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  1. #1
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    Brief Medical History Overview

    Age: 32, Male, Presenting Problem Since: 2 years, Symptom Behaviour: worse, Symptoms Worse (24hr Behaviour): night, morning, Aggravating Factors:: sleeping, excercising deadlifts, squats, Easing Factors:: laying on the floor, No Investigations, No Diabetes, No history of High Blood Pressure, No Medications, No Osteoporosis, No Hx of Cancer, No Unexplained Weight Loss, No Bowel/Bladder issues

    Major problem / Symptomatic Areas

    Lumbar, Spine - Posterior

    Quadratus lumborum pain for 2 years, physiotherapist didn't help

    Physical Agents In Rehabilitation
    Hi
    1. Firstly I will write the story:
    It started when I've changed my bad. All life I was sleeping on very hard mettresse/bad and I've switched to more softer one and the pain started. After half year I wen to physiotherapist and he said that my quadratus lumbar and psoas are compressed, he made also needle therapy for my very low back (firt vertebraes of lumbar region). After that I feel better for one week and pain returned. He also gave me 2 excercises for stretching quadratus lumbar and psoas - but after these excercises + sleeping pain was much bigger so I've gave up with that.

    I've changed mattress to harder one with thermoactive foam at the upper layer. The pain was less but it started to getting bigger and bigger and after couple of months I was not able to fall asleap. I changed my mattress again for one without thermoactive foam but with same hardeness. It was again better for couple of days.

    I went to another physiotherapist and he said that my quadratus lumbar is "irritadet". It was better after deep massage which he did and he said that I have to use lacrose ball for these muscles - It doesn't helped me in longterm what is more I had always 2,3-day long pain in my back (much worse from this one from beggining).

    I went to another one phisiotherapist and he said me that I need to do stretching - so the same as the first one - it also doesn't help

    2. My spine status:
    I need to mention firstly that my job is sedentary 8h/day + couple more in my free time. I'm also excercising in the gym (all excercises but recently I've dropped squats and dead lift because of this pain - so about 1,5h x 3 in week)
    All physiotherapists said that I have very little scoliosis (I had one X-Ray photo but it was very old) and there is nothing to worry about my spine condition - they also said that I can make dead lifts, squats and everything. More problems are with my muscles. My scoliosis is very similar to this one (lumbar):
    scoliosis.jpg

    3. Pain symptoms:
    All trigger points on the picture:
    lower-back.jpg
    Pain is located on the right (my right) side of my spine 4-5 cm from spinous processes and it's really near or exactly located on transverse processes. first trigger point is located on the height of 5-6th spinous process, and another one is located right below first rib.

    third trigger point is located at the spine beggining ( I don't know how to say that) but it started to pain more after spine hyperextension (last image):

    hyper.jpg

    The pain is bigger always in the morning and when I'm trying to sleep. It's getting bigger when I'm laying on my left side (my hip on right side (one with pain) is closest to the first rib).

    3. My questions:
    1. I'm not sure which muscels are painfull. I'm thinking about quadratus lumborum but isn't it strage that I feel pain only very near transverse processes? I've started thinking about other muscles:
    12062tn.jpg

    2. What I should do to stop this? Streching, lacrose ball excercises or both. I'm aslo very concerned about pain day after all this streching etc.. excercises - is it ok? I feel also a little bit better after inserting my finger very deep in pain area to maximize it and holding it for some time - I can feel like breaking muscle fibers? I don't know how to describe it - is it ok to do such kind of deep massage?
    3. And finally do you believe it's related to my mattress? In the past pain was less when sleeping on hard bed but recently I feel pain even when sleeping on very hard bed.

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  2. #2
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    Re: Quadratus lumborum pain for 2 years, physiotherapist didn't help

    Hi there and thanks for your very detailed thread.

    It's always nice to receive a fresh view on someones history and yours does seem like a regular one we see in the clinic. It is very normal, so something to be aware of.

    It appears from your history that what you are exhibiting is a overactivity (increased resting tone) in the lumbar musculature. We need not point out a specific muscle as that is not really relevant to the treatment approach. What we do know is that at times the lumbar extensor musculature is becoming overactive and that this contributes to discomfort/pain. Historically releasing of the tissues does ease the pain temporarily but it returns within a few days. And your soft mattress is another factor where you notice the discomfort.

    So we need to ask, why is the lumbar musculature overactive? The painful response itself is perhaps normal so that is not primary issue, the issue is why your system behaving in this way. Most likely this is due to it having to overplay its supportive mechanism for the underlying skeletal structures (your spine). It could well be that you have a small Wikipedia reference-linkSpondylolisthesis in the lumbar area, or perhaps an unstable facet joint on one side. Often larger Spondylolistheses can be felt in a physical examination however smaller, subtle defects might only be picked up on x-ray. When you have an issue like this repeated flexion of the spine (bending forward/knees to chest/plough in yoga etc), or stretching into lumbar flexion gives relief and 'feels good' for the lumbar region. Conversely repeated extension or overloading of the extensor muscles feels bad (think squats and deadlifts). We don't really need any invasive investigations if we can find a pattern that feels good as we know what we need to work on to get the extensors to 'relax' or reduce their hyperactivity/resting tone.

    Most of the low back is stabilised by the abdominals muscles, especially (and most importantly) those that work in rotation - so think the obliques and transverse abdominus (don't think the rectus abdominus that is worked in the classic 'crunch' style sit-up). If your job is largely sedentary then for sure this is the area to work on. The more normalised resting tone and strength you can get into those rotational support muscles then more the lumbar extensor muscles will be able to 'let go'.

    Yoga might be a good way forward in the first instance to give you a chance to work on the breath and the letting go whilst awakening the supportive muscles through movement. I tend to like this approach rather than a list of specific exercises. After all we can't (shouldn't) provide those without visual guidance - so an online forum is not the ideal place. There are some Pilates floor exercises like the rollovers with and without rotation that could be of use too, as would most pilates Studio equipment based classes or Gyrotonic equipment based classes. These later come at more cost though and are not as widely available so it depends where you are and your circumstances.

    I think your mattress is just letting you know that your spine is not happy to assume the position that it would take once your muscles are more relaxed. Ideally it should be no problem so perhaps it can be used as a subjective feedback for if things are improving over time. Don't jump to a new one right now, see if you can make your spine work with the one you have. And if it's just too soft then sure, make a change.

    Let us know how you get on. For now consider the idea of flexion movements, not passively, but as part of an active movement to develop connection and strength through movement. Passive stretches on their own will have no long term benefit.

    Aussie trained Physiotherapist living and working in London, UK.
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    Re: Quadratus lumborum pain for 2 years, physiotherapist didn't help

    I'm posting xray photo of my scoliosis. Do you believe it could be the reason of pain?
    scoliosis.jpg


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    Re: Quadratus lumborum pain for 2 years, physiotherapist didn't help

    The rotational nature of a scoliosis could well be a contributing factor to your issues. Note that scoliosis is just a term for a rotational 'position' of the spine. In of itself it is not a cause but elements in the spine can get compressed in rotation and some muscle balances also occur in such positions over time. Releasing things can assist of course however I would not consider the fact you have a scoliosis to mean that you cannot resolve your issue.

    Aussie trained Physiotherapist living and working in London, UK.
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    Re: Quadratus lumborum pain for 2 years, physiotherapist didn't help

    I've fixed almost all of my issues.
    What I've made was to stretch quadratus lumborum for 6 months day by day! This one was the only excercise which I was needed for that:
    https://fibretense.com/wp-content/up...0/IMG-3050.jpg
    And what is more important I had very tight gluteal muscles and piriformis muscle which no one physiotherapist pointed out! I had to figure it out by myself;/ I'm still stretching these muscles but it's better and better.


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    Re: Quadratus lumborum pain for 2 years, physiotherapist didn't help

    Aircast Airselect Short Boot
    The mattress can really be a negative factor for such problems. My friend had a strong scoliosis, the reason was that he had slept on the sofa for most of his life and was engaged in weightlifting.


    When he changed the sofa to a bed with a special mattress, it became much easier for him. Seeing your problem contacted him and he advised to see this site 10 Best Mattreses for Neck Pain (May 2019) – Reviews & Buying Guide if you come to the conclusion that your mattress does not fit or will be soft.



 

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