The QL and the Psoas Need Some Counseling

Romeo and Juliet are not the only star crossed lovers to have ever existed. I mean, look at Kim and Kanye, and Pete and Arianna. There are doomed romances all throughout human history. But the ill-fated relationship I want to expose today is that of the Psoas and the Quadratus Lumborum. These deep core muscles find themselves so close together they could touch and yet so far apart they rarely get recognition as a couple. And yet they are. They are a couple bound together by love, romance, and fascia. And, like all star crossed lovers, their tragic fate is sealed unless someone like you steps in to help.

If you look at the orientation of these two next to each other, you can begin to imagine how their love story became a tragedy. Situated just posterior to the Psoas, the QL originates at the Posterior Iliac Crest and reaches up to insert onto the Transverse Processes of L1 through L4 and then extends up even farther to grab onto the 12th rib. Conversely, hibernating just anterior to the QL, the Psoas originates at the Transverse Processes and the bodies of L1 through L5, snuggles into the Iliac Fossa and then reaches down to grab on to the Lesser Trochanter of the Femur.

Think about it like this: The QL is associated with the low back. It starts inferior and reaches up. The Psoas is associated with the hip. It starts superior and drops down. They create opposing actions: The QL will bring the back into extension. The Psoas will bring the the hip into flexion. But both of these muscles throw a wrench in the origin/insertion/action rule - meaning, they each have the ability to not just bring their insertion closer to their origin, as the rule dictates, but also to switch things around and anchor their insertion, creating movement in their origin. We see the QL hike the hip up and we see the Psoas pull the spine into flexion. It is a wacky world.

I would argue that they do this an an effort to find love in each other and meaning in their surroundings. Just like the rest of us. Life has pulled them apart. Society has compartmentalized them. Our attempts to make sense of them has kept the QL in the back, the Psoas in the front, and never the two shall meet. And yet we see them contract in ways that make the spine and hips do incredible things. The fascia that separates them actually connects them. I suspect that they secretly use that sheet of fascia to encode love notes that we have never been privy to.

Ok so maybe that’s a stretch. Maybe it’s not so much about love and romance as it is about function and fascia. But that doesn’t mean they aren’t deeply connected in ways that, once we understand a little more intimately, we can use to our advantage when working with them. The push and pull of the spine and the hip is not limited to the relationship between the QL and the Psoas. But there is no doubt that gifting our clients the connection of these previously isolated structures will only be a good thing.

Try this: With your client in the side lying position, have them scooch back to the edge of the table closest to you. Ask them to extend their leg that is on the table straight and bend their top leg into both knee and hip flexion. The degree of flexion can vary according to what feels easy for your client and how you choose to engage them in this technique. Offer them a bolster to support their flexed knee because not only is it good for the spine, it is also really comfortable.

Then have your client reach up with their top arm to the far corner of the table in front of them. And we don’t have detachable arms so offer them a pillow they can hug with the arm that is smushed by their torso. This helps them to feel more secure about their draping and distracts them if that arm falls asleep. The position you have situated for your client has pulled their hip and lower ribs away from each other offering you more access to the QL and the Psoas.

From here, begin with the Erector Spinae Group. Sink in and begin to slowly move away from the spine, around the paraspinals, and into the QL. This work is nuanced and requires an acute presence. As you slide anteriorly on the lateral edge of the QL, you will sink down and be able to feel the Psoas. This is where the magic happens. Ask your client to move slightly into and out of an anterior and posterior pelvic tilt. Have them hike their hip that is off the table up, and then relax. Have them lift that same leg up off the table and slightly into and out of flexion and extension. And palpate what the QL and the Psoas are doing all the while.

The work you do will differ greatly from client to client. And as much as I wish I could reach through these pages and guide your hand, I can’t. Feel for what is over or under firing. Get a sense of how well these muscles can move and shift. But mostly, bring your client’s awareness to how these muscles communicate. A Psoas and a QL may have lost touch with each other. But that doesn’t mean it has to end in tragedy.

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