Example Myofascial Pain Case: Quadratus Lumborum Trigger Point and Chronic Low Back Pain

Abstract

Chronic low back pain is very common in primary care. If a musculoskeletal etiology is likely, consider myofascial trigger points as an etiology for pain. The quadratus lumborum muscle often harbors trigger points for chronic low back pain. This trigger point can be more easily palpated when the patient is lying in lateral decubitus, with the affected side up. The examiner can then palpate for the trigger point in this muscle, which lies anterior to the paraspinal lumbar muscles, and between the last rib and iliac crest. Once a trigger point is detected, there are various manual maneuvers that can easily be accomplished in the office setting. This includes massage, ischemic compression, isometric contraction, and cold/spray and stretch. If needed, evaluation and control of metabolic/endocrine abnormalities may need to take place in order to eliminate perpetuating factors. Furthermore, home exercises and correction of body postures and ergonomics can also be advised as part of a complete treatment plan.