Eliminate Hip, Low Back and Lateral Knee Pain by Getting your TFL Muscle (Tensor Fascia Latae) to Chill Out.

When we force our TFL muscle (Tensor Fascia Latae) to work overtime, it cops an attitude fast. We wind up with misleading chronic pain and weakness that makes us think there’s something wrong with our hip, low back, knee or even the piriformis. But the real drama queen is the TFL, the primary culprit in the dreaded “IT Band Syndrome (ITBS).”

ITBS is an overuse injury caused by repeated trauma instead of a single incident. The muscle involved runs all the way from the top of the hip down to the outside of the knee, so it’s responsible for multiple actions at multiple joints.

The TFL, or Tensor Fascia Latae, is a small muscle found on the outside of the hip. The primary function of the TFL is to help stabilize the hip and pelvis. It also contributes in movements such as raising the leg out in front, taking the leg out to the side and turning the leg (with a straight knee) so the foot points inwards. The TFL attaches into the top of the pelvis and inserts further down the leg, into a band called the Iliotibial Band (IT Band), which acts as a long, thick tendon.

Symptoms of TFL pain include:

• Pain which may refer down the outside of the thigh

• Pain in the outer hip

• Pain when lying of the affected hip

• Increased pain when weight bearing on one side

• Noticeable pain in the hip and outer thigh when walking up or down stairs/hills

• Pain in the lower back and SIJ

The main cause for TFL pain is overuse and compensation for weaker surrounding muscles. Pain occurring in muscles is often the result of the muscles compensating or working much harder than they were made to work. This compensation occurs due to surrounding muscles being dysfunctional due to inhibition or weakness.

The TFL may also become overloaded with repeated use in the following situations:

• Cycling, swimming, kayaking

• Walking and running

• Excessive sitting, driving or kicking

• Standing with a swayed back

• Wearing high heels too often

• Sleeping in the fetal position

• Meditating with crossed legs

Common problems associated with TFL pain include:

Hip Osteoarthritis

If a person is suffering from TFL syndrome studies indicate they are more likely to develop hip osteoarthritis on the affected side. This may be due to the new biomechanics resulting from the TFL pain, which then places excess stress and strain on the structures of the hip joint. This stress and strain ultimately leads to early onset degeneration and inflammation of the hip structures, resulting in conditions such as osteoarthritis.

Tension and tightness

Muscle pain is often associated with tense and tight compensating muscles. These muscles are in this state due to the ‘high alert’ issued by the brain. If a muscle is on ‘high alert’ and ready to spring into action at all times it will have an increased muscular tone and feel like it is unable to fully lengthen. If this muscle remains in this state, unable to relax and recover, it will become chronically tight and shortened. Poor postures, positions and movements may also contribute to TFL tightness.

Knock knee (valgus) posture

Due to the TFL being an internal rotator of the hip, meaning it helps twist your thigh inward from your hip joint, it can become shortened and tight resulting in a position called ‘knock knees’ where one or both of the knees are internally rotated.

Anterior pelvic tilt

Another posture that may result from a tight TFL is anterior pelvic tilt, or bilateral tightness. This abnormal posture is possible because the TFL is a hip flexor, which means when TFL pain and tightness occur bilaterally (on both sides) in standing the legs are anchored thus TFL tightness pulls the front of the pelvis where it originates down, resulting in anterior pelvic tilt.

Lateral pelvic tilt

On the other hand, when tightness of the TFL is unilateral, or only occurring on one side, it can pull that side of the pelvis down, resulting in what looks like the pelvic dropping to one side.

• Stretching and Strengthening

Initially the best form of relief from TFL pain includes resting from aggravating activities. Gentle exercise, stretching and strengthening is important in assist to relieve pain and can help speed up your recovery. Gentle stretching may decrease the pain associated with TFL pain by encouraging circulation and blood flow to tissues, reducing muscle stiffness and spasm. Secondly, correcting muscle imbalances and building strength in the hip region is important in helping to reduce the demands and stress on the TFL, and subsequently reducing TFL pain. Your Soft Tissue Occupational Therapist may recommend a stretching and strengthening regime, which you will be able to do at home. It is best to consult your Soft Tissue Occupational Therapist before engaging in this program to avoid further aggravating your TFL pain.

Stretches that may help to relieve TFL pain includes:

• TFL stork standing stretch:

To do this stretch, stand beside the wall and place your hand on the wall to support the body. Raise the leg that is closest to the wall and bend the knee and place it on the other leg right above the knee to be in a stork standing position. Place your other hand over the TFL that you are going to stretch. Then while standing on one leg, slowly bend toward the wall. Keep your leg still and bend the torso. You should feel tension force over your TFL. Hold it for 15 – 20 seconds.

• Outer hip stretch:

Lie down on the floor on your back. Cross your left foot over the right knee. Keep your left knee bent. Then using your right hand, pull and push your left knee across your body. It is highly important to keep your left shoulder on the floor. Hold that position for 10 – 20 seconds.

You may also use a foam roller to stretch and release the TFL, for this lie down on a foam roller on your right or left side in a way that foam roller is placed on the upper lateral aspect of the thigh at the level of your side pocket and one inch below to your anterior iliac crest. Then place your opposite leg in front of your right leg. Support your body with your elbow on the floor. Then start moving slowly up and down on foam roller from your anterior iliac crest level to one third upper part of your thigh for 5 – 10 seconds. Swap legs.

At ADVENTUREFIT our highly trained Corrective Exercise Specialist will use a dynamic approach to help treat your injuries, conditions or any concerns you may have. You can make an appointment today by calling 843.284.3029 or email: Darrin@adventurefitnmb.com

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