painful because of two different planes of motion well it's probably being overused to stabilize a weak left hip”
Treatment must begin on the floor with corrected breathing mechanics that do not involve neck or lower back recruitment, because any muscle attaching to the ribcage can be incorrectly recruited for breathing, including the QL.
“you have to start off doing it on the floor you have to make sure you can breathe correctly without using your neck and your lower back because any muscle that attaches to the rib cage can conceivably be used to help you breathe and we know that the ql does attach to the rib cage and it is used in breathing it helps hold on it helps kind of uh anchor the bottom rib into position as you exhale”
Treating the QL muscle directly is ineffective for resolving SI joint pain, contrary to common clinical practice; SI joint dysfunction and QL dysfunction must be addressed through their underlying postural causes rather than local treatment.
“quite often that s i joint pain will also be occurring with ql pain and a lot of people think if you treat the ql it'll treat the si joint that's not really the case”
QL pain and dysfunction is a symptom of overall extension pattern dysfunction (arched back, rotated slightly to the right, consistent with left anterior interior chain/right behavioral chain pattern), not a local structural problem.
“it's just a sign of extension being overall extended back arched and rotated slightly to the to the right which is the left aic right bc pattern and also that weakness in that left hip so from a biomechanical perspective that's generally what you are are dealing with”
In a left anterior interior chain (AIC) pattern, the pelvis rotates anteriorly on the left, posteriorly on the right, and the sacrum rotates rightward while the lower vertebrae orient rightward, creating consistent rotational tension on the left QL that contributes to pain.
“when your weight is on the so that's the issue when you put your weight on the left leg or one of the issues the other issue is that when you're in a pattern a left aic pattern your pelvis on the left side is forward right side is back and that sacrum turns to the right and the lower vertebrae turn orient to the right”
Addressing postural dysfunction (extension patterns, pelvic rotation, hip weakness) and restoring breathing mechanics leads to spontaneous resolution of QL pain without direct QL treatment, because correcting the underlying dysfunction allows the muscle to normalize.
“you got to address those issues and that left ql will usually clear up you”
The left QL dysfunction differs from right QL dysfunction in its etiology and requires different analysis and treatment approaches.
“now the left ql is a little bit different i do get people asking me about the left ql the left ql is painful because of again extension and the ql on the left side will attach to this pelvis”
The speaker has never treated the QL muscle directly in clinical practice, and this absence of direct QL treatment reflects a consistent clinical philosophy that direct muscle work is ineffective.
“and again i've never treated a ql directly because you generally don't have to”
The SI joint is highly ligament-restricted, limiting its movement to small motions, but movement does occur in that articulation.
“on the inside of the si joint there's a lot of ligaments all over this area all right so there's a lot of ligaments all over the si joint that limits its movement but the movement does occur it's small but it moves”
The QL muscle fibers likely run continuously with SI joint ligaments, though the speaker is uncertain of the exact anatomical relationship and cannot definitively confirm this connection.
“the ql is right above it and i again i believe that some of the muscular fibers of the ql uh run continuously with the ligaments of the si but can't say for sure i can't because i can't remember i could look it up uh or you could look it up”