Key Points

• A deep understanding of muscle function on the singular level can open your eyes to connections you haven’t seen—connections that can mean the difference between satisfactory or exceptional relief for your clients.

• Explain to your clients how the psoas and quadratus lumborum communicate—movement of the spine and hip isn’t limited to these two muscles, but they do help us move in incredible ways.

Romeo and Juliet are not the only star-crossed lovers to have existed; there are doomed romances throughout history. But the ill-fated relationship I want to expose today is that of the psoas and the quadratus lumborum (QL). These deep core muscles are so close together they could touch, yet so far apart that they rarely get recognition as a couple. But they are indeed partners (to a degree) and, like most star-crossed lovers, their fate is sealed—unless someone like you steps in to help.

If you look at the orientation of these two muscles next to each other, you can begin to imagine how their positioning could undermine an otherwise healthy relationship. Situated just posterior to the psoas, the QL originates at the posterior iliac crest, reaches up to insert onto the transverse processes of L1 through L4, and then extends even farther to grab on to the 12th rib. Conversely, hibernating just anterior to the QL, the psoas originates at the transverse processes and the bodies of L1 through L5, snuggles into the iliac fossa, then reaches down to grab on to the lesser trochanter of the femur. 

Knowledge is Power

Think about it like this: The QL is associated with the low back, starting inferior and reaching up. The psoas is associated with the hip, starting superior and dropping down. They create opposing actions. The QL brings the back into extension while the psoas brings the hip into flexion, but both of these muscles throw a wrench into the origin/insertion/action rule. They each have the ability to not only bring their insertion closer to their origin as the rule dictates, but also to switch things around and anchor their insertion, creating movement in their origin. We see the QL hike up the hip and we see the psoas pull the spine into flexion. 

I would argue that they do this in an effort to find love in each other and meaning in their surroundings—just like the rest of us. Our attempts to make sense of them have kept the QL in the back and the psoas in the front, and never the two shall meet. And yet, we see them contract in ways that make the spine and hips do incredible things; the fascia that separates them actually connects them. (I suspect they secretly use that sheet of fascia to encode love notes we have never been privy to.) 

OK, maybe that’s a stretch. Maybe it’s not so much about love and romance as it is about function and fascia. But that doesn’t mean they aren’t deeply connected in ways that, once we understand a little more intimately, we can use to our advantage when working with them. The push and pull of the spine and the hip is not limited to the relationship between the QL and the psoas, but there is no doubt that gifting our clients the connection of these previously isolated structures will be a good thing.

Working With, Not Against

Try this: With your client in the sidelying position, have them move back to the edge of the table closest to you. Ask them to extend their leg that is on the table straight and bend their top leg into both knee and hip flexion. The degree of flexion can vary according to what feels easy for your client and how you choose to engage them in this technique. Offer them a bolster to support their flexed knee because it’s good for the spine (and really comfortable). 

Then, have your client reach up with their top arm to the far corner of the table in front of them. Offer them a pillow to hug with the arm on the table, beneath their torso. This will help them feel more secure about their draping and will distract them if that arm falls asleep. The position you have situated for your client has pulled their hip and lower ribs away from each other, offering you more access to the QL and the psoas. 

From here, begin with the erector spinae group. Sink in and slowly move away from the spine, around the paraspinal muscles, and into the QL. This work is nuanced and requires an acute presence. As you slide anteriorly on the lateral edge of the QL, you will sink farther down and begin to feel the psoas. This is where the magic happens. Ask your client to move slightly into and out of an anterior and posterior pelvic tilt. Have them hike up their hip that is off the table, and then relax. Ask them to lift that same leg off the table and slightly into and out of flexion and extension. Palpate what the QL and the psoas are doing all the while. 

Rekindle the Relationship

The work you do will differ greatly from client to client. Feel for what is over- or under-firing. Get a sense of how well these muscles can move and shift. But mostly, bring your client’s awareness to how these muscles communicate. A once-coupled psoas and QL may have lost touch with each other, but that doesn’t have to be the end of the story.