A week ago my regular client called and asked me to help his friend who was visiting him in Los Angeles. According to my client, his friend had been suffering from acute lower back pain for more than 10 days. The pain was so severe that the primary care physician they brought him to was 100% sure that this pain was the result of kidney colic while the stone was passing. The doctor suggested the emergency room and more likely admission to the hospital. They went to the local hospital where kidney pathology was ruled out and after pain medications and muscle relaxants his friend was sent home. The issue was complicated by the fact that he needed to fly back to Europe in two days.
When I saw him for the first time it was obvious that he was in a lot of pain. He barely walked, was severely tilted to the right and forward, and he had very superficial breathing. When I asked him about pain he said that at the beginning the pain was so severe that he became nauseous.
He barely got on the table and even laying down his body was still crooked to the right side. As soon as I started palpation he begun to sweat profusely. Even mild application of pressure on the lumbar erectors triggered a severe pain reaction and quick shallow breathing. When I applied pressure to the upper and lower trigger points in the quadratus lumborum muscle the client didn’t feel any pain but the resistance of the tissues I felt was simply overwhelming.
Considering the intensity of pain and spasm in the lumbar erectors, I started to use this protocol. After almost twenty minutes his breathing normalized, but his body continued to be twisted to the right. It was an “a ha!” moment for me. I suddenly remembered one of Medical Massage seminars on lumbar pain due to acute spasm in the quadratus lumborum muscle. One of the key points was the presence of autonomic reactions – nausea, sweating, headache, etc. I checked again the quadratus lumborum muscle, but application of direct compression wasn’t painful. Despite that, I decided to switch to the quadratus lumborum protocol. In another 20 minutes I noticed that the client started to lay straighter on the table. After we were done, he was definitely better. He was still tilted to the side but he didn’t have forced forward flexion and his breathing pattern normalized.
I recommended a set of home stretchings, exercise in the swimming pool (I actually told the client to spend hours there), hot showers, etc. I told the client there was a good chance that he may have a reaction the next morning in the form of additional spasm and tension.
The next morning I got an early call and when I heard my new client’s voice on the machine, I was afraid he might have gotten even worse before his long trip. To my complete surprise, I heard a joyful and enthusiastic voice profoundly thanking me for what I’d done. I called back and my client told me that he woke up in the morning with only moderate pain and after a long hot shower and a set of stretchings he didn’t have ANY pain in the lower back. Considering the intensity of pain he had for almost two weeks prior, the speed of his recovery was a welcome surprise to both of us.
O. Bouimer, LMT, Los Angeles, California
LESSONS:
1. Indeed, acute spasm in the QL muscle triggers various autonomic reactions mentioned in the article. Other reactions include shallow breathing, goose bumps on the skin, severe white dermographism reaction, etc.
2. Acute spasm in the QL muscle mimics kidney colic and up to 20% of emergency room admissions for kidney colic are actually acute spasms in the QL muscle. However, before jumping on the treatment of the QL muscle, the kidney colic must be ruled out since the clinical pictures are very similar.
3. The differences between lower back pain due to acute spams in the QL muscle compared to any other cause of lower back pain are the patient’s inability to correct forced position even at complete rest and the presence of autonomic reactions.
4. Since the QL muscle is very powerful the developed tension, in some cases of acute spasm, is so strong that it is impossible to elicit a ‘Jump Sign’ during the application of direct compression. This is why there wasn’t any pain during the compression of the trigger points within the QL muscle.
5. Such quick recovery after acute spasm in the QL muscle is very rare. Usually it takes time and re-application to restore proper function of the QL muscle.
Journal of Massage Science
Category: Blog , News