QL-GM force coupleThere are multiple for couples throughout the body. Typically, a force-couple is comprised of:
1) a muscle stabilizing a bone to allow for a stable surface for another muscle to pull against (example: transverse abdominis stabilizes the pelvis for the hip musculature)


2) one muscle initiating a movement before another muscle takes over (example: supraspinatus abducts the shoulder for the first 15-30 degrees to position the humerus for the deltoid to act on it)

One of the major imbalances in treating individuals with lumbo-pelvic-hip pain and dysfunction involves the quadratus lumborum and gluteus medius. The quadratus lumborum is designed to contract to stabilize the ilia to allow proximal stabilization of the gluteus medius in order to control the femur with its distal attachment. (note: contrary to what textbooks teach, the role of the gluteus medius is not concentric hip abduction but rather eccentric hip adduction and hip stabilization.)

Multiple issues can disrupt this local force-couple:
1) Sacroiliac joint dysfunction (upslip / superior translation) – this dysfunction creates a chronically tight QL which can lead to it becoming hypertonic as well which can lead to a hip hike during ambulation
2) Tight hip capsule / weak hip flexors – the body tries to maintain homeostasis of movement. If the hip is unable to flex, the central nervous system creates adaptation. To compensate, the hip (ilia) will hike to compensate for the lack of flexion.
3) Gluteus medius weakness – instability of lateral hip leads to excessive adduction during ambulation. In order to limit the amount of adduction, the hip will hike to decrease foot strike on the lateral foot. This leads to hypertrophy of the quadratus lumborum.

To correct these dysfunctions, a thorough evaluation is required to identify which structures are contributing to the dysfunction. Joint mobilizations would be appropriate for a tight capsule while manual therapy techniques and stretching would be appropriate for tight muscle(s). For weakness, neuromuscular re-education and therapeutic exercise would be the interventions of choice.

These treatments can be augmented by the application of kinesiology tape (Rocktape): applying the tape (4” I cut for larger individuals, 2” I for smaller frames) from the lower ribs to the iliac crest (insertion to origin) will inhibit the quadratus lumborum. Then, the same piece of tape can continue from the iliac crest to the greater trochanter of the femur to facilitate the gluteus medius (origin to insertion). This can immediately change the tone of both muscles and stabilize the lateral fascial line (Myers, T. Anatomy Trains).