The Quadratus Lumborum (QL) is a common culprit in the presentation of mechanical low back pain. Not only will it cause pain, it can cause shifts in pelvic alignment along the coronal plane when hypertonic. As such, it can be an aggravating factor to multiple conditions such as discogenic pain, intervertebral foraminal stenosis, lumbar facet joint dysfunction, hip or knee pathology, ankle sprains, etc. Fortunately, the QL has the potential to respond quickly to both local and distal acupuncture techniques.
A QL strain will often cause pain with movements or positions that elongate it. There is a strong correlation that the QL is involved when a patient experiences pain in the region of Yao Yan (M-BW-24) upward toward Pi Gen (M-BW-16) with contralateral side bending. These patients may also experience pain with forward bending, contralateral trunk rotation, rising from a chair, etc. An ipsilateral hip hike, when the iliac crest on one side is superior to the iliac crest of the opposite side, is a common observation that is frequently caused by a hypertonic QL.
The QL responds well to local acupuncture needling at points such as Yao Yan (M-BW-24) or Pi Gen (M-BW-16). If a patient is uncomfortable with having acupuncture needles inserted into their lower back there are many distal points that can be equally as effective. Outer Yao Tong Xue is one of those exceptional points that is excellent for QL strains. Yao Tong Xue consist of two points in total and the literal translation means “low back pain points”. Clinical experience suggests that the outer of these two points can specifically target the QL.
Outer Yao Tong Xue is located at the junction of the 4th and 5th metacarpals. Clinically, positive outcomes can be observed when needling this point on the affected side. This correlates to a region in Korean Hand Therapy (KHT) that mirrors the superior aspect of the iliac crest where the QL is located.
If a hip hike is present during your initial assessment, immediately re-assess after the needle is removed. This is performed without shoes and with both feet together. If the hip hike was directly caused by a shortened QL, the result is usually immediate. The iliac crests will now be observed as being on the same level with one another. The more specific the clinical observations and examination techniques, the more reproducible the effect from both local and/or distal acupuncture points.