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:
-
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.
-
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.
-
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.
-
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.
-
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!
Related Questions
Concerns About My Daughter's Morning Health Issues
My 17-year-old daughter experiences troubling symptoms each morning, particularly on days when she needs to rise early for school or work. She often wakes up feeling dizzy and nauseated, accompanied by a rapid heartbeat exceeding 100 beats per minute. This situation prevents her from being able to eat and may persist for several hours, or in some cases, throughout the entire day. Standing at 5 feet 8 inches tall (172 cm) and weighing 121 pounds (55 kg), her physical health otherwise seems fine. I have a personal history of inappropriate sinus tachycardia (IST), which is why I take beta-blockers for management. A few years ago, she consulted a cardiologist regarding her frequent episodes of near-fainting, who recommended increasing her water intake and adding more salt to her meals. Given the persistent nature of her symptoms, I am contemplating whether a follow-up appointment with the cardiologist is warranted, especially since all previous tests, including ECG and ultrasound, came back normal. This situation significantly affects her daily life, restricting her ability to engage fully in school and work. Any suggestions would be greatly appreciated!
A Mysterious Illness That Resembles Strep Throat
As an 18-year-old college student, standing at 5'4" and weighing 140 pounds, I maintain an active lifestyle. I do not smoke or have any preexisting health issues, aside from the vitamins and supplements I take daily. Approximately five days ago, I began to feel unusually fatigued and achy. Within just a day, my symptoms escalated to include a high fever reaching between 101°F and 102°F that ibuprofen couldn’t seem to alleviate. I experienced extreme tiredness that kept me bedridden all day, along with a persistent headache and intense throat pain, which was compounded by swollen lymph nodes and the familiar white patches often associated with strep throat. Having dealt with strep throat before, I recognized a need for antibiotics. Two days into feeling unwell, I visited an urgent care facility for an assessment and received a rapid strep test, which unfortunately came back negative. I recalled a previous incident where my rapid strep test also indicated a false negative, only for the culture sent for further testing to confirm the presence of strep bacteria. Given my symptoms and the findings from the examination, the healthcare provider prescribed Cefdinir, as I am allergic to amoxicillin, despite the negative rapid test results. The antibiotics proved effective, and I felt nearly back to normal, leading me to believe that my culture results would also come back positive for strep, suggesting a recurrence of my previous infection. However, I received the culture results yesterday, and to my surprise, they came back negative for strep. While I lack medical expertise, I’ve been led to believe that false negatives in cultures are exceedingly rare. Now, I find myself puzzled about what kind of bacterial infection I might have had if it wasn’t strep. Any insights or information regarding my situation would be greatly appreciated. Thank you!
Chronic Joint Pain Since Childhood
Since I was eight years old, I’ve endured intense and persistent pain in my joints. Initially, the discomfort was primarily in my knees, characterized by a sharp sensation right beneath the kneecap. As someone on the autism spectrum, I often visualize a strange, soothing thought: the idea of removing my kneecap and using an ice cream scoop to relieve the pressure underneath it. My parents sought help from several medical professionals, all of whom attributed my symptoms to growing pains. I even underwent cancer screenings at the age of nine because doctors felt my level of discomfort was excessive for mere growing pains. At school, I frequently had to wear dual knee braces. When I turned 14, I had a CT scan, but the results were inconclusive; doctors continued to insist it was just growing pains. At 18, I had an X-ray that also revealed nothing abnormal. Now at 20, my joint pain persists and is progressively worsening. My hands now ache in addition to my knees, and on particularly bad days, the pain radiates down to my ankles, making walking and sleeping almost impossible for half the week. The discomfort has entirely hindered my ability to work. My family and I strongly suspect that I may have some form of arthritis, but I struggle to convince the medical community of this due to my young age. My father, who suffers from arthritis himself, often empathizes when I express my pain, telling me, "that sounds familiar." I have broken down in front of numerous doctors, pleading for assistance, yet I consistently leave without answers, only to be scheduled for more scans that come back normal. The medical care I have received thus far has been far from satisfactory; for instance, I was prescribed eye drops that nearly resulted in serious damage to my vision when I consulted an eye specialist. This is just one of many frustrating experiences I’ve faced. I feel completely overwhelmed and in agony, and I have no way to reach out for specialized medical help since my only means of transportation is my father, who is also afflicted by arthritis. I feel lost and in deep pain without a clear path forward.
Understanding Mild Uncomplicated Diverticular Disease
I am a 29-year-old female, standing at 5'7" and weighing 130 pounds. Recently, a CT scan revealed that I have mild diverticulitis. About a week ago, I experienced significant discomfort, particularly in the pelvic region, along with pain in my right leg and hip, and some mild discomfort on the left side. After undergoing a CT scan, which confirmed the presence of mild diverticular disease, I was surprised that no one from my medical team provided any follow-up or acknowledged the condition. My blood tests returned normal results, and I was discharged without further information. While the pain subsided after about three days, it has unfortunately reappeared four days later. Is this something I should be worried about? What does this mean for me? I had a colonoscopy around 11 months ago, which indicated no issues.
Prolonged Miscarriage: Over Four Weeks In
A 35-year-old woman managing Type 1 diabetes with an insulin pump has been experiencing a challenging period marked by a recent miscarriage. This occurred just shy of ten weeks into the pregnancy, following an extremely positive pregnancy test, although medical confirmation had not yet been obtained. The physical symptoms were quite severe, with substantial bleeding that included large tissue clumps and blood clots observed during a shower. The size of these clots was rather alarming, comparable to a fist, causing blockage in the drain. Initially, for the first three to four days, there was heavy bleeding, requiring three pads daily. After that, the situation gradually improved, and around a week ago, she reached a point where only a pantyliner might suffice. Despite the reduction, bleeding persisted intermittently, mainly noticeable upon wiping, with instances of no blood at all, leading to inconsistencies in her experience. Recently, she has been feeling bloated and has noticed a resurgence in bleeding, necessitating the use of pads twice daily. Additionally, she has been experiencing light cramps and has developed acne. A subsequent pregnancy test revealed continued positive results. Now, with over four weeks of bleeding, she reached out to her physician’s office. However, the response was not one of concern, suggesting that she could schedule a visit at her convenience if she felt the need. The cost of visiting a doctor or urgent care deters her from seeking immediate professional help unless absolutely warranted. Overall, she reports feeling generally well, but is seeking advice from others. Is there cause for alarm, or is it feasible to let things unfold naturally? Could this miscarriage have evolved into her menstrual cycle instead? Additionally, it's worth noting that she occasionally finds small blood clots on the toilet paper after wiping. Since the onset of this situation, she has abstained from sexual intercourse.