Quadratus lumborum
The Quadratus lumborum is irregular and quadrilateral in shape, and broader below than above.
The quadratus lumborum, or “QL,” is a common source of lower back pain.[1] Because the QL connects the pelvis to the spine and is therefore capable of extending the lower back when contracting bilaterally, the two QLs pick up the slack, as it were, when the lower fibers of the erector spinae are weak or inhibited (as they often are in the case of habitual seated computer use and/or the use of a lower back support in a chair). Given their comparable mechanical disadvantage, constant contraction while seated can overuse the QLs, resulting in muscle fatigue.[2] A constantly contracted QL, like any other muscle, will experience decreased bloodflow, and, in time, adhesions in the muscle and fascia may develop, the end point of which is muscle spasm.
This chain of events can be and often is accelerated by kyphosis which is invariably accompanied by “rounded shoulders,” both of which place greater stress on the QLs by shifting body weight forward, forcing the erector spinae, QLs, multifidi, and especially the levator scapulae to work harder in both seated and standing positions to maintain an erect torso and neck. The experience of “productive pain” or pleasure by a patient upon palpation of the QL is indicative of such a condition.
While stretching and strengthening the QL are indicated for unilateral lower back pain, heat/ice applications as well as massage and other myofascial therapies should be considered as part of any comprehensive rehabilitation regimen.[3]
Fascia
Fascia (făsh'ē-ə), pl. fas·ci·ae (făsh'ē-ē), adj. fascial (făsh'ē-əl) (from latin: a band) is the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures. Fascia is an uninterrupted, three-dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior. It is responsible for maintaining structural integrity; for providing support and protection; and acts as a shock absorber. Fascia has an essential role in hemodynamic and biochemical processes, and provides the medium that allows for intercellular communication. Fascia functions as the body's second line of defense against pathogenic agents and infections after the skin[citation needed]. After injury, it is the fascia that creates an environment for tissue repair. [1]
Spasm
A spasm is a sudden, involuntary contraction of a muscle, a group of muscles,[1] or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes. Spasmodic muscle contraction may also be due to a large number of medical conditions, including the dystonias.
By extension, a spasm is a temporary burst of energy, activity, emotion, stress, or anxiety.
A subtype of spasms is colic, an episodic pain due to spasms of smooth muscle in a particular organ (e.g. the bile duct). A characteristic of colic is the sensation of having to move about, and the pain may induce nausea or vomiting if severe. Series of spasms or permanent spasms are called a spasmism.
In very severe cases, the spasm can induce muscular contractions that are more forceful than the sufferer could generate under normal circumstances. This can lead to torn tendons and ligaments.
Hysterical strength is argued to be a type of spasm induced by the brain under extreme circumstances.
Spasms can be caused by insufficient hydration, muscle overload or absence of some minerals (such as magnesium).
Iliopsoas
The term Iliopsoas refers to the combination of three muscles:
These muscles are distinct in the abdomen, but in the thigh, they are usually indistinguishable, and so in that context, they are usually given a common name. They are occasionally labelled "dorsal hip muscles"[1] or "inner hip muscles
Piriformis muscle
Origin and insertion
It originates from the anterior (front) part of the sacrum, the part of the spine in the gluteal region, and from the superior margin of the greater sciatic notch (as well as the sacroiliac joint capsule and the sacrotuberous ligament). It exits the pelvis through the greater sciatic foramen to insert on the greater trochanter of the femur. Its tendon often joins with the tendons of the superior gemellus, inferior gemellus, and obturator internus muscles prior to insertion.
Shape and location
The piriformis is a flat muscle, pyramidal in shape, lying almost parallel with the posterior margin of the gluteus medius.
It is situated partly within the pelvis against its posterior wall, and partly at the back of the hip-joint.
It arises from the front of the sacrum by three fleshy digitations, attached to the portions of bone between the first, second, third, and fourth anterior sacral foramina, and to the grooves leading from the foramina: a few fibers also arise from the margin of the greater sciatic foramen, and from the anterior surface of the sacrotuberous ligament.
The muscle passes out of the pelvis through the greater sciatic foramen, the upper part of which it fills, and is inserted by a rounded tendon into the upper border of the greater trochanter behind, but often partly blended with, the common tendon of the obturator internus and gemelli.
Variations
It is frequently pierced by the common peroneal nerve (fibular) when the sciatic nerve bifurcates prior to exiting the greater sciatic foramen. Thus, the piriformis is divided more or less into two parts.
It may be united with the gluteus medius, send fibers to the gluteus minimus, or receive fibers from the superior gemellus.
It may have one or two sacral attachments; or it may be inserted in to the capsule of the hip joint.
Clinicals
This syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve.[1] This referred pain is known as "sciatica." Fifteen percent of the population has their sciatic nerve coursing through the piriformis muscle. This subgroup of the population is predisposed to developing sciatica.
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