Quadratus Lumborum and Gluteus Medius in SI Joint Pain After Golf

Dear reader,

Last week in clinic I saw a very familiar modern pattern. A busy female in her 50s came in with pain around the SI region after playing golf. There was also suspicion of arthritis in the SI joint, but as always, I do not stop at the painful postcode. I look at the whole chain.

What did I find

The pelvis was tucked under in a posterior pelvic tilt. The lumbopelvic area felt very stiff and flat. The thoracic spine was also flat and rigid, almost military in posture, with the head drifting forward and the shoulders rolling forward too. The gluteus medius, hamstrings, soleus and quadratus lumborum were all very tight. The hip was stiff in external rotation. There were cramps into the calf and plantar fascia on both sides. The gluteal region on the opposite side felt even tighter, which made the pattern even more interesting.

This is the kind of body that does not rotate well where it should, so it borrows movement from where it should not.

Why golf can irritate this pattern

Golf is a rotational sport, but not just a trunk sport. A good swing is a chain event. Force should travel from the feet through the ankles, knees, hips, pelvis, ribcage and shoulders in a smooth sequence. If one link is stiff, the next link works harder. If several links are stiff, the SI region starts looking like the poor intern doing the work of the whole company.

In this case, the feet and calves were already shouting. Tight soleus muscles and irritated plantar fascia suggest the lower chain is not absorbing load well. That matters because the golf swing starts from the ground. If the feet and ankles cannot adapt and transfer force cleanly, the pelvis receives a more abrupt load.

Then we move up to the hips. A hip that is stiff in external rotation does not allow the pelvis to turn freely. The body still wants to complete the swing, so the pelvis twists with less support from the hip joint. That often increases strain around the SI region and the quadratus lumborum starts gripping to stabilise the area.

Then comes the trunk. A flat thoracic spine is usually not a happy rotating spine. It looks upright and disciplined, but in movement it can be surprisingly stubborn. When the ribcage does not rotate properly, the lumbopelvic junction is asked to do extra work. During golf, this is a problem, because the ribcage and pelvis should share rotation. If the thorax is stiff, the SI region and lower back get dragged into more torque.

Why the SI joint may become painful

Pain in the SI region in a golfer is often not just about the joint itself. It is usually about repeated load transfer through a stiff, imbalanced system.

The posterior pelvic tilt reduces the natural lumbar curve and often shifts the strategy of support into hamstrings and abdominal bracing. Hamstrings then become overprotective. They feel tight, but not because they are powerful and efficient. They are often working as emergency pelvis holders. The gluteus medius can also become tense rather than truly functional, especially when the pelvis is not moving cleanly over the hip.

The quadratus lumborum then joins the drama. This muscle is brilliant at helping control the relationship between ribcage and pelvis, but under stress it can become a rigid side guy, constantly lifting, fixing and compressing. In a golfer with poor thoracic rotation and stiff hips, the QL often tries to rescue the swing by stabilising too much. That can increase compressive forces around the SI area.

Now add stress. Stress changes muscle tone. The body becomes more braced, more guarded, less fluid. The patient was clearly stressed, and that matters. A stressed body does not swing like a relaxed body. It swings like a body preparing for tax inspection. The calves tighten, the thorax stiffens, the shoulders creep forward, breathing becomes more shallow, and the whole system becomes less tolerant of rotation.

Why the tighter opposite glutes also matter

This is where the case becomes more interesting. The gluteal region on the opposite side was even tighter. That suggests a cross body compensation pattern rather than a simple local problem. In golf, the pelvis and trunk work diagonally. One side helps drive, the other side helps decelerate and control. If one gluteal side is holding too much tension, it may be limiting pelvic freedom or altering how force is transferred across the pelvis. The painful SI region may then take more irritation because it is receiving force from a poorly balanced rotational system.

This is exactly why local treatment alone often disappoints. If someone only rubs the painful SI region for 20 minutes and sends the patient home, the body politely says thank you and then repeats the same mistake at the next swing.

The JANMI view of this pattern

From a JANMI perspective, this is a full chain problem presenting as SI pain.

The feet and plantar fascia suggest poor ground adaptation.

The soleus and calves suggest reduced shock absorption and lower chain rigidity.

The hamstrings suggest pelvic holding rather than free hip support.

The gluteus medius suggests altered pelvic control.

The stiff hip in external rotation reduces clean turning.

The flat lumbar and thoracic posture reduce spinal adaptability.

The forward head and shoulders suggest a braced upper chain that does not rotate or breathe well.

The quadratus lumborum becomes overrecruited as a bridge muscle between ribcage and pelvis.

So yes, the SI joint may be irritated. Yes, arthritic change may be part of the story. But the pattern around it is what often explains why the area becomes painful after golf.

What the golf swing does to this body

In a body like this, the golf swing becomes less of a fluid spiral and more of a forced twist.

The lower chain does not absorb enough.

The hips do not rotate enough.

The thorax does not contribute enough.

The pelvis and SI region receive too much of the rotational demand.

The QL and gluteal system overgrip.

The calves and feet continue feeding stiffness upward.

That is how a graceful sport can produce a rather ungraceful pain.

This is why assessment matters more than labels

When someone says they may have SI arthritis, I respect that possibility. But in clinic I am also asking why this area is being overloaded now. Why after golf. Why with this posture. Why with calf cramps and plantar fascia tightness. Why with a flat trunk and a stiff hip.

Pain is often the final complaint of a much larger conversation happening through the chain.

At JANMI Postural Pain Clinic Marylebone, this is exactly how I approach these cases. Not as one angry joint floating alone in space, but as part of a six link chain where the feet, knees, hips, pelvis, ribcage and shoulders are all negotiating load. Sometimes badly. Sometimes very badly. But there is always logic there if you know where to look.

Disclaimer

This article is for educational purposes only and does not diagnose arthritis or replace medical assessment, imaging, or treatment from a qualified healthcare professional.

Untill next time,

Paulius