Understanding QL Pain After Surgery: Insights and Questions
Hello, I’ll keep my background brief. Last year, I endured about seven months marked by intense pain and persistent nausea before undergoing a hip replacement procedure six months ago, followed by a laminectomy (without discectomy, but involving instrumentation such as screws and rods) five months ago to address severe lumbar stenosis. I am a 50-year-old woman of average weight with over seven years of experience dealing with inflammatory arthritis, aligning with a diagnosis of non-radiographic axial spondyloarthritis as confirmed by my rheumatologist. This condition initially manifested in my right ankle and has now affected both my hands and feet. Currently, I’m on Cosentyx, which has recently been increased to a higher dose. Additionally, I am dealing with "advanced" facet arthrosis, which may be linked to my active youth, coupled with my hypermobility. A cyst was identified at my L4 facet joint, causing severe symptoms prior to my surgical intervention. Recently, my physical therapists identified that my right quadratus lumborum (QL) is chronically tight. This tightness has flared up recently, leading to days of painful vomiting and retching until I could take muscle relaxants to alleviate the discomfort. Even when the spasm subsides, any twisting motion of my torso triggers a sharp sensation in my right rib cage. Furthermore, I experience persistent nerve pain in my right leg, which intensifies when I am seated. Despite these challenges, I strive to maintain my strength and health, making an effort to remain active with daily walks. I have two primary concerns: 1. Are the episodes of pain and spasms in my QL connected to my spine? This issue significantly impacted my life and career last year, so understanding this relationship is crucial. 2. Is the QL pain and spasms associated with neurological or surgical factors? I have experimented with narcotics and gabapentin; thus far, only muscle relaxers provide some relief, though it is limited. Thank you for your assistance!
Answers (1)
8/10/2025, 7:20:47 PM
OpenHealth AI
Thank you for sharing your detailed medical history and concerns. It sounds like you’ve been through a lot with your health, and it’s commendable that you’re still striving to maintain your strength and health despite these challenges. Addressing your questions:
Main Points:
- The pain and spasms in your quadratus lumborum (QL) may indeed be connected to your spinal issues, particularly considering your history of lumbar stenosis and surgical interventions.
- The QL pain could also have aspects related to neurological factors or issues stemming from your surgery.
Explanation:
The quadratus lumborum is a muscle in your lower back that plays a key role in stabilizing the pelvis and spine. Given your diagnosis of facet arthrosis and the surgical procedures you've undergone, it’s possible that the tightness and spasms in your QL muscle are related to the surrounding spinal structures. Issues like nerve compression, inflammation from the surgery, or postural changes due to pain can contribute to muscle tightness and spasms.
The episodes of pain exacerbated by twisting motions, as well as the sharp sensations in your rib cage, might indicate irritation or strain in the surrounding muscles or nerves connected to your spine. Chronic tension in the QL could contribute to discomfort further down the line, affecting your mobility and activity levels.
Next Steps:
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Continue with Physical Therapy: Focus on physical therapy that includes targeted stretching and strengthening exercises aimed at the QL and surrounding muscles. This can help alleviate tightness and improve your range of motion.
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Apply Heat or Cold Therapy: Use heat pads or cold packs on the tight area to relieve muscle spasms and reduce inflammation. Experiment to see which provides more relief for you.
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Monitor Your Symptoms: Keep a journal noting when the pain and spasms occur, what activities you were doing, and any other symptoms you experience. This can help identify triggers and inform your physical therapy sessions.
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Adjust Activity Level: While maintaining your daily walks is beneficial, it may be helpful to modify how you engage in activities that involve twisting or strain on your back. Gentle stretching and low-impact activities may be ideal.
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Consult with Your Health Care Providers: To discuss your QL pain further, including the potential neurological aspects and how your surgical history may relate to your current symptoms. Additionally, a pain management specialist may provide alternative treatments or adjustments to your current pain management regimen (including non-narcotic medications).
If at any point you experience significant changes in your symptoms, like increased pain or weakness in your legs, seek professional medical advice promptly. Your health journey is significant, and continuously seeking solutions is the best way to navigate your situation. Please feel free to reach out if you have more questions or need further support!
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