Pain in the testicle is uncommon but may occur to men of any age. The type of pain that I am referring to is muscular in nature and caused by referral from a nerve in the back. In your lower back (lumbar) you have a muscle called Quadratus Lumborum (QL). The QL muscle is responsible for four actions:
- Lateral bending of vertebral column
- Extension of lumbar vertebral column
- Fixes the 12th rib during forced expiration
- Elevates ilium (hip bones)
The QL attaches from the 12th rib and spine to the pelvis. You have two QL muscles, one on each side. The QL is a common source of lower back pain. If you twist, turn, bend or lift improperly you can trigger spasm, strain and injury to the QL muscle. Often times those presenting with QL Syndrome display the following symptoms:
- “Locked up” spine
- Acute back pain and spasm
- Pain is often one-sided
- Pain may radiate towards the gluteal region (buttock)
- Pain upon palpation at the top attachment of the quadratus lumborum (3 cm off the vertebrae in the lumbar spine)
- Elevated pelvis on the side of pain
- Lumbar region may be slightly flexed laterally to the side of pain (antalgic position)
- Acute injury often accompanied by lifting and twisting movements
Males and females may experience referral of pain to their groin region due to an injury to QL. You have nerves that branch off the spinal cord at the level of the lumbar spine in close proximity to QL. You have the Ilioinguinal (L1), which supplies cutaneous distribution to the scrotum (labia for females) AND the Iliohypogastric (T12-L1), which supplies cutaneous innervation to the lower abdominal and groin region. It is important to note that you also have other nerves that branch off the spinal cord lower down. When the QL muscle gets taught, spastic and/or injured, it can affect the nerves that pass near it. If the nerves are inluenced, they can refer to their area of their innervation. Thus, sometimes a muscle strain in the back can create symptoms (such as a sharp shooting pain) in the testicle or labia.
Various treatments can be used to heal a QL strain. First off, a combination of ICE and HEAT will assist in decreasing pain and relaxing the muscle. Moreover, electrotherapy, laser therapy, soft tissue therapy and chiropractic adjustments will help as well. Usually four to six treatments of passive treatment helps to decrease the pain and relax the QL muscle. It is recommended that following passive treatments, you focus on some active care (exercises and rehabilitation) to ensure the QL muscle is functioning properly.
Dr. Luciano Di Loreto, HBSc., D.C.
Chiropractor & Acupuncture Provider